Morning Sickness in Pregnancy

July 20, 2008

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Morning Sickness in Pregnancy

by Marjorie Greenfield, M.D.
reviewed by Marjorie Greenfield, M.D.

As you may already know, "morning sickness" can often be more appropriately called "evening sickness" or "every-minute-of-the-day sickness." While there are the lucky few, most pregnant women (50-90%) experience some degree of nausea, some have vomiting, and a few develop a severe form of vomiting during pregnancy called hyperemesis gravidarum.

What causes the nausea and vomiting of pregnancy?

We can't explain why some people feel fine and others are green for months. Even the same woman may feel vastly different in each pregnancy. There is some relationship between nausea and the level of the pregnancy hormone hCG. In twin pregnancies, and in other situations where the hCG is greater than expected, nausea and vomiting tend to be worse. In a pregnancy destined for miscarriage, hCG levels tend to be low, and nausea is often less severe. This being said, a lack of nausea doesn't guarantee that the pregnancy is destined for miscarriage. The fact that nausea and vomiting are often signs of a healthy pregnancy can offer a silver lining in the dark cloud of miserable nausea.

How long will the nausea last?

Fortunately, for most pregnant women, nausea and vomiting are a first trimester event, peaking at week 9-10 and waning by week 14-16. When you are feeling bad the weeks can go by slowly but most moms do feel tremendously better by the middle of the pregnancy. Whether morning sickness is a brief experience or lasts through most of the pregnancy, there are treatments that can make the weeks or months more tolerable.

What can you do about it?

Diet: See what works for you. Try eating bland dry foods, and avoid fatty or spicy foods. It is okay to eat a less than perfectly balanced diet in the first trimester. Have your liquids separately from dry foods. Try sports drinks, water, clear juices, Kool-aid, or non-caffeinated tea. Avoid carbonated beverages that fill up your stomach. Try eating lots of little meals. If you tend to feel sick when you first wake up, leave crackers next to the bed for a quick snack before rising. Keeping healthy snacks with you all day to nibble when you feel queasy can sometimes even prevent nausea from starting.

Prenatal vitamins and nausea: Pre-natal vitamins can sometimes worsen nausea in pregnancy. While folate is necessary, especially early in the pregnancy, it comes as a smaller pill that many people find more tolerable than the complete vitamin pill. Ask your practitioner if it is okay to temporarily replace prenatal vitamins and iron with just a folate pill if you find a significant worsening in the level of your nausea from the vitamins.

Alternative therapies: Acupressure may be used to treat nausea in pregnancy, and is not known to have any risks for the fetus. Wristbands (marketed for seasickness) that put pressure on an acupressure point at the wrist are often available at drugstores or travel stores. Ginger root is used for nausea in many traditional cultures. Some women take fresh grated ginger or ginger tablets. It is possible that the pill form contains other ingredients or contaminants, so you may want to try fresh ginger first.

Medications: Emetrol® is the only nausea medication approved for use in pregnancy. It is available over the counter and is soothing to the stomach.

A prescription medication called Bendectin® was available in the 1970s-1980's and was shown to be safe in pregnancy, but the company stopped marketing it in the US due to the costs of liability coverage. Bendectin® contained 10 milligrams of vitamin B6 and 10 milligrams of Doxylamine. Two tablets were given at bedtime and a total of up to 4 tablets could be used in a 24-hour period. Interestingly, Unisom™, which contains a higher dose (25 mg.) of the same medication, Doxylamine, is currently marketed as an over-the-counter sleeping pill. Ask your practitioner if creating a vitamin B6/Doxylamine combination with over-the-counter medications would be safe for you.

Prescription medications like Compazine® and Phenergan® can be used if the benefits outweigh possible risks, but these have not been clearly shown to be safe in pregnancy. Zofran®, an expensive anti-nausea medication often used to treat nausea from chemotherapy, can also be used.

Can I throw up so much it harms the baby?

The act of vomiting cannot hurt your fetus, which is protected inside the uterus. If you get dehydrated or develop a metabolic imbalance, this can be unhealthy. As long as you can keep down liquids, you and your baby will generally do all right. Eat when you feel able. If you are unable to keep anything down, or if you notice potential signs of dehydration such as lightheadedness, or concentrated and/or infrequent urination, call your practitioner. Some women need brief hospital admission for intravenous fluids and anti-nausea medications if their condition becomes severe. This severe form of nausea and vomiting is called Hyperemesis Gravidarum.

As with many symptoms of pregnancy, remind yourself that "this, too, shall pass," and you'll have a wonderful baby to show for it!


RELATED INFORMATION

			Fatigue in the First Trimester
			First Trimester Experiences
			The Developing Fetus, Weeks 1-8
			GI Symptoms in Pregnancy

Created August 10, 2000
Reviewed February 24, 2003

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