Morning Sickness

Kate Middleton, the Duchess of Cambridge, has in recent years bought the subject of “morning sickness” to headlines around the world. With all three of her spotlight pregnancies, Ms. Middleton’s more severe condition of hyperemesis gravidarum has heightened awareness about the topic of a fairly common symptom for many pregnant women. While hyperemesis gravidarum is rare, occurring in less than 3 percent of pregnancies, it represents the most severe symptoms of morning sickness that includes nausea, vomiting, or both.

Morning sickness is very common in pregnancy and occurs in around 80 percent of pregnancies, particularly during the early weeks of pregnancy. Additionally, despite it’s misnomer, morning sickness can occur at any time of day or night. Generally nausea gravidarum is not medically treated or concerning unless the symptoms are severe, for instance, if nausea and vomiting do not abate or you are unable to keep fluids down. These could be signs of dehydration and may require medical interventions such as intravenous fluids and medications. Other concerning symptoms can include fainting or dizziness or heart palpations.

Luckily, the majority of women with morning sickness will only experience mild nausea or occasional vomiting for the first trimester of pregnancy. The exact cause of morning sickness is not totally understood, but the prevailing theory is that a woman’s body is reacting to the pregnancy hormone, human chorionic gonadotropin or hCG that occurs at its highest level in the first trimester of pregnancy, hence the reduction of symptoms for most women after the first trimester. In fact, despite the troublesome symptoms, morning sickness can be a reassuring sign that the pregnancy is progressing normally because it indicates the presence of a sufficient amount of hCG that is necessary to maintain a pregnancy. Some studies have shown that women with little or no morning sickness symptoms have a higher miscarriage rate.

Knowing that the duration of morning sickness is brief relative to the entire pregnancy may relieve some anxiety, and there are tricks and tips that can help to alleviate some of the symptoms of morning sickness. Nausea and subsequent vomiting can be worse on an empty stomach, which may explain why some report feeling worse upon waking. Some women keep crackers at their bedside to eat immediately upon waking to avoid nausea. Another tip is to avoid an empty stomach by eating small more frequent meals. Many find that bland foods are easier to digest and some will try to avoid heavy meals or spicy foods.

Staying hydrated is important during pregnancy, and some find that it feels better to drink separately from eating. Water is a perfect fluid for hydrating, but some have a hard time with water during the first few weeks, so carbonated ginger ale or herbal teas might work well to keep nausea at bay. Many report that ginger can help with nausea, and ginger supplements may help. Of course, you should always consult with your healthcare provider before taking any medications or supplements during pregnancy.

It is highly recommended that pregnant women take a prenatal vitamin during pregnancy to ensure that you and your fetus are receiving adequate amount of nutrients to sustain the pregnancy and help with fetal development. However, some women find that taking their prenatal supplement worsens their nausea. It’s a good idea to take your vitamin with food. Another trick is to split the pill in half and take over half in the morning and half during the evening.  In fact, most prenatal supplements contain vitamin B6 that has been shown in studies to improve nausea in pregnancy. If your nausea is acute, your healthcare provider may prescribe additional B6 to help with these symptoms until they end.

Some women find that nausea is triggered by certain smells, as the sense of smell becomes very acute during pregnancy. Avoiding strong odors can help.  Other tips include getting plenty of rest. Some women find relief using alternative health therapies to include acupressure with wristbands, acupuncture, or aromatherapy. While not scientifically proven, some of these techniques have anecdotal success, and as long as they present no negative affect, they can be explored.

If these recommendations do not help with nausea and most importantly vomiting, a woman should contact her healthcare provider if she experiences any of the following symptoms: vomiting more than 4 times in a day, unable to keep fluids down for a day, vomiting blood, or losing more than 2 pounds. Any of these symptoms may require medical attention. Morning sickness can be managed, and for most women it’s a minor and temporary bump on their pregnancy journey. 

Timothy J. Hardy, M.D.

Dr. Timothy Hardy, M.D. has been practicing medicine in the community for many years. He received his medical degree from Eastern Virginia Medical School and founded his own practice, Atlantic OB-GYN, in 1990, where he has been providing women with exceptional care ever since. Website: www.atlanticobgyn.com
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