Morning Sickness

The term "morning sickness" is used to describe the symptoms of nausea and vomiting during pregnancy. If you are are spending most mornings in the bathroom feeling queasy, you are not alone. As many as 90% of all pregnant women experience some nausea, while one-third actually vomit due to this condition. It usually begins 4- 6 weeks after conception and continues until the 14th - 16th week of gestation.

The exact cause of morning sickness is unknown, but several theories exist. Most experts believe it's triggered by hormonal changes, especially the increase of hCG (human chorionic gonadotrophin). High levels of this pregnancy hormone are thought to overstimulate the part of the brain that controls nausea and vomiting. Gallbladder disease, hyperactive thyroid, molar pregnancy, or carrying more than one baby may also cause morning sickness.

Other possible culprits include the physical symptoms of pregnancy: an enhanced sense of smell, stretching of the uterine muscles, displacement of the digestive organs, and excess acid in the stomach. Emotional stress and a high-fat diet may also play a part.

How Do I Know I Have It?

As the name suggests, most women experience morning sickness in the early hours of the day, but it can occur at any time. For some women, it lasts all day. It generally consists of nausea and vomiting, but may also include dizziness and headaches.

How Can I Treat It?

There are no drugs currently approved by the FDA for the treatment of morning sickness, although several medications can help. First, there are several dietary, lifestyle, and alternative-medicine approaches that may help. If you’re not getting better, see your health care provider – waiting until you are completely miserable can make your symptoms harder to treat.

Diet:

• Eat a diet high in protein and complex carbohydrates. Try peanut butter on apple slices or celery; nuts; cheese and crackers; and milk, cottage cheese, and yogurt. Bland foods like gelatin, frozen desserts, broth, ginger ale, and saltine crackers also soothe the stomach.
• Avoid eating fatty foods. Recent research suggests that a high-fat diet contributes to morning sickness.
• Keep your blood sugar even by eating and drinking small portions frequently. Try to eat before you get hungry and nausea strikes.
• Keep crackers by the bed and eat one or two before getting up for the day.
• Drink plenty of liquids. Try to drink between meals rather than with meals to prevent your stomach from getting too full.

Lifestyle:

• Take vitamin supplements at night, as the iron they contain may irritate your stomach. You may have to try several prenatal vitamins before finding one you can tolerate. You can also try cutting your prenatal vitamins in half, having one half in the morning and the other at night.
• Keep morning activities slow and calm.
• Avoid staying in poorly ventilated spaces that trap food or other odors.
• Avoid smoking cigarettes.
• Get extra sleep and try to minimize stress as much as possible.

Alternative medicine:

• Use acupressure wristbands. These apply pressure to specific points on the wrist, and are often used to ease motion sickness. You can find them at drug stores, health-food stores, and travel stores.
• Try acupuncture. Some acupuncturists are specially trained to work with pregnant women. Talk to your health care provider before consulting a licensed acupuncturist. Randomized clinical trials have failed to show that treating morning sickness with acupuncture has a benefit.
• Try eating ginger. A study showed that powdered ginger capsules helped relieve pregnancy-associated nausea and vomiting. Some ginger flavored lollipops are thought to be helpful.

Contact your health care provider if:

• Morning sickness does not improve, despite trying home remedies.
• You are vomiting blood or material that looks like coffee grounds.
• You lose more than 2 pounds in a week.
• There is prolonged, severe vomiting, which can cause dehydration and malnutrition.

Medicines your health care provider may recommend:

• Vitamin B6: This B vitamin has been shown to improve symptoms of morning sickness. The American College of Obstetricians and Gynecologists (ACOG) recommends as the first-line treatment for morning sickness.
• Doxylamine – sold under the trade name “Unisom,” this medication is combined with vitamin B6 to help treat nausea and vomiting.
• Anti-nausea medications: promethazine, metoclopramide, dimenhydrinate, or ondansetron are other options to manage nausea and vomiting during pregnancy.

(For information on severe, persistent vomiting during pregnancy see hyperemesis gravidarum.)

Frequently Asked Questions

Q: I am now in my second trimester. Why hasn't my morning sickness stopped?

A: Some women experience morning sickness during their entire pregnancy. This happens most often for women carrying more than one baby. If you're still having morning sickness, make sure you inform your health care provider to rule out other possible complications.

Q: Is the morning sickness hurting my baby in any way?

A: Luckily, no. In fact, some medical professionals believe that morning sickness is actually a sign that all is well with you and your baby. Multiple studies have shown that women with morning sickness have fewer miscarriages and better-grown babies than those who don’t have nausea. Your symptoms probably show that the placenta is making all the right hormones for your developing baby.

Q: I had horrible morning sickness with my first child. Am I destined to have it again with my second?

A: According to ACOG, about two-thirds of women who have severe morning sickness have bad symptoms again with their next pregnancy, but one-third do much better the second time. If you’ve had bad morning sickness before, make sure you’re taking prenatal vitamins before you get pregnant again. That seems to reduce the risk of bad nausea and vomiting.

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