Morning Sickness in Pregnancy When Does Nausea and Vomiting Start

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What is Pregnancy Nausea Morning Sickness?

The term morning sickness alludes to the fact that nausea only occurs in the morning, but this is a pregnancy myth. Feelings of nausea can spring up at all times of day and may be triggered by certain scents, odors or foods. So, when does morning sickness start?

Between 50 percent and 80 percent of pregnant women have morning sickness. Symptoms can range from mild to severe, with no known definitive cause for why some pregnant women suffer from mild symptoms as opposed to severe symptoms.

Morning Sickness as First Symptom of Pregnancy

Morning sickness, nausea and vomiting can be among the first early pregnancy symptoms and signs. Morning sickness begins around 4 weeks to 6 weeks into the pregnancy or around the time you miss your period.

One of the most common (and most irritating) parts of early pregnancy is morning sickness. Unexplained nausea leading to vomiting during the first month or so of pregnancy can mean you are eating far less than you should and spending more time in the bathroom than you would like.

Morning illness often presents as a set of symptoms that characterize early pregnancy. These often include tender breasts, back pain, constipation and increased sense of smell. There is a good chance constipation and increased sense of smell may be contributing factors to pregnancy illnesses and may even make the condition worse for some women.

When Does Morning Sickness Start?

The first signs of pregnancy often include nausea which usually begins between the 4th and 6th week of pregnancy, or around the time you miss your period. The common symptoms of upset stomach and vomiting last up until the 16th week of pregnancy in most cases, but this is not a number set in stone. There are pregnant women who suffer from nausea for the duration of the pregnancy.

Morning sickness can occur at the following times:

  • Between 4 weeks and 8 weeks after conception and fertilization
  • Implantation
  • Around the time you miss your first period

Causes of Pregnancy Nausea, Morning Sickness

Hormones, specifically estrogen, are thought to be a primary cause of morning sickness. Estrogen levels suddenly increase and fluctuate during the first month or so of pregnancy. As this hormone fluctuates, women often see changes in their sense of smell, which may be linked to nausea. Other causes of morning sickness may include hCG, relaxing digestive muscles, and skipping meals due to fear of vomiting.

Important Facts About Nausea, Morning Sickness 

In most cases, nausea or morning sickness lasts only a short time. Your baby is not affected by typical morning sickness, but if symptoms are severe or persist well beyond the first trimester, your physician monitoring the pregnancy should be notified. Nausea or morning sickness can lead to severe dehydration and a lack of proper calorie intake, which can cause weight loss during pregnancy and slowed growth of the fetus.

Nausea and vomiting during pregnancy (NVP)

Nausea and vomiting during pregnancy (NVP) is also called 'morning sickness'. Nausea and vomiting is a common condition during early pregnancy, it happens in about 70-80% of pregnancies. About 50% of pregnant women will have nausea plus vomiting, 25% will have nausea only, and 25% of women will have neither nausea nor vomiting. 

Though the name suggests it only occurs in the morning, nausea and vomiting can occur anytime throughout the day. Although women experiencing morning sickness may feel as though it will last forever, nausea and vomiting usually go away after the first trimester.NVP usually happens prior to 9weeks of the pregnancy. If it happens later in pregnancy then other conditions should be evaluated in the differential diagnosis.

A more severe form of NVP is called "hyperemesis gravidarum" and can happen in between 1 in 30-300 pregnancies. Hyperemesis gravidarum is a serious life-threatening medical condition which requires immediate treatment.

NVP is one of the first signs of pregnancy, and despite its name, morning sickness may occur at any time during the day. Generally it begins around the sixth week of pregnancy, and stops around the 12th week. Some women experience morning sickness throughout the entire pregnancy, and some who never experience it at all. It does not harm your baby, unless the sickness becomes so severe that you are unable to hold down food enough to keep nutrients in your body to allow the baby to grow. However, if your morning sickness is unbearable you could have hyperemesis gravidarum and your treating physician should be notified.

What Causes Nausea and Vomiting In Pregnancy

There are several theories of why NVP happens. They include:

  • Hormone stimulus
  • Psychologic disposition
  • Evolutionary adaptation

women in bed sick holding head

When NVP Gets Out of Control

If your NVP gets unbearable or so frequent that you have trouble keeping anything down at all, you should contact your doctor right away. You could potentially have a condition known as hyperemesis gravidarum. This condition is noted by severe nausea and vomiting, along with weight loss, and electrolyte imbalances. Hyperemesis frequently requires admission to the hospital so that you can get IV fluids and other treaments. 

How to Prevent Nausea and Vomiting

You can prevent NVP by taking multivitamins prior to and at the time of conception. Take prenatal vitamins at least 3 months before conception to reduce the incidence of NVP.

Treatment Recommendations for Nausea and Vomiting in Pregnancy

  • Take a prenatal vitamin for 3 months before conception
  • Treat nausea and vomiting of pregnancy with vitamin B6 or a combination of vitamin B6 plus doxylamine
  • Ginger can help with decreasing the NVP symptoms
  • Nausea and vomiting of pregnancy should be treated effectively to prevent progression to hyperemesis gravidarum
  • Admission to the hospital and intravenous hydration may be necessary in dehydrated pregnant women who cannot tolerate oral liquids. 
  • Eat frequent smaller meals often can help while overeating is a main cause of vomiting for most people, pregnant or not. 
  • Drink plenty (in small amounts) of fluids to avoid dehydration.
  • Avoid foods and smells that make you sick. 
  • Eat crackers to settle your stomach, or try smelling lemon, ginger, or watermelon to ease the nausea. 

If you allow yourself plenty of time to get out of bed, (about an hour or so before you actually need to get up) and start slow then you should experience less morning sickness. Another tip: drink fluids either before or after your meal (about half an hour) but not with your meals. If the smells of food cooking bothers you, open a window while you cook/or have someone cook for you.

Slow and steady wins the race and the same goes for nausea and morning sickness. Eating meals slowly can greatly reduce the nausea associated with pregnancy. Crackers and water are perfect in the morning when nausea tends to be strongest. If morning sickness happens later in the day, as “morning” is not the same for every pregnant woman, eat only light meals when nausea is the strongest. Eating before bed may also help prevent sickness upon waking, as the stomach tends to feel nauseous when empty.

Most recently, the FDA approved a safe and effective drug for nausea and vomiting in pregnancy called "Diclegis" which contains 10 mg doxylamine and 10 mg pridoxine in a delayed release formulation. Diclegis is usually started at 2 tablets at night, and if symptoms persist 1 tablet is added in the morning on day 3, and if that does not work, 1 tablet is added in the afternoon. Even Kim Kardashian uses and recommends it.

Between 70 to 85 percent of pregnant women experience morning sickness during their first trimester with nausea usually beginning around the sixth week of pregnancy. Since you may not be getting all of the nutrients you need from food during these times of upset stomach,be sure to include a prenatal vitamin every day to ensure you receive all of the vitamins andminerals your body needs.

Fortunately, there are many strategies to manage nausea and vomiting to promote a healthy, more comfortable pregnancy. Read on to learn about possible dietary modifications that can help.

woman-eating-food-in-bed

  1. Small, frequent meals: Keep snacks such as dry toast, cereal, and crackers near you at all times. Get up slowly in the morning and have a snack such as Shredded Wheat bite-sized biscuits kept near your bedside to avoid moving around on an empty stomach. Then make sure your stomach is not empty throughout the rest of the day by eating five or sixsmall meals including easy-to-digest foods such as bananas, rice, applesauce, and tea. Try to eat at least every two hours.
  2. Drink fluids: Your body needs more water during the first few months of pregnancy so it’s important to stay hydrated. Have beverages, soup, and fruit juices mixed with carbonated beverages to settle your stomach between meals. You may want to tryavoiding drinking beverages with your meals as the fluid will fill up your stomach makingless room for food and worsening feelings of nausea. Strive to consume 6 to 8 eightounce servings of fluids per day. 
  3. Control your environment: By avoiding smells that do not appeal to you (some of which may have never bothered you before) you can prevent nausea. Have someoneelse cook for you so you do not become nauseated by a certain ingredient used in thecooking process. Also try to create a restful environment since reducing stress has beenshown to reduce nausea and vomiting. Try listening to relaxing music, practicing yogaor meditation, or breathing exercises. These techniques may also help you get a betternight’s sleep which has also been associated with decreased nausea.
  4. Anti-nausea foods: Fresh ginger has been shown to help alleviate nausea. Try flat ginger ale, ginger tea, gingersnaps, gingerbread, shredded fresh ginger, and ginger candies. Peppermint is another food known to soothe nausea. Citrus fruits also tend to behelpful- just smelling a lemon when you feel queasy may alleviate nausea.
  5. Supplementation: Pyridoxine, or vitamin B6 may help women with severe and persistent nausea and vomiting. Even for women without these symptoms, vitaminB6 is an important vitamin that is required in greater amounts especially during laterstages of pregnancy when the fetus is increasing the most in size. The reason is unclear why vitamin B6 may help prevent nausea and studies are inconclusive regarding its effectiveness. You should consult with your physician before taking B6 since large doses taken for long periods of time may affect the growing baby’s nutritional status. To help alleviate morning sickness, the recommended dose of vitamin B6 is 50 mg which can be obtained through an additional supplement. This is much higher than the amount recommended during a normal pregnancy, which is 1.9 mg/day. To meet your needs for vitamin B6 during pregnancy, try to include the following foods in your diet: Chicken, fish, liver, pork, eggs, soybeans, carrots, cabbage, cantaloupe, peas, spinach, wheat germ, sunflower seeds, bananas, beans, broccoli, brown rice, oats, bran, peanuts, and walnuts. A prenatal vitamin will also contain the required amount of vitamin B6 in case you don’t meet 100% of your needs through food sources.

Avoid making morning sickness worse

Just as there are things that will help to alleviate morning sickness, there are things that will actually make it worse. Skipping meals will enhance the morning sickness, as will lying down after meals. Eating spicy foods (or cooking them) could also make your morning sickness worse.
You should contact your doctor if your morning sickness prevents you from keeping any food down, if your morning sickness is accompanied with a fever, or the morning sickness persists into the second trimester, after the 13th week of the pregnancy. Relax! You will get through it.

For some women, the nausea of the first trimester is so severe that they become malnourished and dehydrated. These women may have a condition called hyperemesis gravidarum (HG). HG refers to women who are constantly nauseated and/or vomit several times everyday for the first 3 or 4 months of pregnant.

Hyperemesis gravidarum keeps pregnant women from drinking enough fluids and eating enough food to stay healthy. Many women with HG lose more than 5 percent of their pre-pregnancy weight, have nutritional problems, and have problems with the balance of electrolytes in their bodies. The persistent nausea and vomiting also makes going to work or doing other daily tasks very difficult.

Many women with HG have to be hospitalized so they can be fed fluids and nutrients through a tube in their veins. Usually, women with HG begin to feel better by the 20th week of pregnancy but in some cases the symptoms may persist throughout all three trimesters. 

dos and donts in pregnancy morning sickness

Dos and Don'ts of Morning Sickness

Do:

  • Eat small meals often
  • Drink fluids 1/2 hour before or after a meal, but not with meals
  • Drink small amounts of fluids during the day to avoid dehydration
  • Eat soda crackers 15 minutes before getting up in the morning
  • Avoid foods and smells that increase nausea
  • Ask someone else to cook for you and open the windows or turn on fans if the odor bothers you
  • Get plenty of rest and nap during the day
  • Avoid warm places (feeling hot adds to nausea)
  • Sniff lemons or ginger, drink lemonade, or eat watermelon to relieve nausea
  • Eat salty potato chips (they have been found to settle stomachs enough to eat a meal)

Don'ts:

  • Do not lie down after eating
  • Do not skip meals
  • Do not cook or eat spicy food

Hyperemesis Gravidarum

Hyperemesis gravidarum is a condition characterized by severe nausea, vomiting, weight loss, and sometimes electrolyte disturbance. Mild cases are often treated with dietary measures, rest and antacids. Severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line. DO NOT take any medications to solve this problem without consulting your health care provider first.

More Information

Cause of Morning Sickness

Most experts agree that morning sickness symptoms have something to do with changing hormones during pregnancy. For this reason, most women start suffering morning sickness symptoms around the 4th week after conception when the egg implants in the uterus and pregnancy hormones increase. Some women report having morning sickness well before the 4th week (the basic answer to how soon does morning sickness start) which could mean human chorionic gonadotropin (HCG) may be linked to the earliest symptoms of morning sickness, though estrogen is thought to be the cause. HCG is released on the day of conception with levels in urine and blood increasing throughout the pregnancy. HCG is the earliest pregnancy hormone.

When in pregnancy does morning sickness start feeling like morning sickness?

Most women do not find out they are pregnant until after the 6th week of pregnancy. This could mean the first signs of pregnancy, morning sickness, may be attributed to stomach flu or other illness early on. After pregnancy is verified, the morning sickness is then linked back to the pregnancy. 

Morning sickness is one of the most common symptoms of pregnancy, though probably the majority of pregnant women with a normal pregnancy will never have morning sickness. The severity of morning sickness ranges from mild triggered by specific scents to severe with no evident triggers. Some women find morning sickness to be the worst during the early morning hours while others complain of having nausea and vomiting in the early evening or overnight.

Estrogen Levels

Estrogen is thought to be the hormone that causes morning sickness. With estrogen on the rise, how soon does morning sickness start? When estrogen levels increase during the 4th or 5th week of gestation, digestion slows and sense of smell heightens. This combination can lead to morning sickness symptoms like nausea and vomiting. Every woman and every pregnancy will be different so one woman may notice morning sickness as early as the 2nd week of gestation while others feel no effects until the 8th week of gestation. There is no way to stop morning sickness from occurring, but there are natural means of treating nausea.

Some women never experience symptoms of morning sickness while others find they fight morning sickness for the duration of their pregnancy. Typically, morning sickness during pregnancy starts in about the 4th week after conception. This is about the time when women miss their first menstrual cycle and often question whether they could be pregnant or not. The most common symptoms of morning sickness during pregnancy are nausea, vomiting and aversion to certain foods.

Nausea and Vomiting

Morning sickness during pregnancy may include nausea, vomiting or both. Many women report feeling sick to their stomach, but never vomit as a result of this feeling. Others tend to vomit from the first few weeks of pregnancy and find they continue to have vomiting throughout the pregnancy. Each pregnancy is different and morning sickness during pregnancy will be different as well. Just because your best friend made it through all 40 weeks without a hint of nausea does not mean you are going to have the same luck.

Aversion to Food

A main cause of morning sickness during pregnancy is aversion to certain foods or scents associated with those foods. Women complain they cannot “stomach” scents of foods they once loved when they are pregnant. This is due to an increase in the sense of smell. As estrogen levels increase so does sensitivity to scents.

twins newborn babies with mother

Twins and Multiples

Morning sickness during pregnancy is not the same for everyone, but singleton mothers tend to report the same symptoms, on average. Women who are pregnant with twins (or more) may have an even harder time with morning sickness during pregnancy. More babies in the uterus means more estrogen causing slower digestion and increased nausea. Later in pregnancy when the multiple fetuses have pushed the stomach upward in the abdominal cavity, pressure can cause acid reflux and severe nausea not associated with morning sickness during pregnancy.

Severe Morning Sickness During Pregnancy

While cases of severe morning sickness during pregnancy are few and far between, some women find they cannot keep down water, let own solid food for a few weeks or months. Severe morning sickness can progress to a medical condition called hyperemesis gravidarum. If this is the case, the obstetrician will work with the expecting woman to treat the symptoms in a safe and effective manner. Some treatments may include prescription medications to stop nausea long enough for a pregnant woman to keep down food for better health and to supply nutrition to the fetus. Occasionally, pregnant women with hyperemesis may have to be admitted to the hospital for treatment and hydration.

pregnancy natural treatment ginger garlic lemon tea

Natural treatments for nausea and morning sickness in pregnancy

The most important thing to remember about pregnancy is that baby will pull the nutrition it needs from mom. Often, women want to know how soon does morning sickness start because they are worried about the health of their baby. Even if the expecting woman suffers from early symptoms with nausea and vomiting, in most cases, the symptoms do not last the entire day so food and drink are being consumed at some point during the day. Ginger tea is a natural means of fighting nausea. Ginger tea bags are sold in most supermarkets, but a sliver of ginger can be added to any hot tea for the same effect. Ginger is safe for use during pregnancy. Peppermint is another natural treatment for nausea. Peppermint is available in tea form and as mouth drops in sugared and sugar-free varieties.

How long does morning sickness last during pregnancy?

A: Morning sickness is something many pregnant women will experience while others will not. The term morning sickness is a bit misleading as the nausea associated with morning sickness can occur at any time throughout the day and night. In most cases, morning sickness will last until the 10th-14th week of pregnancy, though it may last longer in some cases.

Morning sickness, in a normal form, cannot harm the baby. If the morning sickness is severe, a condition called hyperemesis gravidarum can occur. This is when the mother's electrolytes become imbalanced due to dehydration and there are not sufficient enough nutrients for the baby to grow in a normal way. If morning sickness becomes severe enough that no food or drink can be kept down, the obstetrician needs to be notified immediately.
In order to better deal with morning sickness, pregnant women can eat small meals throughout the day. During the time when sickness is most prevalent, eating crackers and sipping on water is the best way to battle the nausea. All fluids should be consumed 30 to 40 minutes before or after meals to prevent vomiting.

If there are smells or scents that make the pregnant woman more nauseous, those smells should be avoided whenever possible. Additional rest in a cool place can also help to fight the nausea associated with morning sickness.

There are also a few activities that should be avoided in order to keep food down after eating. The pregnant woman should not lie down after eating, skip meals throughout the day or eat foods that are spicy.

When does morning sickness start easing up and how can I treat it?

As is the case with most pregnancy symptoms, morning sickness is completely natural and safe. Many obstetricians suggest keeping crackers or toast next to the bed and eating before getting up to start the day to fend off morning sickness. If symptoms occur later in the day, crackers and toast may help, but pregnant women may also find relief by taking a nap or sipping on warm, ginger tea. Peppermint has also been shown to help calm an uneasy stomach associated with morning sickness.