Morning sickness is a popular nickname for a medical term “nausea and vomiting of pregnancy” or NVP (1).
Some women never experience nausea during pregnancy. Some women do not experience nausea every day. In some women nausea goes away at certain time but can return later and come and go throughout pregnancy (1).
Yes, besides missed menstruation, nausea is an early sign of pregnancy and may be accompanied by tender/swollen breasts, fatigue, shortness of breath, constipation, food craving, diarrhea, dizziness, headache, cramping and mood swings (40).
Theoretically, it is possible that a pregnant woman feels nausea before the pregnancy test is positive (34).
For most pregnant women, nausea is worse in the morning, but usually lasts all day (1).
In some women, nausea can extend into the second or third trimester of pregnancy with its severity varying from woman to woman. Possible mechanisms include increased levels of the hormones thyroxine and oestrogen.
NOTE: Nausea that goes away in the fourth month and then appears later unexpectedly, may or may not be related to pregnancy. Food poisoning, gastrointestinal, liver and kidney diseases, low blood pressure, low blood glucose levels (hypoglycemia) and other disorders may cause nausea or vomiting in pregnant women just like in nonpregnant ones.
Nausea during pregnancy indicates that the hormone levels in your body are high enough for the growth and development of your baby. During the early stages of pregnancy, your body produces large amounts of the hormone human chorionic gonadotropin (hCG). The hCG levels drop again when the placenta takes over nourishing and maintaining the fetus. As a result, nausea usually vanish during the later parts of pregnancy, usually between the 12th and 14th week (1).
It is not certain why nausea occurs in pregnancy, but here are some possible reasons:
Women who carry twins or higher multiples usually have more nausea, but some may have no nausea (1). This may be due to high levels of hCG, estrogen or other hormones (1). Women who carry a girl more often have severe nausea (1).
Mild to moderate nausea and occasional vomiting should not affect the baby (15). Even if the mother does not gain any weight during the first trimester, but get enough water and nutrients, she and the baby should be fine. Statistically, mothers who have nausea during pregnancy have healthier babies than mothers who do not (15).
Severe, prolonged vomiting and weight gain less than 15 pounds were associated with low birth weight and preterm births (1).
Statistically, women who have no nausea during pregnancy have more miscarriages. However, absence of nausea by itself is not a bad sign; many women with no or little nausea have had healthy children (2).
Eat whatever you feel you are in peace with and do not be overly scrupulous about having balanced diet. Observe what calms your stomach. Listen your body. Even if you eat somewhat less than usually in your first trimester, this should not affect your baby. In general, pregnant women need between 2,200 and 2,900 Calories per day and they do not need any extra calories in the first trimester (26). Small, frequent meals can help you overcome nausea caused by empty stomach. Eat slowly to prevent bloating and stomach upset.
Recommendations from pregnant women, midwives and obstetricians (2,7,8,9,38):
Limit or avoid (1,27,36,39):
To prevent nausea after eating (11):
During nighttime, you can curb nausea by taking small amount of food any time you wake up; this will prevent you from having an empty stomach.
There are several possible ways to stop nausea in pregnancy, but not every remedy or drug works for every woman.
Ginger supplements containing up to 1,000 mg (1 gram) of ginger extract per day helped to alleviate nausea in some women and there was no evidence of harm for the babies (10,14,15,22). Speak with your doctor before using powdered ginger root capsules. Side effects of ginger powder in capsules include nausea, heartburn, bloating and excessive gas (14,37).
Ginger ale with real ginger may help ease nausea. Ginger ale in supermarkets usually does not contain real ginger, though.
The effect of ginger in soothing nausea is thought to be due its aroma (10).
Herbal teas are some of the best home remedies. Both hot and iced tea can help to relieve the symptoms. Ginger tea is considered safe; there is lack of studies about safety of peppermint and spearmint tea in pregnancy (28).
Over-the-counter (OTC) anti-nausea medications safe in pregnancy:
Doxylamine (an antihistamine) in combination with pyridoxine (vitamin B6), in the form of delayed-release capsule is now again approved by FDA and is a first choice treatment for pregnancy nausea in the U.S. and Canada (11). Side effects include drowsiness, vertigo, headache, irritability, nervousness, insomnia, stomach pain, diarrhea. There are no known reports about increased sleepiness in babies after delivery (32).
Taking doxylamine and vitamin B6 even before the onset of pregnancy symptoms may prevent nausea to develop or decrease its severity (17).
Consult your physician before using any of these medicines as they may cause side effects, such as drowsiness.
The following prescription medications are not approved by the U.S. Food and Drug Administration (FDA), but are used in Canada (11) and some other parts of the world.
Emetrol solution contains dextrose (glucose), fructose and phosphoric acid (31). You can take it alone or with food, but do not mix it with other drinks (31).
Side effects: None with small/regular doses; bloating and diarrhea with large doses; allergic reactions are possible (30,31). There are no known harmful effects of emetrol on the developing baby (30,44).
It is not clear, if Helicobacter pylori infection of the stomach causes nausea during pregnancy; some studies have found no relationship between H. pylori, nausea in pregnancy or birth defects (42,43). It is therefore not clear if the infection should be treated or not. When treated, the combination of antibiotics (amoxicillin, clarithromycin) and a proton pump inhibitor (omeprazole or lansoprazole) can be used (43).
Breath test 14C-UBT for diagnosis of H. pylori is considered safe in pregnancy (24).
Many doctors believe that below drugs are safe to use in pregnancy, but here are some possible dangers:
Wrist bands, such as sea-sick band, “travel band” and acustimulation bracelets probably have only a placebo effect. Some women find them helpful, though (20).
There is lack of studies that would prove effectiveness of hypnotherapy in pregnancy nausea (21).
Essential oils used for aromatherapy include scents, such as mint, peppermint, spearmint, lemon, lime, orange, ginger (occasionally) (37,39).
Reflexology is a type of massage that helps to relieve your symptoms by relaxing your muscles. Make sure to see a certified practitioner since a wrong massage session can aggravate your symptoms. Your body may need some time to come to terms with the treatment, so, it is normal for the symptoms to worsen to some extent before they subside after the first treatment session.
Currently, there is no definitive cure for morning sickness, but the following was often reported as effective: