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Nausea and vomiting of pregnancy, in two minutes

Nausea and vomiting of pregnancy (NVP) touches up to 80 percent of pregnancies. It usually starts around week 6, peaks near week 9, and eases for most people by week 14 to 20. For some it lasts the whole pregnancy. "Morning sickness" is a misnomer: it can strike at any hour and for many women it is all day.

Hyperemesis gravidarum (HG) is the severe end: persistent vomiting, weight loss of 5 percent or more, dehydration, and difficulty keeping food or fluids down. It affects 1 to 3 percent of pregnancies and is a leading cause of hospital admission in early pregnancy. It is not caused by anything you did, and it is treatable.

When to call

Call your care team today if

• You cannot keep fluids down for 24 hours.
• You are urinating less than every 8 hours, or it is dark.
• You have lost weight, or your clothes are suddenly loose.
• You feel faint, dizzy on standing, or your heart races.
• Your HELP Score is 33 or higher, or climbing day over day.

Go to urgent care or the emergency department now if you cannot keep any fluid down, feel confused, or have not urinated in 12 hours.

What works · evidence stated

Remedies with studies behind them

• Small, frequent meals and fluids. Sip, do not gulp. Cold and bland is easier than hot and fragrant. Evidence: consistent clinical guidance.
• Vitamin B6 (pyridoxine). First-line in major guidelines, alone or with doxylamine. Ask your care team about dose. Evidence: randomised trials.
• Ginger. Modest but real effect on nausea in trials. Capsules, tea, or chews.
• Acupressure wristbands. Mixed evidence, low risk, worth a try.
• Prescription anti-nausea medication. Several options, stepped up as needed. The moderate range is where they usually earn their place. Evidence: guideline-backed.
• IV fluids and scheduled medication. Standard care in the severe range. Thiamine should be given before IV dextrose.

For your appointment

What to tell your clinician

Three numbers change what gets prescribed: your HELP Score, how many times you vomited in the last 24 hours, and how much you kept down. Say them in that order. If your clinician does not know the HELP Score, send this line:

"The HELP Score is a clinically validated 12-item measure of nausea and vomiting of pregnancy from the HER Foundation. 0 to 19 is mild, 20 to 32 moderate, 33 to 60 severe. My score today is ___."

Work and home

You are allowed to be sick

Nausea and vomiting of pregnancy is a medical condition, not a character test. A note from your care team can cover time off, remote work, or schedule changes. If you have hyperemesis, say the word hyperemesis. It is understood differently from "morning sickness."

Further reading

Where the numbers come from

The HELP Score and its validation: MacGibbon KW, Kim S, Mullin PM, Fejzo MS. Geburtshilfe und Frauenheilkunde 2021;81(1):90 to 98. The HELP Score is a clinically validated tool created by the HER Foundation and is used with permission.

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