Nausea and Vomiting During Pregnancy
Authored by:
Anna Glezer, M.D.
For many women, some nausea and vomiting, particularly in the early part of pregnancy, seems inevitable. For some, however, the condition becomes severe enough to compromise well-being and impact quality of life and mood. Severe nausea and vomiting of pregnancy (NVP) can impair a woman’s ability to function at work and at home, and can even have negative effects on the baby, such as lower birthweight or preterm delivery.
Anywhere from 65-80% of women experience NVP, with onset in the first 4-6 weeks, peak around 12 weeks, and resolution in after the fourth month. However, for almost a third of women the symptoms continue throughout pregnancy and as many as 2% experience the severe form known as hyperemesis gravidarum. The exact cause of nausea and vomiting during pregnancy is not usually known, but it is thought that there are both physiological and psychological elements.
How is NVP related to mental and emotional health?
Research has found that this relationship goes in both directions: those with symptoms of depression and anxiety are more prone to developing more severe nausea and vomiting during pregnancy, while those with more severe nausea and vomiting are more apt to develop symptoms of emotional distress.
Many have attempted to explain this relationship, with the exact cause still unknown.
One explanation is the fact that severe NVP can lead to poor nutrition and insomnia, which impacts mood.
Another is that anxiety and depression can often have very physical sensations – sometimes numbness, palpitations, difficulty breathing, and in this case, nausea.
Third, women with severe NVP sometimes describe a fear that they are somehow harming their unborn baby, which creates more anxiety and nausea and a negative cycle.
What are treatment options for NVP?
Generally, the first line interventions target nausea. This includes advice regarding eating dry foods and eating smaller meals more frequently. The next step is usually medications to treat nausea and reflux. But what if those are not completely effective?
An interesting study published just last year sorted women with NVP into two groups: 1) those who received traditional medical therapy such as anti-nausea medications, and 2) those who received that plus a 3 week course of psychotherapy that focused on mindfulness and cognitions (called Mindfulness Based Cognitive Therapy, MBCT). The second group had more of a decrease in symptoms of nausea and vomiting, as well as in symptoms related to depression and anxiety and overall pregnancy distress.
Multiple studies have also noted the significant effect of social support. Women with more social support report less stress and this modifies the impact of NVP. Practically speaking, this means it is important for pregnant women to seek out a support system, particularly in cases where the pregnancy might be unplanned or a partner is not available. Many hospitals and clinics have groups for expectant mothers, as do yoga studios, gyms, and similar establishments.
Finally, if you are struggling with significant NVP, please consider screening for depression and anxiety. Though screening for depression is now universally recommended for pregnant women, it does not always occur. One screening questionnaire can be found here. Consider sharing your result with your obstetrician as the first step to further evaluation and treatment.
Selected References:
Faramarzi, M., Yazdani, S. & Barat, S. A RCT of psychotherapy in women with nausea and vomiting of pregnancy. Human Reproduction (2015) 30: 12, 2764-2773.
Swallow, B.L. et. al. Psychological health in early pregnancy: Relationship with nausea and vomiting. Journal of Obstetrics and Gynaecology (2004) 24:1, 28-32.
