Morning sickness

What is morning sickness?

Morning sickness is nausea and vomiting during pregnancy. Despite its name, it can strike pregnant women at any time of the day.

Morning sickness is very common. Estimates vary, but up to around 85% of pregnant women experience some nausea or vomiting. ^[1] Fortunately, it tends to settle down by the 20^th week of pregnancy and there are practical things you can do to reduce your symptoms and feel better.

Signs and symptoms

Morning sickness tends to start in the first month of pregnancy and stop by 16-20 weeks.

Symptoms include:

• Feeling nauseous or sick in the stomach;
• Loss of appetite and aversion to some foods, and;
• Vomiting.

Some women can feel anxious or depressed along with the morning sickness.

Causes

The cause of morning sickness is unclear. A range of theories have been suggested, such as changes in hormone levels, or reductions in blood pressure or blood glucose (sugar) level, but none of these theories have been proven.

You may be more likely to experience morning sickness if you:

• Have experienced morning sickness in a previous pregnancy;
• Tend to experience motion sickness;
• Have had gastrointestinal problems such as reflux or stomach ulcers;
• Have menstrual migraines;
• Experience nausea or vomiting when taking estrogen-based medication;
• Are having a multiple pregnancy, or;
• Are having a molar pregnancy.

Methods for diagnosis

Your doctor will do a physical examination and ask about your symptoms.

If your doctor is concerned that another medical condition may be causing your symptoms, they may recommend other tests such as blood tests, a urine sample and an ultrasound.

Types of treatment

Taking steps to deal with morning sickness early in your pregnancy may help to reduce your level of symptoms. As well as helping you to feel better, it is important to be able to drink and eat enough so that you do not become dehydrated or lose weight.

Avoiding things that trigger your morning sickness

There are many things that can trigger morning sickness and they can vary between women. By working out what triggers your morning sickness and avoiding it you can reduce your symptoms.

Common triggers include:

• A range of smells and odors (such as perfumes, coffee, smoke and some foods);
• Stuffy, enclosed rooms;
• Lots of noise;
• Hot, humid environments;
• Flickering lights, and;
• Physical motion (such as driving).

Because motion is a trigger, you may be able to reduce your symptoms by:

• Moving slowly, particularly when getting out of bed or standing up from being seated, and;
• Avoiding excessive exercise.

Nutrition

What, when and how you eat can make morning sickness worse.

You may find it helpful to:

• Avoid eating spicy foods;
• Avoid eating a lot of high-fat or high-sugar foods;
• Eat foods high in protein, such as cheese, milk and yoghurt;
• Eat foods that have complex carbohydrates such as wholegrain crackers;
• Eat small amounts of food more frequently, rather than large meals;
• Drink small amounts of water frequently;
• Consume food and liquids separately;
• Try cold and frozen foods and drinks, and;
• Eat dry crackers before getting out of bed in the morning.

Avoiding fatigue and stress

Morning sickness can be worse when you're tired and stressed, so pacing yourself and getting plenty of rest can help to reduce symptoms.

If you have symptoms of depression or anxiety, seeking advice from your doctor or a mental health professional may help.

Prenatal vitamin supplements

Some women can find that their morning sickness gets worse when taking prenatal vitamin supplements that contain iron. It may be helpful to take the supplement at night, before going to bed, rather than first thing in the morning. If symptoms continue to bother you, your doctor can advise what alternatives may be suitable for you.

Complementary therapies

Some complementary therapies, such as ginger supplements, acupressure and acupuncture, have been recommended for relieving morning sickness. However, there is variable evidence supporting the effectiveness and safety of many of these therapies.

Ginger

There is evidence that products containing ginger may be helpful to pregnant women experiencing nausea and vomiting. The safety of taking high doses of ginger is unclear. If you wish to use ginger products, your doctor can discuss what may be suitable for you.

Acupuncture

Acupuncture is an alternative therapy that involves fine needles being inserted at various points of the body in order to provide health benefits. It has not been shown to relieve nausea and vomiting in pregnant women.

Acupressure

Acupressure is an alternative therapy based on acupuncture that involves a therapist applying pressure at various points of the body in order to provide health benefits. Applying pressure to the lower forearm has been studied for relieving nausea and vomiting in pregnant women; however, evidence is limited regarding its effectiveness.

Medications

Many women with mild symptoms do not require medications for morning sickness. However, if symptoms are bothering you, there are safe medications you can take. Remember to discuss any new medications with your doctor before you start taking them as not all medications are safe to take during pregnancy - this includes over-the-counter medications, nutritional supplements and herbs.

Pyridoxine

Pyridoxine (vitamin B6) can be taken to help reduce mild to moderate nausea. It is important to follow your doctor's recommendations regarding taking pyridoxine because in high levels it may cause health problems. Taking 200 mg/day has been shown to be safe for pregnant women.

Antiemetics

Antiemetics are medications that can help reduce vomiting. They may often be combined with pyridoxine for morning sickness. If you think that you may require medication it is best to discuss this option with your doctor.

Treatment of severe morning sickness

While most women experience mild to moderate symptoms of morning sickness that gradually get better without treatment, a small percentage of women experience severe, persistent nausea and vomiting that can last the entire pregnancy. This condition is called hyperemesis gravidarum.

Persistent vomiting can lead to dehydration which, if severe, can be dangerous and may require hospitalization.

Signs that you may require further care include:

• Dehydration (look for dark-colored urine, urinating infrequently, or being dizzy while standing);
• Vomiting continually throughout the day;
• Blood in the vomit;
• Being unable to keep any food or liquids in your stomach for more than 12 hours, and;
• Losing weight.

Potential complications

Whilst unpleasant, morning sickness usually does not cause any harm to pregnant women and their babies. In fact, women with mild morning sickness symptoms have been shown to be less likely to experience miscarriage or stillbirth than women who do not experience it.

Oral health

Vomit is quite acidic and this can damage the tooth enamel. However, avoid brushing your teeth directly after vomiting. Waiting 30 minutes before brushing your teeth can help to avoid further weakening of the enamel.

In the meantime, you can:

• Rinse your mouth out with water or a mouthwash straight after vomiting;
• Rub toothpaste on your teeth with your finger, and;
• Chew sugar-free gum, which helps to stimulate saliva and neutralize the acid.

If excessive saliva is a problem, spitting or using a mouthwash can help.

Prognosis

Most women who have nausea and vomiting due to morning sickness recover without any ongoing health problems for themselves or their babies.

Prevention

While it is not possible to prevent morning sickness, taking steps to reduce symptoms when they first occur may reduce the severity of symptoms.

References

1. National antenatal care guidelines. The Department of Health. Accessed 10 October 2014, from link here
2. 1492.pdf. Accessed July 31 2014. link here
3. 7.8 Nausea and Vomiting. Accessed August 1 2014. link here
4. Hyperemesis Gravidarum - National Library of Medicine - PubMed Health. Accessed July 31 2014. link here
5. Interventions for Nausea and Vomiting in Early Pregnancy | Cochrane Summaries. Accessed August 1 2014. link here
6. Morning Sickness - National Library of Medicine - PubMed Health. Accessed July 31 2014. link here
7. Nausea and Vomiting of Pregnancy. Accessed July 31 2014. link here
8. Pregnancy - Morning Sickness | Better Health Channel. Accessed July 31 2014. link here
9. Department of Health | National Antenatal Care Guidelines. Accessed October 10 2014. link here

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