The spectrum of pregnancy sickness
Nausea and vomiting in pregnancy (NVP) affects up to 94% of pregnancies to some degree and severity, from mild NVP to the condition at the extreme end of the pregnancy sickness spectrum, hyperemesis gravidarum (HG).
Often called morning sickness, though this is an outdated term as sickness can occur at any time of day, you can usually go about your normal routine without too much hinderance, and symptoms usually ease in the second trimester.
What does mild NVP look like?
- Typically, short bouts of mild nausea and/or occasional vomiting
- Generally, no negative physical or mental impact
- Usually lasts for the first trimester
- Can be managed through diet and lifestyle changes
- An often expected and wanted experience
Moderate - Severe NVP
Moderate to severe NVP is often mistaken for mild NVP, which can lead to a barrier in treatment. Unlike Mild NVP sufferers will experience more persistent nausea and vomit more often.
What does Moderate - Severe NVP look like?
- Some people experience excessive saliva
- Can last to 20 weeks and beyond
- Diet and lifestyle alterations may help but medication is most likely appropriate
- Emotional and psychological support may be needed
- Quality of life impacted
- May lose weight
What is hyperemesis gravidarum?
Hyperemesis gravidarum (HG) is a condition at the extreme end of the pregnancy sickness spectrum. It affects approximately 3% of people with pregnancy sickness and is incredibly debilitating for sufferers. It is important that you seek medical attention if you are unable to keep any food or fluids down as you can become dehydrated very quickly when suffering with HG.
- Approximately 30,000 pregnancies per year in the UK suffer with HG
- May begin very early, even before a positive test
- Symptoms peak at 9-13 weeks, can improve around 16-24 weeks but may continue throughout the whole pregnancy
- Weight loss is severe and rapid, and dehydration is common
- If not managed appropriately complications can ensue
- Medical treatment is necessary
- Psychological support is beneficial
- Spectrum condition, not all HG looks the same
- 1 in 5 people with severe HG will have symptoms throughout their whole pregnancy
NVP and HG can be 'dry', meaning that there is no vomiting, but the other symptoms are so severe, especially nausea, that it still affects your food and fluid intake, ultimately leading to potential dehydration and malnutrition. Contact our support team for coping strategies and up to date medical information.
When to seek help
Now. Chances are you are reading this page because you have sickness in pregnancy and are not sure if what you are going through is 'normal'. Especially in a first pregnancy, or first pregnancy with sickness, it can be hard to know when to seek help.
As soon as the quality of your life is impacted, and you can’t go about your usual routine then it’s time to seek medical support. Before contacting your GP or midwife chat with our support team so you can prepare yourself with all the correct and up to date information. Early treatment could reduce admission rates to hospital and prevent dehydration so seek support as soon as you can after your symptoms start. Some GPs can refer you to a consultant if your symptoms are particularly bad, or if you have previously had a severe HG pregnancy, then consultant care may be beneficial from early on in a subsequent pregnancy.
You can read more about treatment here.
If you are showing clinical signs of dehydration then you will be in need of IV fluids and medication. To obtain these you will need to go to your local Early Pregnancy Unit or A+E. Each hospital has a different admission protocol, you can contact the support team for help with what options are in your area.
When you speak to any healthcare professional describe your symptoms in detail to enable them to understand the severity of your symptoms and treat you accordingly. You will want to tell them:
- Number of times sick per day
- Number of hours of nausea
- Number of times retching per day
- Amount (mm) of drink you are having per day and keeping down
- Amount of food (bites etc) you are having per day and keeping down
- Changes in urine: darker, not going as much, when you go you pass less
- Any other symptoms of dehydration: dry mouth, dry lips, headaches, dizziness, weakness, confusion and disorientation
The Pregnancy-Unique Quantification of Emesis (or PUQE score for short) is an assessment tool which healthcare professionals would use to help them to determine the severity of your symptoms and where you may be sitting on the pregnancy sickness spectrum. Each question has a score between 1 – 5 depending on your answer, and the total number scored can be used to get a better understanding of where you may be on the Pregnancy sickness spectrum.
There are other things that you should take into consideration also:
- Are your symptoms affecting your ability to eat and drink?
- Have you lost weight since you became pregnant? If so how much?
- Are your symptoms making it hard to function normally?
- Are you having to take time off from work?
- Are you struggling to do day to day normal activities or even just to get out of bed?
If you answer yes to one or more of these questions, then you need to seek medical support.