Enf.º Tito Félix

Maternal and Obstetric Health Specialist Nurse 
Gynecology and Obstetrics Service

Strategies for a more relaxed first trimester

HPA Magazine 24 // 2025

Pregnancy is a period in which women face multiple challenges, with countless changes that require successive adaptations. In the first months, it is common for pregnant women to experience a variety of symptoms indicating their bodies are adapting to this new phase: intense fatigue, drowsiness, breast tenderness, mood swings, increased urinary frequency, nausea, and vomiting, among others.
In the context of the HPA Maternal Health Nursing Consultation, the most common complaints of pregnant women in the first trimester are nausea and vomiting, for which they seek clarifications, strategies, and solutions.

In the specific case of nausea and vomiting discussed in this article, these symptoms vary greatly from pregnant woman to pregnant woman, both in intensity and persistence. However, although they are considered normal in most cases, it is important to understand when they become serious. It is estimated that between 50% and 80% of pregnant women experience mild nausea and vomiting up to 9 weeks of gestation, and these symptoms can persist up to 16 weeks and be a reason for seeking emergency care. It is also reported that only 0.3% to 3% of pregnant women may develop hyperemesis gravidarum. We will, therefore, focus specifically on nausea and vomiting, distinguishing the differences between mild and more severe symptoms, in addition to providing guidance on the care and strategies needed to minimize them and ensure the health of the mother and baby.

Hormonal changes
During pregnancy, several hormonal changes occur, especially an increase in Bhcg (human chorionic gonadotropin, beta fraction) and oestrogen, which determine the occurrence of episodes of nausea and vomiting. In addition to the hormonal factors mentioned, emotional factors such as stress and fatigue must be taken into account, as well as aversion to certain foods or strong smells. Each woman reacts differently, and understanding these causes helps to better manage the discomfort felt. In short, nausea during pregnancy results from a combination of hormonal, psychosomatic, neurological, and gastrointestinal factors.
Bhcg is secreted by the body after the embryo implants in the uterus, and its levels increase rapidly in the first weeks of pregnancy. High levels of Bhcg are related to a higher incidence of nausea and vomiting, especially between the 6th and 12th week of pregnancy. For this reason, the vast majority of pregnant women see this discomfort disappear almost completely by the end of the first trimester.
In turn, the increase in oestrogen levels directly interferes with the gastrointestinal system, favouring reflux and changes in digestion.

Classification of Symptoms
Mild nausea and vomiting: These are occasional episodes that do not significantly compromise the health of the pregnant woman or the baby. They usually appear in the morning or after meals and can be controlled with changes in diet, medication, and rest.
Uncontrollable nausea and vomiting: When the episodes become frequent, intense, and completely compromise the intake of solids and liquids, requiring prolonged fasting and high ketonuria. This condition requires the use of the emergency room and immediate medical attention, as it can irreparably lead to severe dehydration, loss of body weight, and complications for the mother and baby.

Hyperemesis Gravidarum
During pregnancy, vomiting, especially when intense and persistent (also called uncontrollable vomiting), can lead to complications such as dehydration and hydro electrolytic imbalance, resulting in the clinical condition known as Hyperemesis Gravidarum. Dehydration occurs because the excessive loss of fluids through vomiting is aggravated by complete dietary intolerance to solids or liquids, leading to weight loss. Hydro electrolytic imbalance occurs when there is a disproportionate loss of electrolytes, such as sodium and potassium (verified analytically), which are essential for maintaining many vital functions, and an increase in ketone bodies in the urine. Symptoms such as weakness, asthenia, dizziness, muscle cramps, mental confusion, and even cardiac alterations may be felt. In the context of pregnancy, these problems can compromise the mother's well-being and also affect the baby's development.

Hospital Treatment
Generally, treatment is carried out in an emergency setting for a few hours and involves the administration of antiemetics, replacement of fluids and electrolytes, either orally or intravenously, in addition to preventing and treating vomiting. When food intake is tolerated, the pregnant woman is discharged with instructions to minimize this discomfort.

Strategies and Care
When it comes to treating and caring for nausea and vomiting during pregnancy, diet plays a key role in relieving symptoms and avoiding complications. Here are some important guidelines:
• Eat fractional meals: instead of large meals, eat small portions every 2-3 hours. This helps to avoid excess volume in the stomach, which can worsen nausea and make vomiting easier.
• Choose light, easily digestible foods: crackers, toast, plain cookies, non-citrus fruits, and cooked foods. These foods help to reduce the feeling of nausea and prevent overloading the stomach.
• Avoid fatty, spicy, and acidic foods: these difficult-to-digest foods can irritate the stomach and increase the feeling of nausea or reflux and lead to vomiting.
• Adequate hydration: drink liquids in small sips throughout the day, preferring water, ginger tea, or diluted natural juices. Avoid very cold, very hot, or carbonated liquids, which can worsen discomfort. There are also oral hydration serums on the market.
If you experience signs of reflux associated with nausea and vomiting:
• Avoid lying down immediately after meals. Try to stay upright for at least 30 minutes to help prevent reflux.
• Sleep with the head of your bed elevated or use extra pillows to help reduce nighttime reflux.

Always remember to go to the HPA Obstetrics Outpatient Consultation where your Obstetrician or the Nurse Specialist in Maternal Health and Obstetrics are available to give you specific guidance, especially if the symptoms are intense or persistent.
This will ensure a more comfortable, calm, safe, and healthy pregnancy for you and your baby.