Morning sickness: Causes, concerns, treatments
Why do they call it morning sickness if I feel nauseated all day long?
About three-quarters of pregnant women have nausea (and sometimes vomiting) during their first trimester.
For some, it’s worse in the morning and gets better over the day, but “morning sickness” can strike at any time.
Nausea usually starts around 6 weeks but can come on as early as 4 weeks and tends to worsen over the next month or so.
About half of women who get it feel complete relief by about 14 weeks. For most of the rest, it takes another month or so for the queasiness to ease up, though it may return later and come and go throughout pregnancy.
What causes nausea and vomiting during pregnancy?
No one knows what causes nausea during pregnancy, but it’s probably some combination of the many physical changes taking place in your body.
Some possible causes include:
- Rapidly increasing levels of the hormone hCG during early pregnancy. No one knows why it contributes to your nausea, but the timing is right: Nausea tends to peak around the same time as your levels of hCG. Estrogen is thought to play a role, too.
- An enhanced sense of smell and sensitivity to odors. It’s not uncommon for a newly pregnant woman to find that she’s now overwhelmed by the smell of a bologna sandwich from four blocks away, for example, and that certain aromas instantly trigger her gag reflex. This, too, maybe a side effect of rapidly rising amounts of estrogen in your system.
- A tricky stomach. Some women’s gastrointestinal tract is more sensitive to the changes in early pregnancy. One study even found an association between h. pylori (a gastrointestinal bacteria that can cause ulcers) and severe nausea during pregnancy, although no one knows why the two might be related.
You may have heard that morning sickness can be caused by a B vitamin deficiency.
While taking a vitamin B6 supplement does seem to help ease nausea in many pregnant women, that doesn’t mean they have a vitamin deficiency.
At least one study has shown no significant differences in the levels of B6 in women with morning sickness and those without.
No one knows why B6 is helpful. There’s also some evidence that taking a multivitamin at the time of conception and in early pregnancy helps prevent severe morning sickness, but again, no one knows why.
Some researchers have proposed that certain women are psychologically predisposed to having nausea and vomiting during pregnancy as an abnormal response to stress.
However, there’s no good evidence to support this theory. (Of course, if you’re constantly nauseated or vomiting a lot, you certainly may begin to feel more stressed!)
Are some pregnant women more likely than others to feel nauseated?
You’re more likely to have nausea or vomiting during your pregnancy if any of the following apply to you:
- You’re pregnant with twins or higher multiples. This may be from the higher levels of hCG or other hormones in your system. You’re also more likely to have a worse case than average. On the other hand, it’s not a definite thing — some women with twins have no nausea at all.
- You had nausea and vomiting in a previous pregnancy.
- You have a history of nausea or vomiting as a side effect of taking birth control pills. This may have something to do with your body’s response to increased levels of estrogen.
- You have a history of being susceptible to motion sickness.
- You have a genetic predisposition to nausea during pregnancy. If your mother or sisters had severe morning sickness, there’s a higher chance you will, too.
- You have a history of migraine headaches.
Will my nausea affect my baby?
Mild nausea and occasional vomiting commonly associated with morning sickness won’t threaten your baby’s well-being as long as you’re able to keep some food down and drink plenty of fluids.
After all, for most of the first trimester, you’re just talking about a tiny embryo that doesn’t need too many calories.
If you find that you’re unable to eat a balanced diet, it’s a good idea to take a multivitamin (one with a low dose of iron or no iron if that mineral makes your nausea worse) to make sure you’re getting the nutrients you need.
It’s usually not a problem if you don’t gain any weight in the first trimester, as long as you’re not starving yourself and able to stay hydrated.
Have faith that your appetite will return soon enough and you’ll begin gaining weight.
If I don’t have morning sickness, does that mean I’m more likely to have a miscarriage?
Not necessarily. Several studies have indeed shown that women who have miscarriages are less likely to have had nausea. (If your baby or your placenta is not developing properly, you’ll have lower amounts of pregnancy hormones in your system, so it follows that you would have little or no nausea.)
But there are also plenty of women with perfectly normal pregnancies who manage to escape nausea during their first trimester. Count yourself lucky and don’t obsess about it if you’re not suffering!
What can I do to get relief?
Not all of the following suggestions are supported by hard evidence, but they’re all commonly recommended by obstetricians and midwives, and many women swear by them.
- Try to avoid foods and smells that trigger your nausea. If that seems like almost everything, it’s okay to just eat the few things that do appeal to you for this part of your pregnancy, even if they don’t add up to a balanced diet.
- It might also help to stick to bland foods and try to eat food cold or at room temperature, which tends to have less of an odor than hot food.
- Keep simple snacks, such as crackers, by your bed. When you first wake up, nibble a few crackers and then rest for 20 to 30 minutes before getting out of bed.
- Snacking on crackers may also help you feel better if you wake up feeling nauseated in the middle of the night.
- Eat small, frequent meals or snacks throughout the day so that your stomach is never empty. Some women find that carbohydrates are most appealing when they feel nauseated, but one small study found that high-protein foods were likely to work better.
- Try to avoid fatty foods, which take longer to digest, particularly during pregnancy, when your stomach takes longer to empty. Also avoid rich, spicy, acidic, and fried foods, which can irritate your stomach and digestive system.
- Try drinking fluids primarily between meals. And try not to drink so much at once that your stomach feels full, as that will make you less hungry for food.
- A good strategy is to sip something frequently throughout the day and aim to drink about a quart and a half altogether. If you’ve been vomiting a lot, try a sports drink that contains glucose, salt, and potassium to replace lost electrolytes.
- Give yourself time to relax and take naps if you can. Watching a movie (preferably not one about food!) or visiting with a friend can help relieve stress and take your mind off your discomfort. Or try hypnosis. While there’s no definitive evidence that it helps with morning sickness, it’s been shown to be effective in combating nausea during chemotherapy.
- Try taking your prenatal vitamins with food or just before bed. Or ask your healthcare provider whether you can switch to a prenatal vitamin with a low dose of iron or no iron for the first trimester since this mineral can be hard on your digestive system.
- Ask your provider about taking vitamin B6. No one knows why B6 eases nausea in some women, but research indicates that it works for several women and it’s been consistently shown to be safe when taken in commonly recommended doses.
- The usual dose for treating morning sickness is between 10 and 25 milligrams three times a day but check with your provider before taking anything. She can tell you how much to take and whether or not the amount in your prenatal vitamin should count as one of the doses. (The amount of vitamin B6 in supplements varies by brand.)
- Try ginger, an alternative remedy thought to settle the stomach and help quell queasiness. See if you can find ginger ale made with real ginger (most common sodas aren’t). Or grate some fresh ginger into hot water for ginger tea, or see if ginger candies help.
- A few studies found that taking powdered ginger root in capsules provided some relief. (Ask your provider before taking ginger supplements. As with many other things that are helpful in normal amounts, the effects of megadoses are unknown.)
- Try an acupressure band, a soft cotton wristband that’s sold at drugstores. This simple and inexpensive device, designed to ward off seasickness, has helped many pregnant women through morning sickness (although some research suggests that it may be largely a placebo effect).
- You strap it on so that the plastic button pushes against an acupressure point on the underside of your wrist.
- Ask your provider about a device that regularly stimulates the underside of your wrist with a mild electric current. The device costs about $75 and is available by prescription only — but it’s safe, and research has shown that this “acustimulation” technique works well for some women.
- If nothing else works for you, ask your provider about taking an anti-nausea medication that’s considered safe during your first trimester.
What if I just can’t keep anything down?
Call your provider if you haven’t been able to keep anything (including fluids) down for 24 hours. (If you’re newly pregnant and don’t yet have a doctor or midwife, go to the emergency room.)
You may have a condition called hyperemesis gravidarum (literally, “excessive vomiting in pregnancy”). This condition can be difficult to manage.
But the sooner you’re diagnosed and begin treatment, the more likely you’ll be able to avoid severe symptoms.
Your caregiver will probably want to give you some intravenous fluids right away since you’ll most likely be seriously dehydrated.
Then she’ll need to do some tests to check your electrolyte levels and make sure no underlying disease is causing your constant vomiting.
Depending on your condition, you may need to be hospitalized for a few days so that you can continue to receive IV fluids and medication.
Many women feel much better after they’re rehydrated and can control their symptoms with anti-nausea medication.
In rare cases, you’ll need to continue to receive intravenous therapy on and off either in the hospital or at home.
If inadequately treated, this condition can result in chronic dehydration, weight loss, malnutrition, and other complications for you and your baby.
For more information, visit the Hyperemesis Education and Research Foundation Web site.