Nausea and Vomiting of Pregnancy (NVP)
- I feel extremely nauseated in the morning. When will this stop?
Nausea during pregnancy is definitely a distressing issue and creates a lot of fear and uncertainty. Women truly suffer when they have severe symptoms and may need hospitalisation. The range of severe Nausea and vomiting of pregnancy (NVP) is from a mild feeling of nausea to excessive vomiting.
There are three important reasons identified to be a cause of NVP.
1. The rising level of the pregnancy hormone HCG which rises exponentially, doubling every 48 hours. This hormone is postulated to stimulate the vomiting center in the brain. The center needs some time to adjust to these rising levels and this sort of happens when 12 weeks of pregnancy is accomplished.
2. The sudden demand for energy needs due to increased metabolism in the body causes a drop in sugar levels in the blood, which is called hypoglycaemia. The body is undergoing phenomenal changes. It is producing hormones and is influenced by these hormones to help create a perfect environment for the pregnancy to grow. This hypoglycaemia if not supported with proper foods, can cause nausea, which can gradually catapult into vomiting.
3. Exaggeration of underlying Gastroesophageal reflux disease (GERD) can be the cause. Many women suffer from underlying issues such as increased acid production, and indigestion which can have symptoms such as a burning sensation, gas formation, and bitter rest in the mouth due to acid reg. urge etc. This is called GERD. This may become overt or exaggerated during pregnancy and needs to be controlled.
All the above three causes can come together and cause NVP or excessive vomiting disorder during pregnancy. Such excessive vomiting is also called “Hyperemesis gravidarum“ in medical dialect. Many times psychological issues have also been associated with NVP. Anxiety, fear and concern about many issues can contribute to NVP.
Usually, it starts at around 6 to 7 weeks, peaks at 10 -11 weeks and ends at 12 weeks, and many times disappears after that.
NVP in its severe form raises concerns about the mother’s and the baby’s well-being. Some diseases such as hepatitis, pancreatitis, diaphragmatic hernia, hyperthyroidism, and severe gastrointestinal disorders are to be ruled out and these, if present, can be complicated.
There are simple solutions as well as medications that can help control NVP. Many preventive safe medications can help prevent the occurrence of pregnancy vomiting. Practices such as healthy food choices, taking dry finger foods, fruit cuts, flavoured cubes, crackers, and nuts yogurts can help. Likewise, one should avoid junk food, spicy food, and long hours of starvation. In my experience, women who remain without food for more than 10 hours suffer from NVP the most. Anxiety, worry, and fear also lead to exaggerated NVP.
I use a scoring system that helps in guiding the need for medical therapy or hospitalisation . This way one can overcome the serious consequences of HG and ensure that pregnancy continues to be a wonderful experience.