Feeling an unexpected return of nausea at 32 weeks pregnant can be unsettling, especially after early “morning sickness” has passed. This late-stage queasiness is common, often linked to the physical and hormonal shifts occurring as the body prepares for delivery. While usually benign, the symptom warrants attention to distinguish normal discomfort from a more serious, underlying issue. Understanding the physiological changes causing this late-trimester nausea can help guide steps for relief and safety.
Common Causes of Nausea in the Third Trimester
The primary reasons for nausea’s return around 32 weeks are mechanical pressure and hormonal influence on the digestive system. As the fetus grows significantly, the enlarged uterus occupies considerable abdominal space, physically compressing the stomach. This compression reduces the stomach’s capacity, meaning even a small meal can cause uncomfortable fullness or push stomach contents upward.
The hormone progesterone remains elevated throughout pregnancy, relaxing smooth muscles, including those lining the gastrointestinal tract. This slows down the movement of food, causing delayed gastric emptying. Food stays in the stomach longer, contributing to bloating and nausea.
The slowing of the digestive tract, coupled with uterine pressure, frequently leads to increased acid reflux (GERD). Stomach acid backs up into the esophagus, causing heartburn that is often accompanied by general nausea. Fluctuations in other late-stage hormones may also sensitize the digestive system.
Warning Signs Requiring Immediate Medical Consultation
While most third-trimester nausea is benign, new or sudden onset can signal a serious complication requiring immediate medical evaluation. Pre-eclampsia is a concerning possibility, characterized by new hypertension and organ injury, often involving the kidneys or liver. Worsening nausea and vomiting can be an accompanying symptom, especially if it occurs with a severe headache, sudden visual changes, or excessive swelling of the face and hands.
HELLP Syndrome is a serious, rare condition and a severe variant of Pre-eclampsia. HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. Severe liver involvement manifests as intense, persistent nausea and vomiting, often accompanied by severe pain in the upper right quadrant of the abdomen. This upper abdominal pain is a specific warning sign that requires immediate contact with a healthcare provider.
Intrahepatic Cholestasis of Pregnancy (ICP) is a liver disorder that may cause late-pregnancy nausea. The most distinctive symptom is intense, generalized itching, especially on the palms and soles, not relieved by typical creams. If nausea accompanies this unrelenting itching, blood tests are needed immediately to check liver function and bile acid levels. Persistent, severe vomiting that prevents keeping down food or fluids also warrants medical consultation to prevent dangerous dehydration.
Practical Strategies for Managing Nausea
For nausea determined to be a result of normal third-trimester changes, several dietary and lifestyle adjustments can offer relief. Instead of consuming three large meals, adopt a pattern of eating small, frequent meals throughout the day to avoid overloading the compressed stomach. This approach helps manage the reduced stomach capacity and eases the digestive burden.
It is helpful to avoid foods that slow down digestion or trigger acid production, such as items that are spicy, high in fat, or highly acidic. Bland, carbohydrate-rich foods like crackers, toast, or plain pasta tend to be better tolerated when nausea is present. Staying adequately hydrated is also crucial, but sip fluids throughout the day instead of drinking large amounts during meals, which can contribute to stomach fullness.
Postural changes can significantly mitigate the symptoms of reflux-induced nausea. Avoid lying down immediately after eating; remain upright for at least 30 to 60 minutes after a meal to allow gravity to help keep stomach contents down. Elevating the head of the bed by six inches, using blocks or wedges, can also reduce nighttime acid reflux and the associated morning nausea.
Safe over-the-counter options, such as antacids for reflux or ginger supplements, may provide relief. However, any supplement or medication should first be discussed with a healthcare provider to ensure safety during pregnancy.