Women's Healthcare Topics

Morning Sickness

Reviewed by James Brann, M.D.

What is morning sickness?

Between 50 to 90 percent of pregnant women suffer some degree of morning sickness, pregnancy-related nausea with or without vomiting. Remember that “morning sickness” doesn’t always happen in the morning; it can be at any time during the day.   If you are experiencing nausea, gagging, vomiting, or an aversion to food, then you have morning sickness.

Don’t worry—mild cases of nausea and throwing up won’t hurt your baby. It’ll eventually end and you’ll be able to eat and feel better. Morning sickness symptoms tends to be first noticed around 5 or 6 weeks with a peak at 9 weeks. It should go away in the second trimester.  

What are the Symptoms of Morning Sickness?

The symptoms include fatigue, nausea and vomiting, gagging, and aversion to food. Morning sickness starts early in pregnancy and if you're feeling these symptoms on a regular basis, you have morning sickness.

Mild to moderate cases of nausea and vomiting do not hurt your baby. It will eventually end and you will be able to eat and feel better soon.

When does Morning Sickness Start?

When does morning sickness start.

The symptoms of morning sickness usually start at five to six weeks of pregnancy. Your symptoms gradually gets worse until your ninth week, and stops by the 16th to 20th weeks.

When does Morning Sickness End?

Morning Sickness usually ends by the 16th to 20th weeks of pregnancy. But up to 20 percent of pregnant women may continue through the third trimester and 5 percent up to delivery.

Most women realize around their sixteenth week that their stomach is no longer doing cartwheels and that food is appetizing once again. Notice I said most women. There are a few women for whom this particular ailment is a gift which keeps on giving...well into the second trimester, even occasionally right up until delivery

Do all pregnant women get morning sickness?

No, but 9 out of 10 pregnant women experience nausea during early pregnancy.

What Causes Morning Sickness?

Morning sickness is not a good description of the nausea and vomiting associated with pregnancy. It is not exclusively a morning experience. There is no clear consensus within physicians on what causes morning sickness. But this unpleasant symptom has been associated with many varied conditions, slowing of digestion, a genetic cause, many psychological factors, and even increasing levels of hormones during pregnancy.

Other factors may also be involved to one degree or another. For your own reference, the causes of morning sickness aren't known for certain but may include some of the following:

  • On-going stress

  • Ambivalence about the pregnancy

  • Increased hormone levels

  • Slower digestion

  • Increased sensitivity to smells

  • Missing nutrients from the diet, i.e. zinc

  • Fluctuating rates of metabolism (low blood sugar)

  • You have had menstrual migraines

  • You are prone to motion sickness

  • You have family members that have had morning sickness

  • You have problems with gastric reflux

  • You have twins

What are the triggers that may make morning sickness symptoms worse?

  • Rooms that do not have fresh air movement “stuffy”

  • Specific odors that you find offensive

  • Hot and humidity environment

  • Aggressive loud sounds or noises

  • Blinking lights

  • Motion sensations similar to that felt when driving

  • Fatigue

  • The excessive production of saliva that is commonly seen in pregnancy

  • High sugar content foods and snacks

  • Spicy foods

  • Food with high-fat content.

I have morning sickness what can I do to feel better?

If you have morning sickness, fortunately there are some time tested remedies that may help relieve some of the symptoms:

  • Eating as soon as you have the sensation of being hungry, or even before you feel hungry

  • Snack frequently and try eating small meals. The easiest foods to eat are foods that have lots of protein or carbohydrates, but not a lot of fat. Crackers, bread, and low-fat yogurt are good choices.

  • Drinking cold, beverages that are clear and fizzy. Lemonade and ginger ale are good choices

  • Eating lollipops that are ginger flavored

  • Smelling lemon, mint, or orange helps

  • Brushing your teeth as soon as you finish eating

  • Avoid lying down after eating

  • Only take your vitamins at bedtime with a small snack, instead of the morning

  • Avoiding things that make you feel nauseous. Examples could be stuffy rooms, and strong smells

  • There are also wrist bands that you can wear called "acupressure" bands. The acupressure bands are supposed to decrease morning sickness symptoms

What dietary changes should a pregnant woman with morning sickness make?

To try and decrease your morning sickness symptoms eat when you feel hungry. You do not want to have an empty stomach. An empty stomach will make your nausea worse. [Reference].

Snacking at appropriate times will help with your symptoms. Try a snack before bedtime and if you get up in the night for your bathroom trips. A small snack such as crackers may help.

Just like an empty stomach can make your symptoms worse, an over full stomach will also make symptoms worse. Make sure to eat small amounts very frequently, every few hours.

You should make a mental note of which foods you can tolerate and which ones make symptoms worse. You should try to avoid the foods you cannot tolerate.

Start by changing your diet and avoiding the following foods: [Reference].

  • Coffee

  • Spicy foods

  • Fatty foods

  • Very sweet foods

Change your diet to include the follow foods that are better tolerate:

  • Protein rich

  • Low fat

  • Bland meals

  • Dry foods, such as cereals, crackers

  • Salty foods

  • Peppermint

It is best to drink liquids 30 minutes before and 30 minutes after you eat? This will avoid that overfull stomach sensation that increases nausea. Carbonated and cold beverages are tolerated the best. Drinking through a straw and sips of sports drinks seems to help as well.

What are the self-treatments for Morning Sickness?

The goal of treatment is not to totally eliminate your morning sickness symptoms, but to make the nausea and vomiting tolerable. The treatment plan chosen is to make you comfortable, and allow you to hold things down better. With or without treatment most symptoms will stop around the 16 week of pregnancy or shortly thereafter.

Mild symptoms have been treated with wrist bands that you can wear called "acupressure" bands. The acupressure bands are supposed to reduce morning sickness. The wrist band exerts pressure on an acupressure point (p6 or Nei-Kuan) that has shown to relieve nausea and vomiting. [ Reference]

Marijuana usage during pregnancy has been increasing. Pregnant women have self-report that it does alleviate the morning sickness symptoms. [Reference]. Despite this fact, the American College of Obstetricians and Gynecologists recommends avoiding marijuana use in pregnancy sighting concerns could exist for the baby’s safety.

Ginger tea may also help with the nausea and vomiting of some pregnant women. Ginger is also available, in forms as ginger lollipops, and ginger ale.

Are there safe medical treatments I can take for morning sickness?

Yes, there are many common drugs that are used to treat morning sickness

Pyridoxine or Vitamin B6 is the initial drug of choice. Pyridoxine (Vitamin B6) is safe and has minimal side effects. The recommended dosage is 10 to 25mg, every 6 to 8 hours.

Pyridoxine works well to treat nausea but does not reduce the vomiting. [Reference] When pyridoxine treatment alone has not been beneficial, it is combined with a second medication called Doxylamine.

Doxylamine is found over-the-counter in sleeping pills and in a prescription antihistamine.

Doxylamine-pyridoxine combination appears to be a more effective treatment than when they are taken alone. [Reference]

There are two other common medications you can try, but they will make you sleepy. Diphenhydramine (Benadryl) and Meclizine (Dramamine) Both of these medications are sold over the counter and have been used to easy the symptoms of morning sickness.

Can the Symptoms of Morning Sickness Be Prevented?

Women gagging while pregnant.

Multi-vitamins before and in early pregnancy may reduce the risk for morning sickness symptoms. [Reference]

Every woman that is planning conception should take a multivitamin. A multivitamin is still the #1 source of folic acid and other vitamins before conception. It may be this combination of Vitamin B6 and folic acid that leads to a decrease in early pregnancy morning sickness symptoms.

Will morning sickness hurt my baby, I am not gaining weight?

Almost all pregnant women that had severe vomiting in pregnancy will recover completely and gain adequate weight. But, it has been shown that you will probably not gain as much weight as others.

This is not a problem for your baby unless you were 10% underweight before your pregnancy. If you were heavy before pregnancy, it is less of an issue if you don’t gain the average amount of weight. The normal weight gain for pregnancy is depended on your weight before pregnancy, but on the average a woman will gain 25 to 35 pounds.

If you had to be admitted to the hospital many times for severe vomiting and did not gain the normal amount of weight, there is a small chance your baby will be smaller than normal. If you had severe vomiting during this pregnancy, there is a 15 to 20% chance that you will experience this during your next pregnancy

.

When Should I Call my Physician?

If your vomiting become severe and you are not able to keep any foods or fluid down, call your doctor. You need to be evaluated for a condition called Hyperemesis Gravidarum, that may require admission to a hospital for treatment.

Hyperemesis Gravidarum is a form of severe morning sickness that usually only affects less than 1 percent of pregnant women. It is characterized by persistent and extreme nausea and vomiting, where the affected individual might vomit as much as 10-30 times per day.

When morning sickness is mild, you do not have to see your physician until your scheduled appointment, but you should definitely be seen if any of the following symptoms occur along with your vomiting:

  • Decrease frequency of urination

  • Dark colored urine

  • Dizziness when you standup

  • Constant vomiting during the day

  • If blood is seen in your emesis (vomit)

  • Associated lower or upper abdominal pain

  • Cramping and/or pelvic pain

  • You are not able to hold any liquids down

  • Fever

  • Diarrhea or constipation

Conclusion:

Morning sickness is a very common pregnancy illness that fortunately will get better over time. Rarely, a woman will experience morning sickness for her entire pregnancy. Fortunately there are a number of things you can do to easy the symptoms of morning sickness.

If you are concerned that you might have a more severe form of morning sickness or are vomiting several times per day for an extended period of time, be sure to consult with your caregiver for advice.

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