Morning Sickness Severity Quiz (PUQE-24)

PUQE stands for Pregnancy-Unique Quantification of Emesis — a short, validated index developed by Koren and colleagues (2002) to grade how severe nausea and vomiting of pregnancy is, later extended and validated over a full 24-hour window (the PUQE-24, Ebrahimi et al., 2009). It asks three questions about the last 24 hours — how long you felt nauseated, how many times you vomited, and how many times you retched without bringing anything up — each scored 1 to 5, for a total of 3 to 15. A total of 6 or less is mild, 7 to 12 is moderate, and 13 or more is severe. Clinicians use it to grade symptoms and track them over time; it isn't a diagnosis by itself.

Very normal: nausea and vomiting affect the majority of pregnancies — up to about 8 in 10 — and despite the name it can strike at any time of day. It typically begins in the first weeks after a missed period, peaks at around 9 weeks, and improves for most people by 16 to 20 weeks. Normal doesn't mean you have to white-knuckle it, though: effective, pregnancy-safe treatment exists at every level of severity, and treating symptoms early can keep them from getting worse. Symptoms that are severe, getting worse, or starting for the first time late in pregnancy deserve a call to your provider.

The measures with published evidence behind them are simpler than the folklore: eat small, frequent meals so your stomach is never completely empty or completely full; keep bland, dry snacks like crackers by the bed and eat a few before getting up; avoid the smells and foods that set you off; and try ginger, which has trial evidence for reducing nausea. Vitamin B6 (pyridoxine) is a published first-line option in ACOG's guideline — worth discussing with your provider, who can confirm whether it fits you and how to take it. If self-care isn't holding the line, that's exactly when to call rather than push through.

Yes. This is one of the best-studied areas in pregnancy care: ACOG's guideline names the combination of vitamin B6 (pyridoxine) and doxylamine as the first-line medication for nausea and vomiting of pregnancy when diet and lifestyle changes aren't enough, and it has a long safety record — it's available both as an FDA-approved prescription combination and as separate components a provider can direct. If that isn't enough, clinicians have several further options. The point is that you don't have to earn treatment by suffering: a moderate score is a good reason to call your provider and ask.

Hyperemesis gravidarum (HG) is the severe end of the spectrum — persistent vomiting that leads to dehydration, electrolyte problems, and weight loss (often described as losing more than about 5% of pre-pregnancy weight). It affects a small minority of pregnancies — roughly 0.3 to 3% — but it is a genuinely medical situation, not a stronger version of an inconvenience: it usually needs prescription anti-nausea treatment and sometimes IV fluids, and untreated it can harm both you and the pregnancy. A PUQE-24 score of 13 or more, or any dehydration warning sign, is a reason to be seen the same day rather than to try more home remedies.

Yes. This quiz runs entirely in your browser: your answers are scored on your own device and are never sent to a server, saved, or shared — close the tab and they're gone. In a post-Dobbs world we treat reproductive health data as sensitive by default, so nothing here is stored or tracked. It's general educational information based on a published, validated index; it can't diagnose you, and it doesn't replace your OB, midwife, or prenatal clinic — especially if your score is moderate or severe.