Counseling For Nausea and Vomiting In Pregnancy
Nausea and vomiting can be caused by hormonal changes, psychological factors
such as anxiety about the pregnancy, and poor diet habits.
Do nutrition and weight evaluation to determine if there is weight loss,
inadequate weight gain or adequate weight gain.
Important to teach on first visit:
 Eat 5 to 6 or more small meals per day. Eat every 2 to 3 hours or more often.
 If you go long periods without eating (and have an empty stomach), you are
more likely to have nausea. If you eat larger meals you are more likely to
have nausea
 You are the expert in which foods you can or can’t tolerate – but choose
healthy foods as listed on the Daily Food Guide – (unless you clearly are
unable to tolerate them). For example, if you can tolerate well watermelon – it
is okay to eat lots of it - be sure to have plenty available. Ask yourself - ‘what
am I likely to tolerate’ – then try it – keep plenty available. Perhaps, ask a
family member if they can go buy some of those foods that you are likely to
tolerate, so plenty is available in the home.
 If you can’t eat, then you can’t eat. But, if you don’t feel like eating, but you
can eat, then that is the time to eat. (i.e. don’t go all day without eating just
because you don’t feel like eating)
 Aim for the Daily Food Guide recommended number of servings for the food
groups, but, if you can’t tolerate any foods from one food group, choose those
foods that you can tolerate from other food groups

Avoid unhealthy foods such as sugary foods and sugary drinks (for example:
cakes, cookies, candies , ice cream, chocolate, sweet breads, lollipops,
popsicles, Jello, flan, sugary cereals, flavored yogurts, (Hispanic favorites:
’pan dulce’, ‘arroz con leche’), soda , Gatorade, Koolaid, fruit punch, Sunny
Delight , Tampico, Tang, Caprisun, lemonade, instant iced tea from powder,
bottled iced tea, Powerade, Kern’s, Schnapple, Quik, ‘high energy drinks’,
(Hispanic favorites: ‘agua de jamaica’, ‘agua de tamarindo’ , ‘horchata’,
‘maicena’, ‘atole’, champurrado, Chocomil, ‘aguas de fruta’ (they lack
nutrients/nutrition and ruin the appetite for more nutritious foods)
 Take advantage of every time you are hungry or have an appetite by eating a
meal or healthy snack (don’t wait hours before eating). If you leave the
house, take along healthy snacks in your purse.
 Keep well hydrated. Drink fluids, including soups, between meals rather than
with meals
 Avoid greasy or fried foods
 Avoid spicy foods
 When cooking, use exhaust fan and open windows to reduce odors.
 Try to keep air fresh, especially in the room where you sleep
Other things to try:
Cut a lemon in half and smell it – this gives relief to some women
Put crackers or cereal or toast or dry bread at your bedside at night – in the
morning, eat some before rising.
Get up slowly in the morning, avoiding sudden movements
May be important to teach on the first visit:

Limit fruit juice to 4 ounces per day or less preferably, unless you are unable
to tolerate more healthy foods (you may want to allow them to continue a
higher fruit juice intake (if it is 100% fruit juice) until a follow-up visit.

If a pregnant woman continues to lose weight, she is at risk for developing
ketone bodies in her blood (from the breakdown of body fat), which is
dangerous for the baby, and can affect the baby’s intelligence. High levels of
ketones in the blood may also contribute to more nausea. If the body is also
becoming dehydrated (due to fluid losses and inadequate water intake), the
ketone concentration in the blood can be even higher.
Optional teaching for first visit:

During pregnancy there is a big change in the hormones in the body,
especially at the beginning of the pregnancy. Poor nutrition can contribute to
a lack of balance of hormones in the body which can contribute to nausea.

Eating nutrient-rich food can help restore hormone balance.

Stress can contribute to nausea.

Nausea may be provoked by smells, noises, movement, stress
Inadequate weight gain can be followed by a high rate of weight gain
as the patient’s appetite returns. This high rate of weight gain is called “catch-up”
weight gain and is considered acceptable (the patient that has “catch-up” weight
gain should also be counseled regarding getting adequate exercise, avoiding
sugary foods and sugary drinks, and limiting fruit juice to 4 ounces per day or
less).