IVs for Pregnancy and Morning Sickness
IVs for Pregnancy
Article Written By: Dr. Taylor J. Graber MD
Peer Reviewed By: Dr. Emily Ngan MD (OB/GYN)
Date Updated: April 29th, 2021
What is Morning Sickness?
For the female body to create an egg for fertilization, generate an appropriate uterine lining for embryo implantation, and subsequently receive and appropriately grow the developing fetus, there are significant shifts in hormones in the body. These hormones are generated from the Hypothalamic-Pituitary Axis. Gonadotropic Releasing Hormone (GnRH) acts on the Anterior Pituitary to release Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH). LH and FSH act on the adrenal glands and ovaries to generate Estrogen and Progesterone, which eventually carry out many of the critical processes in maintaining and generating a pregnancy.
One of the major drawbacks of these dramatic hormonal shifts is nausea and vomiting, which is frequently manifested during the first trimester as Morning Sickness. Morning Sickness is the nausea and vomiting experienced during normal pregnancies and can range from a mild and uncomfortable nausea to a severe dehydration.
Although called “morning” sickness, these symptoms can occur at any time of the day. Many times, our clients have experienced significantly uncomfortable symptoms throughout the day.
The symptoms of morning sickness are typically the worst in early pregnancy when HCG (human chorionic gonadotropin, a pregnancy hormone detected on home urine pregnancy tests) levels are the highest and usually improve by the end of the first trimester (as the levels of the HCG hormone decrease). However, for some individuals, these symptoms can continue into the second or third trimesters.
What is hyperemesis gravidarum?
Hyperemesis gravidarum (HG) is a severe form of pregnancy related nausea and vomiting. This is more frequently associated with increased medical care, higher needs of hydration, and more frequent incidence of needing intravenous therapy.
Does everyone get morning sickness during pregnancy?
Morning sickness is not a sign of an abnormal pregnancy. In fact, it is incredibly common, occurring in as many as 90% of normal pregnancies. In a slightly smaller percentage, the nausea is so significant that it can cause vomiting, and an even smaller amount experience significant dehydration from the symptoms. The smallest percentage of these patients can progress to a syndrome called “hyperemesis gravidarum”, which is nausea and vomiting which is so severe that it can cause dehydration and weight loss.
When does morning sickness happen?
Morning sickness can be symptoms of normal pregnancies, and the incidence of symptoms is therefore incredibly variable. The symptoms usually start within the first 8-10 weeks or first trimester of pregnancy (which is the first 13 weeks of pregnancy), and frequently peak in intensity between weeks 8-12. The symptoms usually taper off by weeks 16-20, although some of our clients have had symptoms which have persisted throughout their pregnancy.
When should I be worried about my morning sickness symptoms? When can they become problematic?
Symptoms can range in their intensity from mild to severe. Some symptoms which should alert you to discussion with a medical professional may include:
Increased frequency of vomiting, especially daily vomiting. If symptoms are so severe that there is any amount of bright red, or dark red, blood in the emesis, you should immediately get in touch with a professional.
Decreased urine output, or urine which is much darker than usual.
Are unable to keep down fluids when drinking them. Especially if this is leading to weight loss. If symptoms are significant enough to cause dehydration, they can lead to symptoms such as tachycardia (increased heart rate), hypotension (low blood pressure), concentrated or dark urine, or postural syncope (dizziness or fainting when standing up too quickly).
Have abdominal pain, cramps, or any kind of vaginal discharge or bleeding.
If symptoms are so significant that you cannot keep down oral fluids, you will need to be evaluated by a medical professional. Prompt evaluation should be performed on Labor and Delivery to ensure that you do not have electrolyte imbalances that could affect you or your baby. Following a reassuring medical evaluation, if you continue to have significant nausea/vomiting, your obstetrician may recommend scheduled IV fluid infusions to prevent ongoing dehydration.
This is what we specialize in at ASAP IVs. We provide on-demand IV therapy solutions to you in the comfort of your own home. We can provide same day appointments, which are frequently much faster and more cost-effective than going to the emergency department, urgent care, or infusion centers.
As a disclaimer, our IV therapy is not a substitute for complete and initial medical evaluation. Fluid shifts and overload are common problems in pregnancy (especially in patients with other high risk medical issues); therefore, you should only begin a scheduled IV fluid hydration regimen under the recommendation of an obstetric medical provider. Do not be afraid to discuss any symptoms with your medical provider or Obstetrician.
Should I have any medical tests or procedures done to evaluate me during morning sickness or hyperemesis gravidarum?
Blood work or labs are not always indicated, especially for mild symptoms. As symptoms become more severe, your physician may want to evaluate your body to determine the level of dehydration and how it is affecting your body. These tests may include:
Blood testing (complete blood count to look at your hemoglobin and hematocrit ratio, basic metabolic panel to look at your electrolytes and BUN/creatinine)
Urine tests (to evaluate the concentration of your urine. More concentrated urine, or urine which contains blood, can indicate severe dehydration or kidney injury).
An ultrasound to check your baby (persistent dehydration can lead to oligohydramnios, or low amniotic fluid, and small-for-gestational-age babies)
Without seeing a physician or medical professional, what can I do to feel better on my own?
For mild symptoms, you can try any of the following:
Snack frequently and in small amounts throughout the day, even if you do not feel you are hungry. These should be snacks with more protein and carbohydrates, but low on fats. Examples include low-fat yogurt, bread, and crackers. Spicy foods can make the symptoms worse.
Ginger flavored beverages, snacks, or lollipops.
Drink cold, clear beverages that are either fizzy or sour – Good choices are lemonade and ginger ale.
Smell or eat fresh citrus, such as lemons, limes, oranges, tangerines. Mint can also be helpful.
Take your prenatal vitamins with food and at bedtime. Taking them early on an empty stomach without food can make the symptoms of nausea worse.
What medications can I take to help my symptoms? Which medications are safe during pregnancy?
There are several medications which can be helpful with morning sickness and hyperemesis gravidarum, and which are also usually safe to take during pregnancy. Some of these medications are:
Vitamin B6 (Pyridoxine)
Anti-Histamines such as: Diphenhydramine (known as Benadryl) and Meclizine (known as Dramamine) or Doxylamine. These can be effective with nausea, and can also lead to sedation or sleepiness.
Ondansetron (known as Zofran). This is a serotonin based medication which is provided in the oral-dissolving form, intramuscular injection, or intravenous injection.
Although not medications, there are pressure points on the inner side of the wrist which can be activated through “acupressure” bands or Acupuncture, which can help alleviate the symptoms of pregnancy. These pressure points can also be used during surgical cases or with general anesthesia to help reduce the symptoms of post-operative nausea and vomiting (PONV). Discuss with a medical professional to see if Acupuncture therapy could help you with your morning sickness symptoms.
Is there anything I can do to prevent morning sickness from becoming a problem for me?
There is no universally effective medication or strategy which can effectively prevent morning sickness or hyperemesis gravidarum. Medical professionals highly encourage patients who are pregnant or may become pregnant to take a prenatal vitamin containing at least 400 mcg (micrograms) of folic acid. Not only are these multivitamins potentially helpful in reducing the incidence of nausea, morning sickness, and hyperemesis gravidarum, they are very clearly shown to prevent some devastating neurologic birth defects, including neural tube defects and spina bifida.
Is morning sickness harmful for my developing baby?
For a majority of patients, there is no harm to the developing baby which will come from pregnancy related nausea, morning sickness, or hyperemesis gravidarum. Many patients have variable weight gain throughout pregnancy (average of 25-35 pounds by the end of pregnancy for patients with a normal body mass index). If symptoms become so significant that they lead to severe dehydration leading to maternal syncope, they should be aggressively treated before any harm comes to the mother or baby, although it is rare for this to happen. Babies born to mothers with persistent dehydration from morning sickness or hyperemesis gravidarum can be small for gestational age (have low birth weights).
What IV drip would you recommend to me to help my morning sickness?
There are several different IV solutions which can be helpful for pregnancy. We don’t have any of them specifically labeled as a “Pregnancy IV”. The most helpful of these is the fluid itself, which comes in the form of 1-2 liters of intravenous crystalloid (IV bag). This helps with the physical dehydration and will immediately overcome the intravascular fluid deficit, which usually will immediately resolve many symptoms. We have also included Ondansetron (Zofran), Diphenhydramine (Benadryl), and B6 (pyridoxine) in these IVs which have significantly helped symptoms and helped our clients to prevent future episodes. We have not had a single adverse event, to either mother or fetus, related to any of these treatments.