Women need to consume adequate fluids (and foods) to avoid dehydration and electrolyte imbalance, both of which can cause seriously complications during pregnancy. Further, these scenarios are not uncommon in women with severe NVP, and may require one or more emergency department visits.
If women (and their partners/support) learn hydration strategies, make fluid intake a priority (but not forced), and learn to recognize the signs and symptoms of dehydration and nutrient deficiency, then complications and hospital visits can be prevented.
A major complication of NVP is dehydration, which can occur quickly. Women already need to drink more during NVP to replace the loss of their normal fluid intake, help increase blood volume which occurs normally during pregnancy, and replace any fluids lost due to vomiting. Further, as stated above, dehydration can lead to numerous additional symptoms that can worsen nausea and vomiting.
Symptoms of dehydration include:
Dizziness (especially when standing)
Dehydration can also lead to dry mucus membranes, a lack of tears, fast heart rate, poor skin turgor (“tenting”) and decreased blood pressure (due to low blood volume).
Blood pressure can drop dramatically when women move from lying down to sitting up, or from sitting and then standing too quickly. This leads to a temporary loss of vision (black spots) or faintness. Women who experience this, especially after getting out of the shower or bath, need to sit back down immediately to avoid falling until the episode passes (orthostatic hypotension).
There is no specific amount of water or requirement that has been established during the first trimester of pregnancy and every individual has different fluid needs. Women should drink when they can, and if they are unable to retain fluids for about 12 to 24 hours, or experience any signs/symptoms of dehydration, they need to call their HCP, or visit the emergency department.
Electrolytes help carry electrical signals from cell to cell and are found in both foods and beverages. When an individual does not consume enough of either, the balance of minerals and electrolytes in the body is disturbed, which negatively affects the way the body functions. Deficiencies of specific nutrients can cause serious complications during pregnancy and are often seen in women with NVP/HG.
Thiamin (B1) can be depleted in a matter of weeks, resulting in Wernicke’s encephalopathy, a neurological condition resulting in repetitive, uncontrolled eye movements (nystagmus), loss of control of body movements (ataxia), and confusion; as of 2016, this condition was reported to be on the rise in women diagnosed with HG.
If potassium levels drop too low, this is known as hypokalemia and can be life-threatening if not treated.
The above complications can be prevented through sufficient fluid intake that contains electrolytes. Sports drinks and small amounts of sugar can be helpful. Broths, Pedialyte®, ice pops (with sugar/salt) can also help, along with daily doses of prenatal vitamins. If women are having difficulty swallowing their vitamins, their HCP can recommend alternatives.
If women cannot obtain fluids/electrolytes on their own, they may require intravenous (IV) saline/electrolytes, usually in a hospital setting. The role of IV hydration is to increase plasma volume (component of blood) and therefore blood pressure, and restore electrolytes, to include thiamine and glucose (sugar). Women requiring multiple hospitalizations for IV fluids may be considered for in-home IV hydration.
While plain water is the best choice for hydration, all non-alcoholic drinks can count towards fluid intake (i.e. coconut water, milk, low-sugar juice); however, if a woman is not eating much due to nausea/vomiting, plain water may need to be switched to an electrolyte drink.
For women who cannot easily tolerate fluids, they should try the following:
Ice cold water
Sucking on ice cubes
Warm drinks (broth, tea)
A water bottle that can keep water cold (or hot) for a lengthy period
A straw to obtain small amounts in the mouth, which can then be swallowed slowly
A sippy cup if tolerated better than a straw
A sippy cup can also be flipped upside down to drip small amounts into the mouth if women want to move as little as possible
If the sucking action from a sippy cup, straw, or water bottle triggers a gag reflex, women can find a water bottle that has a small pop open lid that can also be tipped over and poured slowly into the mouth
If using bottled water, women should remember that different brands of bottled water taste different, and a favorite brand prior to pregnancy may no longer taste the same; women should experiment with different brands if necessary.
Women should drink/sip fluids throughout the day, but may want to avoid larger amounts of fluids at the same time as food, to avoid the discomfort of a full stomach.
Variety is necessary, and since women with NVP need to consume small amounts of fluids around the clock, it can be difficult sticking with just plain water or ginger ale after a while.
If women find a specific beverage type that works, they should make sure it at least has small amounts of sugar and electrolytes, especially if not eating regularly.
Small, flavored, salty liquids are particularly advisable in women who may not be eating much or are vomiting (Pedialyte®, Gatorade®, Powerade®, milk, coconut water all provide different flavor options).
Coconut water has not been studied for NVP specifically, but has been recommended to relieve symptoms. It has, however, been studied in pregnant animals for possible beneficial outcomes (which have not shown harm).
Therefore, although it is not quite known what effect it could have at relieving NVP symptoms, but it is expected to be currently safe and somewhat effective.
Many women tolerate ice cold carbonated drinks very well during NVP, but some women may find carbonation leads to bloating and discomfort – therefore, carbonation is based more on personal preference.
Women can try sipping ginger ale – either flat or carbonated, made with real ginger; women can also add powdered ginger to it (the ginger will cause the soda to fizz up when stirred).
Women can also add powdered ginger to any carbonated drink of choice (i.e. lemon-lime soda).
Artificial sweeteners, considered safe during pregnancy with proper use, should be avoided during NVP to prevent bloating and possible diarrhea, which could make dehydration worse.
Lemonade is highly tolerable in most women with NVP. Water with slices of lemon, lime, orange, and cucumber can be also added to any drink if women want to avoid higher amounts of sugar [there are also water bottles available that keep the pulp and seeds out of the water.]
Fruit-flavored water can help prevent fluid monotony – women can add peach slices, raspberries, blueberries, mint leaves, and ginger slices.
Using a straw with flavored drinks can help avoid the sugar/citric acid from sitting on the teeth, contributing to tooth decay which can be exacerbated through vomiting.
Note: Women with acid reflux, which is a known cause/contributing factor of NVP for some women, should avoid citrus, which can make their reflux and nausea worse.
Water can be frozen to various degrees (cubes, chips, slush) that can slowly be melted in the mouth; women can also experiment with different shapes/textures of ice.
Note: Craving ice has not been definitively shown to indicate a nutrient deficiency, but it is possible; if women are finding they have strong cravings for ice, they should contact their HCP.
Popsicles are an easy way to remain hydrated and may be better tolerated than cold fluids; popsicles can get boring/filled with sugar, so women can try different types and make their own (or have their partner/support do it).
Almost any fluid can be frozen in an ice cube tray or other mold (yogurt, juice, Pedialyte®, coconut water, milkshake, tea, lemonade, soda); small berries/fruit slices/toothpicks can be added before freezing.
In general, it takes about 2 to 4 hours to freeze popsicles, depending on size and content; small home countertop machines can make popsicles in under 10 minutes.
The biggest benefit of anything frozen is that it can be made ahead of time and is therefore very easy to prepare and store when needed.
For ice cold water that is not completely frozen, women can take plastic water bottles half-filled with water and freeze them; when frozen, women can take the bottle out and add cold refrigerated water to fill up the rest of the bottle. This provides ice cold water for a longer period of time as the ice on the bottom-half thaws.
Smoothies can be very beneficial for some women as they can be tailored to a woman’s texture and taste preferences. Smoothies can be made with as little as two ingredients (fruit, ice or electrolyte drink) and women can add yogurt, ice cream, or other ingredients as they begin to tolerate more foods.
There are many different types of ready-made chicken broths; women can boil up broth from a package, can, or container and pour it into a mug. They can also take the broth from their favorite quick-serving soup and save the noodles/vegetables for later (or another family member).
If warm liquids are tolerated, ginger, peppermint, and non-caffeinated teas may be helpful at easing nausea and avoiding dehydration. Women can also add honey, lemon, sugar, and/or boiled ginger slices.
The U.S. Food and Drug Administration, the European Medicines Agency, and the United Kingdom’s Medicine and Healthcare Products Regulatory Agency, do not formally review tea manufacturers/contents in the same way as medicines.
There is very limited information regarding herbs (and tea) during pregnancy, and even less when consumed during and for NVP. Further, the small number of studies that have evaluated tea consumption during pregnancy are small in population size, assess for very specific outcomes, are designed differently, and cannot necessarily distinguish between tea in general, type of tea/herb, caffeine level, and manufacturer.
Therefore, there is a significant lack of information regarding tea/herbs during pregnancy. If pregnant women choose to drink tea, they should purchase herbal teas from reputable manufacturers but understand no specific recommendations can be made regarding tea consumption during pregnancy or during NVP.
Be Ill Prepared
Keep several bottles of water/electrolyte drinks in the car, purse, living room, bathroom, bedroom, and desk/workstation
Put water bottles in the refrigerator and freezer at home; make flavored ice cubes ahead of time
Purchase a specifically designed water bottle to keep fluids cold/hot for a prolonged period
Place soda, chicken broth cubes, tea bags, honey, mugs, water, and spoons on the kitchen counter or table within easy reach and always available
Cut-up fruit slices and place in sealed container in the refrigerator or freezer
Purchase popsicle molds (ice cube trays will also work)
Women who want an ice cold drink after work can keep a cooler full of ice in their car if their office space does not have a readily-available refrigerator or freezer for use. If a refrigerator or freezer is available, women should keep a post it on their desk or computer to remember to grab the bottle before they head back to their car (read more).
There are many strategies to help women achieve adequate hydration with NVP to avoid complications and hospital visits. Options, variety, and creativity are key to success, and women should experiment with flavor, temperature, and texture, and choose options that are quick to grab, easy to prepare, and keep women hydrated enough to allow them to eat.
Women should consider sharing their NVP experience (below), especially how they felt, how long it lasted, what may have caused or contributed to their symptoms, and anything they did that relieved symptoms, even if only temporarily. Further, women should offer any management strategies that helped them consume fluids while experiencing symptoms.
If pregnant women remain hydrated while nauseous and/or vomiting, they can stay out of the Emergency Department/hospital, and avoid uncomfortable and potentially dangerous side effects of dehydration.
Partners, family members, and other support in the same household can take certain steps to help pregnant women remain hydrated. Partners/support should read the Be Ill Prepared page, and learn their partner's beverage preferences very early in pregnancy so they can help as much as possible from the beginning.
Although her preferences can change day to day (or even hour-by-hour), partners/support can help her try as many different non-caffeinated and non-alcoholic beverages as possible by preparing different drinks or ice (decaffeinated iced tea, popsicles, water with fruit, smoothies), and try to keep her favorites available in the house within quick and easy reach.
Nausea and Vomiting of Pregnancy: Committee Opinion 189; January 2018 (American College of Obstetricians and Gynecologists)
Morning Sickness: Nausea and Vomiting of Pregnancy (American College of Obstetricians and Gynecologists)
Pregnancy sickness (nausea and vomiting of pregnancy and hyperemesis gravidarum) (Royal College of Obstetricians and Gynecologists)