Early Pregnancy Nausea

Early pregnancy nausea is mild nausea with or without occasional vomiting beginning at 4 to 9 weeks of pregnancy and settling by 16 to 20 weeks. It is related to rising hCG and affects up to 70 percent of pregnancies. It matters because it is usually benign, but it can progress to more severe disease, and early care prevents dehydration.

• Risk factors: first pregnancy, multiple pregnancy, previous nausea in pregnancy, family history, migraine.
• Peak at 9 weeks.
• Does not harm the baby.

Women report nausea often worse in the morning but possible at any time, with occasional vomiting and food aversion, and normal weight and vital signs.

• Eats and drinks enough to avoid weight loss.
• No ketonuria.
• Differential diagnosis: gastroenteritis, urinary tract infection, hepatitis, peptic ulcer disease, malaria, molar pregnancy, multiple pregnancy.
• Complications: progression to nausea and vomiting of pregnancy, dehydration, poor nutrition, mood effects.

The diagnosis is clinical.

• Check weight, pulse, blood pressure and hydration.
• Urine dipstick for ketones and infection.
• Ultrasound if pain, bleeding or severe symptoms to confirm an intrauterine pregnancy and exclude molar or multiple pregnancy.
• Malaria test in endemic areas if fever.

The principle is dietary and simple measures with early escalation if symptoms worsen.

• Supportive: small frequent dry meals 2-hourly; ginger; avoid trigger smells and fatty foods; oral fluids in small sips; rest; stop iron tablets for 2 to 4 weeks until nausea settles.
• Pharmacological: ginger 250 mg oral 6-hourly; pyridoxine (vitamin B6) 25 mg oral 8-hourly; if symptoms persist add promethazine 12.5 to 25 mg oral 8-hourly at night or metoclopramide 10 mg oral 8-hourly for up to 5 days.
• Procedures: none.
• Red flags: vomiting more than 3 times a day, weight loss above 5 percent, unable to keep fluids down, dark urine, dizziness, abdominal pain, jaundice.
• Follow-up: review in 1 to 2 weeks; weigh at each visit; admit for assessment if ketonuria or weight loss develops; antenatal booking at 8 to 12 weeks.