Are you sick of morning sickness?

Abstract: Morning sickness is a common condition affecting women during pregnancy. In spite of the name, morning sickness may occur at any time of the day. Symptoms of the condition usually include changes in smell and taste, nausea and the need to vomit.

There are a number of theories behind the contributing factors leading to morning sickness, including release of the pregnancy hormone, the ‘Human Chorionic Gonadotrophin’ or HCG, low blood sugar, and stress and anxiety. Changes in lifestyle, and eating habits have been found to be beneficial in alleviating the condition. Also of benefit is vitamin B6, ginger, natural therapies, and in more severe cases, medication.

Morning sickness (which can occur anytime throughout the day or night), is one of the most common physical signs of early pregnancy. Not all women experience morning sickness during pregnancy. Typically, morning sickness starts around 6 weeks of the pregnancy (or about 2 weeks after the period was due) and continues until about 12 to 14 weeks of the pregnancy. However, morning sickness may start later than 6 weeks and may continue later into the pregnancy. In some cases, morning sickness may last throughout the pregnancy [1,9].

Morning sickness may make you feel constantly nauseous, or bring on ‘waves’ of nausea at different times of the day. Some women will occasionally (or regularly) vomit and a few will vomit excessively to the point of becoming dehydrated or produce more saliva, known as ‘ptyalism’ (pronounced ‘tie-al-ism’) [9]. The nausea can change your eating habits for a while and some women will not gain weight initially (or even lose weight for a few weeks) because of their morning sickness. This is normal and your baby will rely on your body’s fat stores to grow. Usually when the nausea and/or vomiting settles, your appetite returns and you experience a ‘growth spurt’ as your body ‘catches up’.

We don’t really know exactly why ‘morning sickness’ occurs or why some women suffer from it more than others. Some believe that in the past morning sickness provided a protective function for the unborn child by causing women to avoid foods that were more likely to be contaminated with parasites, bacteria or other harmful substances [7,9].

While the main symptoms of morning sickness are nausea, vomiting and loss of appetite, women can also experience depression or anxiety. For some women this may be the first time they have had any significant period of illness and knowing how to deal with it can be difficult. Feeling unwell can lead to feelings of frustration, hopelessness and depression. Women also tend to feel anxious about the effects their morning sickness could be having on their unborn child.

Also, it is not unusual for morning sickness to worsen during times of emotional stress (particularly in the later months of pregnancy) and many pregnant women will vomit without warning, either as a reaction to a certain smell or something like accidentally pushing the toothbrush too far down the back of their throat.

Likely theories behind morning sickness

The pregnancy hormone ‘HCG’

During the first 12 weeks of pregnancy the developing baby produces a hormone referred to as the ‘Human Chorionic Gonadotrophin’ (or ‘HCG’). HCG is released into the woman’s blood stream soon after her baby implants into the lining of her uterus (about 8 to 12 days after conception, or just before the next period is due). The HCG blood level initially starts off very low (at least 5 IU/L), but then rapidly increases (doubling every 2 to 3 days) so that within several days to a week or more, it becomes high enough to be detected in the woman’s urine (at least 50 to 80 IU/L). A urine pregnancy test will show up being ‘positive’ at this point.

The HCG hormone peaks to its highest levels between 8 and 11 weeks of the pregnancy [9]. Then the level slowly decreases, lowering at 12 weeks and again at about 16 weeks of the pregnancy. The HCG level remains lower until several weeks after the birth of the baby. As the HCG levels lower, the maturing placenta takes over the role of producing other hormones to support the pregnancy (at around 12 weeks). Higher than average HCG levels may indicate a multiple pregnancy. This is why women carrying twins or triplets or more can experience more severe morning sickness [7].

Low blood sugar levels

Many women who experience morning sickness often find that by eating something their nausea improves or goes away. Low blood sugar levels can produce nausea and may result from a lack of food and energy [9]. During early pregnancy, a woman’s metabolism increases by up to 20%. This means that her body burns through the food she eats more rapidly. The ‘low blood sugar theory’ may explain why many pregnant women feel worse in the mornings (because they haven’t eaten all night) and why a small, plain snack will usually make them feel better [13]. A good tip is to keep biscuits next to the bed to snack on first thing in the morning.

Women with morning sickness usually describe only being able to tolerate certain foods at this time. It is not unusual to hear stories of women surviving on little more than peanut butter or jam and toast during their early weeks of their pregnancy! This changes back to ‘normal’ as the nausea subsides, allowing you to return to having a more balanced diet.

Changes to smell and taste

During pregnancy many women find that their sense of smell and taste are acutely sensitive [13]. Odours and aromas that may have previously been tolerable or enjoyable can now make you heave, literally! While these do not generally cause morning sickness, they are certainly capable of making it worse.

Stress and anxiety

Pregnancy can be a stressful time for all involved. Early pregnancy is often accompanied by feelings of ambivalence about having a new baby and what that will mean to your life, career, relationships, finances and other children (if you have them). While stress and anxiety may not actually cause morning sickness, they can contribute to its intensity and perhaps make the sickness continue beyond 16 weeks (and possibly see its return in later pregnancies). Some women will seek homoeopathic remedies for this.

Emotional stress may be an ongoing issue if the woman has concerns, fears and anxiety about the pregnancy itself. This may stem from simply not enjoying the pregnancy process, or from a past experience of miscarriage or stillbirth. Waiting for the results of genetic tests can also bring weeks of continuous stress or if your caregiver questions the health of you or your baby.

Persistent emotional stress can often be accompanied by nausea and maybe even vomiting [13]. This can make the situation even more difficult to deal with. The nausea may continue until after the pregnancy progresses beyond a certain point in time, or even until your baby is born. Sharing your fears with others you trust, or seeking professional advice may be helpful at this time.

What some women find helpful for morning sickness

Morning sickness is an age old complaint. Therefore it has a long history of proposed remedies and tips on how to relieve it. Most suggestions include dietary changes, sometimes with natural therapies and if the sickness is quite severe, your caregiver may offer you medical treatments.
Everybody is different. Morning sickness is an individual experience for each woman so the effectiveness of most remedies and treatments will vary from woman to woman.

The following are some current suggested remedies and treatments for morning sickness:

Lifestyle choices

Changing what you eat and when you eat it is often the key to keeping morning sickness under control. Some of these changes can include:

Eating small meals regularly (5 to 6 times per day) rather than 3 large meals. This keeps your blood sugar levels more stable and stops you from overfilling your stomach [13]. Take time to eat and chew your food thoroughly. You may like to carry around a few snacks to munch on during the day such as dry biscuits, nuts or fruit. Try to eat something light before you go to bed at night and again first thing when you wake up. Some women find eating a dry, plain water cracker or a plain piece of toast, a cup of tea or a glass of non-acidic fruit juice (such as apple or pear juice) first thing in the morning helps. When you do get out of bed, do this slowly.

Eating complex carbohydrates such as cracker biscuits, breads, toast, rice, potatoes and pasta. These increase your blood sugar levels and maintain them for longer periods of time in your system, rather than sweet, sugary foods that tend to only provide short bursts of energy [13]. Avoid fatty and spicy foods and anything you have an aversion to at this time. Some women find umeboshi plums (pickled Asian plums) help.

Separating your food and drinks at meals. Some women find that eating and drinking fluids in one eating session aggravates their morning sickness. Try to avoid drinking anything at least ½ an hour before or after you eat [13]. Don’t reduce your fluid intake, as you don’t want to become dehydrated. You may prefer ‘liquid meals’ such as banana smoothies or fresh fruit and vegetable juices. Mineral waters and sports drinks can also help balance the body’s mineral intake. Some liquid remedies may include lemon and honey drinks, hot water with milk and honey or a teaspoon of cider vinegar in hot water with honey.

Look at the stresses in your life and how you honestly feel about being pregnant. Share how you feel with someone you trust or seek out counseling if you feel this will help. Deep breathing, yoga, meditation, massage, or relaxation exercises may be beneficial [13]. Organise some time off from work or mothering. Try to rest or look at strategies to take the pressure off. Some women will use visualisations or listen to relaxation tapes. You can read more in stress and relaxation.

Natural therapies

The following are some natural therapies that some women have found helpful:

Vitamin B6. Recent studies have shown that vitamin B6 (Pyridoxine) can be quite effective in reducing nausea, but not necessarily vomiting [1]. Caregivers may prescribe about 10-20mgs three times a day. Check with your caregiver before supplementing [10,12].

Ginger. There is some evidence that ginger may be beneficial. This can be eaten fresh in foods or in a powdered form (about 1g daily) in water [1,6,11,12]. You may prefer ginger capsules, flat ginger ale, ginger sweets or ginger biscuits or cookies. Some women cut up fresh ginger and place it in boiling water to make a ginger tea. You can also chew crystallised ginger (available from health food stores).

Lollipops. There are some lollipops now on the market aimed to specifically relieve morning sickness [12]. They are made with natural ingredients and include flavours such as ginger, sours (raspberry, lemon and tangerine), peppermint and spearmint. Some women find they help and they would work towards preventing your blood glucose level getting too low.

Acupressure. There is some evidence that the acupressure point PC6 (‘Neiguan’) helps [4,12]. This is a point on the inside of the wrist that seasickness wristbands place pressure on. You can obtain these wristbands from chemists or natural health stores or you can intermittently place pressure on this point yourself when feeling sick.

The wrist point is on the inside of the arm, about 3 finger widths above the wrist crease, between the tendons. Pressure is placed on the point firmly, usually until you feel some relief. This may take up to five minutes or so to be effective. You can repeat pressure on the point when necessary to either or both wrists. You may like to use a blunt object such as the end of a pen, rather than your finger.

Hypnosis. Some women find hypnosis helpful [12]. This may be something that also helps you to manage stress and perhaps becomes part of your preparation for the labour and birth.

Herbal. Herbalists may suggest teas such as mint, anise and fennel seed or chamomile [12]. Herbal remedies can include ginger, wild yam root, dandelion root and others. You may be offered raspberry leaf tea or tablets, but this can cause nausea in some women and many caregivers advise against using it during the first 12 weeks of pregnancy. Check with your caregiver before taking [1].

Homoeopathy. Depending on your individual symptoms, homoeopaths may prescribe a range of treatments including Ipecacuana, Nux Vomica, Sepia or Pulsatilla [12]. See your homoeopath for an individual assessment.

Aromatherapy. Essential oils are generally not recommended during the first 12 weeks of pregnancy. However, if your pregnancy is more advanced than this your aromatherapist may suggest a drop of lavender on your pillow at night or placing a few drops of spearmint or ginger oil in a bowl of boiling water or vapouriser near your bed to breathe, to help calm your stomach [12]. (Usually only used for 3 consecutive nights). Peppermint oil used to be recommended, but it is now considered toxic during pregnancy.

Medical treatments

If you can tolerate your morning sickness without the use of medications, this is ideal. Many medications normally used to stop nausea and vomiting in people who are not pregnant are generally not proven to be safe during the first 12 weeks of pregnancy. Debendox (‘Bendectin’ in the USA) was prescribed from about 1964 for morning sickness but was withdrawn from sale in 1983 due to the claim it caused birth defects [2]. This was despite many research studies that failed to confirm a definite link between human birth defects and the use of Debendox. However, the pharmaceutical company could not definitely prove that it didn’t cause birth defects and animal tests showed an increase in limb deformities. Since this time there has been a reluctance to prescribe new medications to women during early pregnancy for morning sickness.

One group of medications that may be prescribed by doctors for severe cases of morning sickness are antihistamines such as meclozine, promethazine or prochlorperazine [1-3]. So far there appears to be no adverse effects on the baby by the small amount of research carried out. Antihistamines may be prescribed as a tablet or administered as an injection if you are vomiting excessively. Antihistamines do cause drowsiness and some women will experience blurred vision.

Another commonly prescribed medication is metoclopramide [1,2]. As with antihistamines, this is usually prescribed for severe cases of morning sickness. Research to date suggests that there are no adverse effects on foetal development. Metoclopramide may be prescribed as a tablet or administered as an injection if you are vomiting excessively, with possible side effects including drowsiness, diarrhoea, and/or an increase in prolactin production (hormone for breast milk production). Other side effects may include dizziness, headache and a dry mouth.

Depending on what reference books you use, both metoclopramide and antihistamines may be listed as Category A or Category B drugs. As with any medication, their use during pregnancy needs to weigh up the possible benefits against any small possible risks.

Excessive vomiting (‘Hyperemesis Gravidarum’)

Less than 1% of pregnant women with morning sickness will experience excessive vomiting to the point that they become dehydrated. The medical term for this is ‘Hyperemesis Gravidarum’ and for some reason it is more common for women during their first pregnancy (but can still be experienced by women during subsequent pregnancies) [8].

If you are vomiting several times a day and are unable to keep food or fluids down for a couple of days or more, you may need to be admitted to hospital to have a drip placed in your vein to administer fluids. You may also be prescribed an antihistamine [3] or metoclopramide [2] (usually as an injection) for the vomiting (see above). These can make you feel drowsy. You may just stay in hospital overnight or for a few days, depending on how unwell you are and how quickly the vomiting settles. Often resting in hospital is a remedy in itself. A few women find they are in and out of hospital over a period of several weeks during early pregnancy, whenever the vomiting becomes severe [8].

It is important to note that not all cases of excessive vomiting are caused by severe morning sickness during early pregnancy. You may have a virus or food poisoning, meaning it could be caused by a health condition or illness totally unrelated to the pregnancy. If your doctor is concerned they will probably perform a range of blood tests and other investigations to make sure the vomiting isn’t being caused by something else. In very rare circumstances, excessive vomiting may be caused by a pregnancy variation called a molar pregnancy (an abnormal of pregnancy, characterized by the presence of an anomalous growth containing a nonviable embryo which implants and proliferates within the uterus).

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