Nausea and Vomiting of Pregnancy

Nausea and Vomiting of Pregnancy (NVP), commonly known as "morning sickness", is the most common complication during pregnancy, affecting the majority of pregnant women to some degree.

While it is true that some women will only experience mild NVP or none at all, it appears the vast majority of women suffer with moderate to severe NVP, which places a major burden on not only pregnant women, but their partners, families, and places of employment, as well as health care providers and facilities.

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"Morning Sickness" Introduction
Nausea and Vomiting of Pregnancy (NVP) or "morning sickness”, is the most common complication during pregnancy. It is recommended women learn as much as possible about NVP prior to becoming pregnant or immediately after learning they are pregnant.
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About NVP

EATRS
Based on all current evidence-based information regarding Nausea and Vomiting of Pregnancy (NVP), the best way to manage the condition is to learn about it and prepare for it, even if women only suffer from mild severity.
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Causes and Contributing Factors
The development of NVP is currently assessed to be multifactorial, and different women will experience different combinations of these factors, which is why symptoms are so variable among women, and so difficult to treat.
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Symptoms and Complications
NVP can lead to complications such as extreme fatigue, dehydration, acid reflux, headaches, dental issues, trouble sleeping, weight loss, malnutrition, electrolyte imbalances, and hospitalization, as well as anxiety and depression.
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Severity (NVP vs. HG)
NVP symptom severity varies dramatically from woman to woman – and even within the same pregnancy – depending on time of day and the presence of associated symptoms.
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Hyperemesis Gravidarum
Hyperemesis Gravidarum is considered the most severe form of NVP, affecting almost every aspect of a woman’s life (and her family’s) for weeks – usually months.  In women with HG, nausea and vomiting is unrelenting, constant, and debilitating.
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Fetal Effects
Women with NVP are often concerned about the health of their baby while they suffer from constant nausea and vomiting, but evidence indicates that even in extreme cases, most babies will likely be born completely healthy.
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When It's Not NVP
Nausea and vomiting are two of the most common symptoms in early pregnancy, but women should not always assume this is due to normal NVP, especially if severe and/or accompanied by abdominal or pelvic pain.  
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Fear of NVP
It is very common for women to be afraid of "morning sickness", especially if they are afraid of vomiting. However, it is currently estimated that less than half of women actually vomit during pregnancy – for any reason.
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To Partners, Employers, and the Media
Nausea and Vomiting of Pregnancy or “morning sickness” is the most common complication experienced by pregnant women, yet very little is known about the actual condition among those who have not experienced it.
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Main Management

Management Introduction
Management of Nausea and Vomiting of Pregnancy (NVP) is complex. Since researchers currently do not know what causes it, or even how to best manage NVP's associated symptoms (NVP causes many other symptoms than just nausea and vomiting), there is no single best management method for all women.
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Be Ill Prepared
Current evidence-based information regarding NVP management indicates the better a woman understands the condition, learns management techniques ahead of time, and prepares various aspects of her life – even minimally – the better her chances for success.
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Living with NVP
Based on how long Nausea and Vomiting of Pregnancy (NVP) symptoms may last, and that up to a third of women with NVP may experience severe symptoms, many women realize they need to learn how to live, parent, work, socialize, travel, and function with their symptoms.
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Vomiting
While vomiting can occur with NVP – not every woman will vomit. Some women can remain nauseous the entire first trimester (or longer), and never vomit.  However, some women may vomit regularly, or even every day during early pregnancy.
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Drinking
The main goal of fluid intake when experiencing NVP is to prevent dehydration and avoid electrolyte imbalances that can lead to an emergency department visit or hospitalization. 
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Eating
When managing NVP symptoms, women need to take one day at a time – eating whatever they can, whenever they can – to prevent nutritional deficiencies, dehydration, and possible malnutrition.
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Morning and Daytime Nausea
While some women absolutely get nauseous as soon as they wake up in the morning, many women also feel nauseous all day long, even after eating something. Therefore, simply telling a woman to eat something, or eat every few hours, may not be enough to control symptoms.
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Evening and Overnight Nausea
It is not uncommon for women to wake up feeling normal during early pregnancy only to get more nauseous as the day goes on, especially the late afternoon, into the evening, and overnight.   
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NVP Medication Introduction
Women have numerous options available to help them manage their NVP symptoms if diet and lifestyle modifications do not work. Suffering is no longer necessary, and women should call their HCP to discuss their options if NVP becomes too severe.
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NVP Medication – Detailed
When lifestyle and diet modifications are inadequate at controlling symptoms to a tolerable level, women have effective non-pharmaceutical and pharmaceutical options with good (or increasing) safety profiles.
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Ondansetron (Zofran®)
The use of ondansetron during pregnancy is intensely debated due to its significant effectiveness in most women with NVP/HG, but controversial safety profile. 
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Taking Medications and Vitamins
NVP can dramatically change a woman's medication schedule, based on when she is able to eat or avoid food long enough to take certain medications. Women also frequently have questions regarding what do if they miss a dose or need to change the time they take their dose.
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Additional Strategies

Ginger
Although studies are relatively limited in scope and size, ginger has largely been shown to be an effective strategy for reducing nausea and vomiting during early pregnancy for some women.
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Distraction
Various types of mental, physical, auditory, and visual distractions can be powerful tools in the management of constant nausea, especially when eating/drinking or medication only partially relieves symptoms – or not at all.
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Physical Activity
Although not specifically studied for NVP, light exercise may reduce NVP symptoms by improving digestion, fatigue, hydration (by helping women better tolerate fluids), and improving women’s ability to obtain better sleep.
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Getting Sleep (with NVP)
Getting enough rest and sleep during early pregnancy (with NVP) is critical to avoid future pregnancy-related complications. A lack of sleep leads to worsened fatigue, which is already a major symptom of the first trimester.
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Holistic Therapies
Traditional methods of treating Nausea and Vomiting of Pregnancy include dietary changes, lifestyle modifications, and medications. However, many holistic therapies can also help women physically, mentally, and emotionally cope with their various NVP-related symptoms.
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Acupressure/Acupuncture
Evidence for all types of PC6 stimulation is mixed, but due to a lack of harm and very few side effects, some women may find these methods helpful. 
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Aromatherapy
A drop or two of a pure essential oil on a cotton ball (or other method) can be very effective in combating and getting through brief nausea waves, especially when coupled with controlled breathing.
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Mental Health
Mental health concerns occur as a direct result of NVP; they are not the cause of NVP. It is imperative that women find an HCP who understands the true reality of this condition, and treats not only its physical symptoms, but the emotional and mental health aspects as well.
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