Morning Sickness (Nausea and Vomiting of Pregnancy)
What is morning sickness?
Morning sickness, also called nausea and vomiting of pregnancy, is a common condition. It occurs in about 70% of pregnancies and usually starts around 6 weeks of pregnancy and lasts for weeks or months. Symptoms usually improve during the second trimester (weeks 13 to 27; the middle 3 months of pregnancy). In a few women, however, morning sickness occurs throughout their pregnancy.
Despite its name, “morning” sickness can happen at any time of the day.
Can morning sickness become severe?
Yes. Most women who experience morning sickness usually feel nauseous for a short time each day and may vomit once or twice. In more severe cases of morning sickness, nausea can last several hours each day and vomiting occurs more frequently. This most severe type of nausea and vomiting, which occurs in up to 3% of pregnant women, is called hyperemesis gravidarum.
Symptoms and Causes
What causes morning sickness?
The cause of morning sickness is not totally known. It may be caused by low blood sugar or the rise in pregnancy hormones, such as human chorionic gonadotropin (HCG) or estrogen. Morning sickness may be worsened by stress, being overtired, eating certain foods, or having sensitivity to motion (motion sickness).
What are the symptoms of severe morning sickness (hyperemesis gravidarum)?
Symptoms of hyperemesis gravidarum include:
- Vomiting more than 3 times a day.
- Becoming severely dehydrated (signs of which include little-to-no urine production, dark-colored urine, dizziness with standing).
- Losing 5 or more pounds.
Women with severe morning sickness may need to be admitted to the hospital to receive IV fluids to restore hydration and medications to relieve nausea.
Management and Treatment
What can I do to feel better if I have morning sickness?
There are a few things you can do to feel better. These include:
- Eat a few crackers or toast in the morning to help settle your stomach. Keep a few crackers at bedside and eat a couple before getting up.
- Eat 5 or 6 small meals a day instead of 3 large meals.
- Avoid spicy and fatty foods. Eat bland foods such as bananas, rice, dry toast, plain baked potato, gelatin, broth, eggs, tofu, or applesauce.
- Eat healthy snacks between meals, such as yogurt, peanut butter on apple slices or celery, cheese, milk, or nuts.
- Drink plenty of fluids, especially water, throughout the day.
- Take your prenatal vitamins with a snack. If your prenatal vitamin contains iron, try taking it at bedtime. Talk with your doctor about other vitamin options.
- Avoid odors, flickering lights, other situations that bother you and trigger your nausea.
- Make tea with real grated ginger or try ginger candies.
- Get plenty of rest.
- Keep rooms well ventilated, turn on a fan, or go outside from time to time to get some fresh air.
- Smell fresh-smelling, pleasant scents such as lemon, orange, or mint.
Other methods may help reduce nausea. Talk with your healthcare provider before trying these:
- Acupressure wrist band. These bands apply pressure to certain points on the wrist.
- Acupuncture. In this treatment method, thin needles are put into the skin.
Do not use marijuana to treat morning sickness! It has not been shown to be safe for your baby during pregnancy.
What medications are available to treat morning sickness?
Your healthcare provider may recommend taking vitamin B6 (also called pyridoxine) and doxylamine. Doxylamine is also used as a sleep aid and to treat hay fever or other allergies. Both products are available over-the-counter and don’t need a prescription. However, there is a pill that contains the combination of these 2 products. It is available by prescription only and is known by the trade name Diclegis®. Unlike the separate over-the-counter products, Diclegis® is a slow-release single pill. This may be more convenient or helpful for women who have trouble (for example, have a gag reflex) taking many pills per day.
Medications to prevent nausea (also called antiemetics) can also be prescribed. If these drugs don’t help, other drug classes can be tried including antihistamines and anticholinergics. You and your healthcare provider will decide which medications work best for you.
Does morning sickness harm my baby?
Mild to moderate nausea and vomiting of pregnancy usually is not harmful to you or your baby. However, it can become a problem if you can’t keep food or liquid down, become dehydrated, and lose weight. Unmanaged severe nausea and vomiting can prevent you from getting the nutrition you need and affect the weight of your baby at birth.
Are some women more at risk for developing severe morning sickness?
Yes. The risk for severe morning sickness is increased if a woman:
- Is pregnant with more than 1 baby – twins, triplets, or more.
- Has a personal history of severe morning sickness with a previous pregnancy and/or has a mother or sister who had a history of severe morning sickness with a pregnancy.
- Is pregnant with a girl.
- Has a history of motion sickness.
- Has a history of migraines.
- Is overweight.
- Has a condition called trophoblastic disease, which leads to abnormal cell growth in the womb (uterus).
When do I need to call my doctor?
Do not wait until vomiting becomes severe to call your doctor. Seeking care for morning sickness early in pregnancy can help prevent it from becoming more severe. Severe vomiting is not a normal aspect of pregnancy and requires medical care or even hospitalization.
Another reason to investigate severe nausea and vomiting is that it may be a symptom of other medical conditions including ulcers, reflux (heartburn), food-related illnesses, thyroid disease, gallbladder disease, or inflammation of the appendix, stomach, pancreas, or liver.
Call your doctor right away if you:
- Have nausea that lasts all day long and keeps you from eating and drinking.
- Vomit 3 or more times a day.
- Have vomit that is brown in color or has blood in it.
- Lose weight.
- Feel extremely tired or confused.
- Feel dizzy or have fainted.
- Have a fast heart beat.
- Produce little to no urine.
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