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.
Eating with NVP is more nuanced than consuming ginger, small meals, and crackers, and avoiding an empty stomach – women have more options than this. If women understand that normal “socially acceptable” rules of eating do not, and should not, apply during NVP, they can be more open minded about various methods and are likely to have more success.
Women should eat any food, at any point of the day or night they need to, to keep their nausea/vomiting under control. This may also require a bit of preparation to ensure foods that work are always available and available immediately (for sudden, intense waves).
Background
Dietary changes are often recommended as the first strategy for relieving NVP symptoms – especially in first time pregnancies. For women with mild symptoms, these steps may be all that are necessary to manage their NVP.
Women should understand that based on what is currently known about NVP regarding its causes and contributing factors, the stomach is likely not the sole culprit, even though nausea and vomiting manifest through the stomach.
There are numerous physiological factors involved as well. This means that in some cases, eating may not do anything to relieve symptoms; in that scenario, eating should be viewed simply as a means to gain energy, nutrition, and fluids, prevent complications, and not make symptoms worse.
Every time a woman with NVP decides she can eat, she should eat whatever she feels like eating, whenever she can, while aiming for the most nutrition possible. However, women should also not feel guilty if less nutritious items relieve their nausea.
Women can eat more nutritious foods and possibly counterbalance any weight gain as they begin to feel better. Women with moderate-to severe NVP may need to just get through this part first.
Trigger Avoidance and Taste
Other than actual nausea waves, two of the biggest hurdles women need to overcome to help themselves eat is avoiding triggers and aversions and adapting to taste- and smell-related changes.
Aversions to food and a change in smell perception can contribute to waves of nausea and vomiting. Several studies have indicated that women who are adversely affected by odors early in pregnancy may have more severe nausea and/or vomiting (read Aromatherapy).
Examples of some triggers may include warm and stuffy rooms, bright lights and sounds, fast movement, tablets and other devices, as well as odors related to coffee, garbage, eggs, smoke, dairy, alcohol, seafood, as well as other warm, savory food items and smells.
Women need to identify these aversions early and let other household members know what they are; it is impossible to feel hungry/eat if these triggers are not avoided.
Brushing teeth after a meal, spitting out saliva, and frequently washing out the mouth may help prevent taste aversions. Women with aversions to mint may need to switch their toothpaste flavor to something fruity or more neutral. Conversely, some women may be triggered through the act of brushing the teeth or spitting. Women who have trouble brushing their teeth can read more here.
Taste may also be affected in women with severe NVP/Hyperemesis Gravidarum (HG) that further inhibits their ability to eat more nutritious items. A well-designed study reported that women affected by HG performed worst in taste identification when compared to healthy pregnant and non-pregnant women.
However, the same study noted that fruity smells such as lemon, banana, and coconut were tolerated well, as well as the flavors of apples, watermelon, and oranges.
Reflux can also cause foods to taste differently, exacerbating aversions that can lead to nausea. Reflux also leads to irritation of the upper esophagus and more easily triggers the gag reflex leading to gagging, coughing, and/or vomiting.
Women should call their HCP to be evaluated for acid reflux in early pregnancy, especially if symptoms appear to be worse at night or when sleeping. This is important – some common management techniques for NVP can make reflux worse (i.e. ginger, citrus).
It is often reported that an empty stomach can trigger NVP; therefore, it is recommended that women eat something as soon as they feel hungry. A regular schedule of small meals/snacks every 1 to 2 hours may be very beneficial in women who are not actively vomiting, and some women generally feel they need to eat constantly.
Some authors recommend a 1 to 2-hour schedule even if a woman is not hungry; women may have to try this method and tweak it as necessary.
The Be Ill Prepared page details beneficial strategies of preparing various aspects of a woman’s life/home that can aid specifically in the avoidance of an empty stomach.
Women should avoid napping or lying down within 30 minutes after a meal which slows digestion and can trigger nausea once the woman sits up or changes position.
Women should also avoid getting full even when they do feel well enough to eat. Additional food can always be eaten 20 minutes later but overdoing it can cause significant nausea and/or vomiting shortly afterward in some cases.
Meal/Food Breakdown
Based on studies that evaluated cravings in early pregnancy, starchy, sweet, and high-fat substances may help alleviate nausea and vomiting, obtain quick energy, and protect the mother from potential toxins in other items (vegetables, meat). However, this hypothesis is also controversial.
Regardless, women with NVP appear to tolerate certain foods better than others, but these foods may not be the best option for long-term relief.
Bland, low fat foods digest easier and faster than higher protein/fat meals, but bring back hunger sooner (and therefore nausea comes back sooner) and lead to constipation; women should balance simple carbohydrates with some protein to avoid a never-ending cycle.
Protein meals may also help with gastric dysrhythmias, which may be a contributing factor to NVP in some women. Protein-based meals have been shown to reduce dysrhythmic activity in the first trimester of pregnancy when compared to carbohydrate and fat meals of the same caloric value.
Women should also forget about certain acceptable foods at certain points of the day. “Breakfast” foods do not need to be eaten only at breakfast, and “dinner” foods can be eaten at breakfast. Eating in the middle of the night may also curb nausea enough to go to sleep (but this can also cause reflux). NVP does not play to social norms, therefore neither management strategy.
Bland Foods/ Carbohydrates
A bland diet is often temporarily recommended for nausea/vomiting illnesses because these foods are easier to break down and digest, which lets the GI tract rest. Less acidity in these foods also causes fewer bowel movements.
A “bland” diet and the BRAT diet (bananas, rice, applesauce, and toast) are different; further, the BRAT diet was originally formulated to treat diarrhea.
Bland foods may consist of low-fat dairy, white bread, crackers, puddings, juices, broths, and plain potatoes and noodles (and the avoidance of raw, spicy, high-fat, and uncooked food items).
A bland diet, when indicated for GI distress, is usually meant to be temporary, lasting a few days to a week. Some women with NVP may stay on this diet for weeks, even months, which could cause possible nutrient depletion in severe cases.
Further, it is unclear how effective a bland or BRAT diet may be for NVP specifically, since the causal factors of NVP are different than a stomach/diarrheal illness. However, it is very unlikely a bland diet will make nausea worse in the short-term, but it can cause constipation.
Constipation can lead to significant discomfort and potentially worsen NVP symptoms. Constipation is already an uncomfortable early pregnancy systmpm, regardless of NVP symptoms. Therefore, if women eat a bland or BRAT diet for more than a few days, constipation can be made more severe, causing extreme discomfort in women with NVP symptoms.
Women may have to work slightly harder at eating more fibrous foods to balance these effects; women may need to talk to their HCP for additional tips, as well as to discuss the possibility of stool softeners.
Ground Floor/Step-up Options:
Crackers: saltines and other crackers are always (albeit “annoyingly”) recommended because they are bland, easy to swallow and digest, and have a bit of salt for taste. Women should try a variety of different crackers, to include crackers with a little bit of sugar, fat, or fiber depending on nausea level and tolerance (graham crackers, etc).
Women who try crackers or eat them a lot should have water nearby. NVP can make the mouth very dry, and crackers can be hard to get down and potentially trigger the gag reflex without something to drink.
“Crust cookies” may be a good option over dry crackers. Crust cookies are made using homemade or pre-made pie crust, cut into small squares, and baked. They are easy to digest, have a tiny bit of fat to help with moisture and taste, and can be topped/made with any flavor (salt, cinnamon, sugar, ginger powder); they can also be baked and rolled out to texture preference (soft, chewy, crunchy).
Pretzels: Pretzels are also quick and easy carbohydrates that are simple to digest and have salt (and are not crackers); women may also find soft pretzels to be an acceptable option.
Bread: Bakeries and grocery stores have many different plain or flavorful, soft or chewy white breads that are all possible options; women can grab a plain slice or chunk very quickly without any preparation to curb nausea immediately or before getting out of bed (kept in a bag on an end table/dresser).
If tolerated, a small slice of palatable cheese, butter, cream cheese, or other spread can be added for protein/fat, which could add a little bit more time between nausea waves.
Noodles: Plain noodles/pasta are a great simple carbohydrate option different from bread and crackers that can provide fast energy/calories.
Although they are already quick to make, the process can be made even quicker by boiling noodles ahead of time and storing them in the refrigerator (add a little olive oil to prevent sticking, store in airtight container for 3 to 4 days). A quick re-boil or 60-seconds in the microwave provides an instant food option when needed (optional salt).
Women can also try using:
Vegetable-based noodles: provide additional nutrients
Whole wheat varieties: provide much needed fiber but may cause bloating/cramping
Egg noodles: can add some protein and boil faster than regular pasta
Different pasta shapes and cooking times to play with texture
Potatoes: Small, peeled or boiled/microwaved potatoes with salt and a little butter can provide additional nutrients while remaining easy to digest. Red, white (russet), sweet (yams), and gold are all varieties that offer different tastes and textures women can try. Mashed potatoes are another option, that may be better tolerated than a solid potato.
Pancakes: Pancakes serve the same purpose as the food items above but women can add more variety. Plain, blueberry, chocolate chip, and strawberry pancakes made ahead of time and placed in the refrigerator or freezer can break up carbohydrate monotony but remaining relatively easy to tolerate. These are not meant to be eaten with butter and syrup (but can be), but rather taken right out of the fridge, warmed up quickly, and eaten as is.
Rice: White rice can cause significant constipation if eaten frequently but offers yet another simple carbohydrate option apart from bread and crackers; instant rice can be made in less than 10 minutes. If women can tolerate brown rice, this will help add protein and fiber to their diet.
When possible, women can try adding very small pieces of fruit (mango, strawberry, kiwi) for “tropical” rice that will likely go down easier than savory varieties.
Dry cereal: Dry cereal is a popular and beneficial option for many women. With countless varieties and added nutrients, cereal can make a big impact on a woman’s ability to eat and obtain calories. If women have a favorite cereal they can tolerate during NVP, they should buy more than one box (backup) to make sure it is always available when nausea hits.
The best option may be to purchase several boxes of one-serving boxes/bags that have up to 10 different varieties. NVP is about options – having 8 to 10 different cereals with different textures and tastes can solve a late night/early morning problem in a matter of a few seconds.
Again – it needs to be stressed – if a sugary cereal gets the job done, then it gets the job done. Women can work on better nutrition when they feel better. Right now, it is important to eat whatever will stay down.
Texture and Temperature
Texture and temperature may make the difference between tolerable and intolerable. In general, cold foods appear to be more acceptable than warm foods. Women should try to determine early on what texture/temperature is most appealing to them. Almost all foods can be changed to meet certain criteria: For example:
Texture:
Noodles, bread, and oatmeal can be made chewier; instead of a warm bowl of oatmeal, women can try granola bars or "energy balls" that mix dry oats with other ingredients
Toast can be crunchier
Drier options can be made to be more moist (plain crackers to graham or pie crust)
Potatoes can be diced, mashed, boiled, or roasted
Cereal can remain crunchy, or sat in milk for a softer texture
Sliced apples vs. applesauce
Temperature
Various fruits can be made frozen (grapes, blueberries, bananas)
Fruit inside popsicles
Iced tea to hot tea (or vice versa)
Yogurt can be frozen (“ice” cubes, “to-go” tubes placed in freezer)
Almost any drink can be turned into a popsicle (see Drink page)
Sugar, Fat, Fiber, and Protein
Sweet/higher-fat foods may be among the easiest to tolerate during NVP, and many women find success with these types of foods. Further, a small amount of potato chips or candy may curb women’s nausea enough to eat something more nutritious afterward. Even better, if protein is added, this could increase the length of time before women feel hungry/nauseous again.
Fiber-rich foods can also help women stay fuller longer, but many women worry that fiber-rich foods may make them bloated or uncomfortable, leading to a worsening of NVP symptoms. However, according to a study published in April 2021, dietary fiber was well tolerated in women with NVP. Further, fiber consumption could help alleviate constipation and heartburn, which may, in turn, help improve symptoms for some women.
If sweet/higher-fat foods prove to be the most successful, women should try to avoid worrying about weight gain while in the middle of severe or extreme NVP, as this will add much more guilt and mental stress than necessary (some women with severe NVP gain weight due to the constant need to eat to avoid gagging).
It comes down to risks and benefits. If Pop Tarts® and Lucky Charms® are the only food items that stay down, it may be enough to allow a woman to obtain sufficient fluids and calories to stay out of the emergency room.
Women should work with their HCP to help better balance their diet, but for most women, this will come in time. As they begin to feel better, they can balance out weight/nutrition in the second trimester, or even later in the same day.
Ground Floor/Step-up Options:
String cheese (mozzarella is relatively benign)
Yogurt: add fruit or granola, make a smoothie (read Artificial Sweeteners)
Yogurt covered raisins, chocolate covered peanuts/almonds
Ice cream: add frozen fruit; nuts for additional protein/healthy fats
Toast with honey
Biscuits with jam
Sweet rolls
Short bread cookies
Potato chips
Rice cereal treats/cereal bars
Granola bars/various “morning” bars
Flavors
Every woman has flavor preferences which may or may not be affected during NVP. However, some studies have shown that taste can be dramatically affected in women with HG and starting from scratch with taste trial-and-error during severe NVP can cost valuable time in getting symptoms under control.
At least one study (also mentioned above) showed that fruits such as apples, watermelon, oranges and bananas were the least likely to provoke nausea and/or vomiting in women with HG.
There are no studies or reviews on the effects of cinnamon on NVP, but women may find the flavor palatable, especially in warm drinks. Ground cinnamon can be put on top of crackers, pie crust, apples, bananas, yogurt, breads, sweet potatoes, granola, oatmeal, and plain pancakes.
Cinnamon has been anecdotally shown to have antiemetic (anti-nausea) properties, but in general, has not been studied during pregnancy. Ground cinnamon is safe when used as a food ingredient.
However, women should not take cinnamon capsules or cinnamon extract (or any herbal supplementation) for nausea relief without talking to their HCP. Whether cinnamon has any antiemetic properties (similar to ginger) for NVP has not been studied.
Although studies are relatively limited in scope and size, ginger has largely been shown to be an effective strategy for reducing NVP symptoms in some women. However, ginger is not a well-liked flavor in all women, and women should not force ginger tea or other ginger-flavored food items simply for its anti-nausea properties, especially since different forms of ginger (i.e. powder vs. capsules) have not been well studied (read Ginger).
If women like ginger, there are many options: ginger root boiled in tea, cut up ginger in breads/cookies, ginger powder in sodas or baked items, gum, candies, etc. Women should read the ingredient labels to make sure the item contains actual ginger. Women can also buy ginger/ginger powder and add their own to different foods and drinks.
Peppermint is assessed to act as an anesthetic on the stomach wall that stops nausea and vomiting, but the flavor (vs. aromatherapy) or its consumption has not been studied for NVP relief, and many women may be unable to tolerate any mint flavor during NVP.
However, a clinical trial is currently underway (June 2019) to assess if peppermint-flavored chewing gum is effective at reducing post-operative nausea. Specifically, researchers want to assess whether it can be as effective as ondansetron (Zofran®). It is possible these results – if positive – could be extrapolated to NVP. No results as of September 2020.
Citrus and sour flavors are popular and well-tolerated during NVP and may help relieve bad taste in the mouth. However, women with acid reflux may want to avoid actual citrus from oranges, lemons, or limes as citrus can make reflux worse.
Action
Women may find significant struggle in even figuring out what to try to eat, let alone trying to eat that food. Women should try thinking about food as if different foods are all on flash cards and cautiously flip through images of food in their brain. Women should ask: do I think I could eat this? If the answer is no, they should flash to the next food image as quickly as possible. If the answer is yes, she should try whatever it may be.
Women who need to eat constantly to avoid nausea should try to keep to a 1 to 2-hour schedule and eat small amounts of food each time. From a realistic standpoint, this can be very difficult to maintain during employment, parenting, errands, and social functions (read more for information on how to Be Ill Prepared).
Women should also track and save which of the above management methods work best for them, and which techniques they have already tried, with little success. Although this can change week-to-week as pregnancy progresses, it can also help partners/support learn quickly what to purchase, cook, prepare, and what to avoid without much prompt from the woman so she can focus on her symptoms.
Women need to call their HCP if they are experiencing NVP they cannot control or manage effectively. Additionally, women should not be afraid to ask for help simply because they are not vomiting; nausea alone can result in complications especially if it prevents women from eating.
Although the baby is currently assessed to experience no adverse effects with mild to moderate NVP (and even severe, in most cases), management help from an HCP can help women avoid complications.
Women also need to call their HCP anytime they desire to eat anything that is not considered "food", such as clay, dirt, chalk, or soil (read Pica).
Women should also 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 eat while experiencing symptoms.
Partner/Support
Partners, family members, and other support can take a lot of steps to help pregnant women with mild to severe NVP symptoms eat enough to avoid complications.
It can be difficult for women to grocery shop, cook food, or even be around food. Partners should learn pregnant women's aversions and try to avoid them as much as possible.
Partners should also learn what women appear to tolerate best, and always have those items available, or within easy reach. Partners should also read Be Ill Prepared to learn the additional steps they can take to help pregnant women manage their NVP symptoms. This entire condition is easier to get through if pregnant women do not have to do it alone.
Resources
Bland and BRAT Diet (StatPearls/NCBI; February 2020)
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)