Table 1: Symptom management protocol for NVP used in this study [24, 11, 13].

DietaryLifestyle

(i) Try eating smaller portions (even spoonful or handful), every 1-2 hrs
(ii) Dry, salty, bland, and soft foods may help relieve symptoms
(iii) Add a source of protein or its alternates to all meals and snacks (e.g., nuts, seeds, beans, dairy, and nut butters)
(iv) Keep solids and liquids separate by drinking your fluids 20 to 30 minutes before and after you eat
(v) Fluid intake should be 2 liters per day (8 cups)
(vi) To help increase your fluid intake and to prevent getting dehydrated, you may also add electrolytes (e.g., sports drinks, vitamin water or coconut water)
(vii) Colder fluid intake, such as slushies, popsicles and ice chips will help maintain hydration
(viii) To minimize bitter or metallic taste, try adding candies, gums, or lozenges and consume colder fluids
(ix) Liquid nutritional/protein products (or bars) may be added for extra nutrients
(i) To minimize heightened sense of smell, try sniffing lemons, limes, or oranges. You may also ventilate the area, have someone else cook if possible, and instead of hot foods, try to consume room temperature/cold meals or snacks
(ii) It may be helpful, if you have a lot of saliva, it may be helpful to spit it out and to do frequent mouth washing
(iii) Try not to brush your teeth after eating
(iv) Get plenty of sleep and rest, try not to get overly tired
(v) Avoid an empty stomach or feelings of hunger
(vi) When rising, try to get up slowly and if possible, snack beforehand
(vii) Try not to lie down after meals
(viii) If possible, ask for help from family members or friends

Others

(i) If you have low iron levels, try splitting the prenatal vitamin (take one half in the morning and one half in the evening) for tolerability.
If your iron level is normal, try switching to a children’s vitamin or a multivitamin with lower iron and added folic acid; resume with
prenatal vitamin after 12 weeks
(ii) For constipation, try to increase dietary fiber, such as psyllium, whole grains, fruits; and if needed, try adding a stool softener
(e.g., docusate sodium)
(iii) For symptoms of acidity, such as belching, burping, lump at the back of throat, burning, indigestion, and reflux, treatment
with antacids, H2 blockers or PPIs may be suggested. Try not to overeat or leave your stomach empty. Try to sleep elevated to help
reduce acid symptoms. Also, screening for Helicobacter pylori may be beneficial, as it has been associated with severe NVP and HG
(iv) For symptoms of gas and/or bloating, monitoring diet and switching to lactose-free may help, and if needed, try adding an
anti-flatulent agent (e.g., simethicone)