The term morning sickness can be a bit deceptive. It alludes to the fact that nausea only occurs in the morning, but this is a myth. Feelings of nausea can spring up at all times of day and may be triggered by certain scents, odors or foods.
Between 50-80% of pregnant women have morning sickness. 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. Symptoms can range from mild to severe, with no known definitive cause as to 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. It typically begins around 4 weeks to 6 weeks into the pregnancy or around the time you miss your period. Morning sickness is one of the most common (and most irritating) parts of early pregnancy. Although women may feel as though it will last forever, nausea and vomiting usually go away after the first trimester.
Unexplained nausea leading to vomiting during the first month or so may mean you are eating far less than you should while also spending more time in the bathroom than you would like. It often presents as a set of symptoms that characterize early pregnancy. These often include tender breasts, back pain, constipation, and increased sense of smell. Unfortunately, constipation and increased sense of smell may make the condition worse.
Nausea and vomiting may last up until the 16th week of pregnancy in most cases, but this isnot a number set in stone. There are some 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
- Around the time you miss your first period
Causes Of 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.
When Morning Sickness Gets Out of Control
If your nausea and vomiting becomes 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. 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.
Treating Morning Sickness
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.
- 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 six small meals including easy-to-digest foods such as bananas, rice, applesauce, and tea. Try to eat at least every two hours.
- 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 try avoiding drinking beverages with your meals as the fluid will fill up your stomach making less room for food and worsening feelings of nausea. Strive to consume 6-8 eight-ounce servings of fluids per day.
- 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 someone else cook for you so you do not become nauseated by a certain ingredient used in the cooking process. Also try to create a restful environment since reducing stress has been shown to reduce nausea and vomiting. Try listening to relaxing music, practicing yoga or meditation, or breathing exercises. These techniques may also help you get a better night’s sleep which has also been associated with decreased nausea.
- 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 be helpful- just smelling a lemon when you feel queasy may alleviate nausea.
- Supplementation: Pyridoxine, or vitamin B6 may help women with severe and persistent nausea and vomiting. Even for women without these symptoms, vitamin B6 is an important vitamin that is required in greater amounts especially during later stages 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.
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.
Dos and Don'ts of Morning Sickness
- 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)
- Do not lie down after eating
- Do not skip meals
- Do not cook or eat spicy food
Twins and Multiples
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.