Definition of Morning Sickness
Morning sickness is a popular nickname for a medical term “nausea and vomiting of pregnancy” or NVP (1).
When Does Morning Sickness Start and How Long Does It Last?
- The onset of morning sickness is usually at sixth week, or, rarely, as early as at fourth week of pregnancy (which is, actually, two weeks after conception) (1). Rarely, women have reported having nausea immediately after conception (34).
- Nausea usually peaks at the second month (1).
- In most pregnant women, nausea ends at about 12-18th week (fourth month), but in some it can extend throughout the whole pregnancy (1,11,39).
Do all women experience nausea during pregnancy?
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).
Is nausea an early sign of pregnancy?
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).
Is it possible to have morning nausea and negative pregnancy test?
Theoretically, it is possible that a pregnant woman feels nausea before the pregnancy test is positive (34).
What Does Morning Sickness Feel Like?
- Nausea is usually worse in the morning and often lasts all day. Women may describe morning sickness as indigestion, hunger pains, dry heaves, or having feelings resembling car sickness or food poisoning.
- Some women vomit several times a day.
- Typically, women develop increased sensitivity to certain smells and tastes, such as fish or meat, or common foods in a refrigerator, and aversion to certain foods (6,7).
- In some way, nausea is a good sign, since it suggest you that you may be pregnant.
Can morning sickness last all day?
For most pregnant women, nausea is worse in the morning, but usually lasts all day (1).
What Are Other Symptoms Related to Nausea During Pregnancy?
- Heartburn due to gastroesophageal reflux disease (GERD). What can help: avoiding eating before bed, sleeping with elevated head, antacids (16).
- Excessive salivation (ptyalism or sialorrhea) (35)
- Constipation, which may be worse when you are not eating or drinking regularly
- Headache or migraine, especially in women who had menstrual migraines (39)
- Dizziness, fainting, fatigue, bad (metallic) taste in mouth, which may be symptoms of dehydration due to lack of drinking or after repeated vomiting (33).
Nausea in the Second and Third Trimester
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.
Acute, Severe, Extreme Sickness — Hyperemesis Gravidarum
- Nausea, which is so severe that prevents a woman to eat and drink
- Vomiting several times a day
- Usual remedies, vitamins and antihistamines recommended for nausea do not help
- More than 5% weight loss (of pre-pregnancy weight), especially rapidly losing weight (more than a pound per day)
- Dry mouth, wrinkled skin and other symptoms of dehydration
- (Reference 39)
- Detached retina, torn eardrum, broken ribs, torn esophagus (4).
- In one study, doxylamine (an antihistamine) was effective only in 20% women (4). According to a study performed by UCLA university, women with severe nausea who take antihistamines to help them sleep have significantly increased risk to have a premature birth or have low-birth-weight babies (4).
- Starting therapy before or immediately at the nausea onset may significantly reduce the severity of symptoms (25).
- The IV drugs that might be used by your practitioner include antihistamines, dopamine antagonists, serotonin antagonists, chlorpromazine and glucocorticoids (3).
What Causes Nausea in Pregnancy?
Nausea in the Early Pregnancy
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:
- Increased levels of pregnancy hormones (1):
- Human chorionic gonadotropin (hCG)
- Estrogen or other hormones
- Increased stomach sensitivity (1)
What else can trigger nausea or vomiting?
- Stress, anxiousness
- Smell of certain foods or perfumes; certain odors can trigger gag reflex
- Flickering light (more likely in women who have migraine)
- Hot or crowded rooms
- Changing positions quickly
- Travel with a car or ship
- (Reference 1)
Is nausea worse when carrying, twins, a boy or a girl?
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).
What increases the risk of nausea in pregnancy?
- Nausea in previous pregnancies
- Nausea after contraceptive pills
- History of migraine headaches
- Genetic predisposition: your mother or sisters had nausea during pregnancy
- Gastric reflux
- (References 1,9)
Can nausea during pregnancy affect the baby?
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).
Does absence of nausea increases the risk of miscarriage?
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).
What To Eat and Drink to Overcome Nausea?
What to eat?
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):
- How to get over nausea in the morning? Have some saltine (soda) crackers or dry toast (maybe with ginger jam) and then wait about 20 minutes before you get up. The principal object is to consume something mild, plain and starchy before rising up. Get out of the bed slowly, maybe sit on the bed for a while.
- Avoid having an empty stomach. Protein foods, such as beans, peas, lentils and lean meats, and whole grain cereals stay in the stomach for a longer time than plain sugars or rapidly digestible starches (white bread, potatoes, white rice). You can have some of these foods in the evening to keep the stomach full throughout the night and thus prevent morning sickness.
- Examples of carbohydrate foods that many women tolerated well: whole-grain bread, cereals, potato chips, tortilla chips, egg bagels
- Examples of high-protein foods that may ease nausea: scrambled eggs, peanuts or peanut butter, tuna melt, scrambled eggs
- Fruits in moderation: a banana, kiwi, watermelon, apple slices, or dried fruits to increase fiber intake in constipated women. Eat fruits and vegetables having a high water content to prevent dehydration and constipation, two main triggers of nausea. Snack on lots of carrots, celery, melons, apples, grapes and pears throughout the day.
- Vegetables: lemon cauliflower
- Soups, broths
- Suckers: hard candies, fruit popsicles, lollipops
- Snacks: celery sticks, pretzels, nuts (trail mix)
- Other: fudge ice pop, gelatin
What to drink?
- Drink the amount of fluid that will keep you well hydrated. A general recommendation is to drink at least 8 cups (8 x 8 oz or 2 liters) fluid per day, but this depends on how much water and salt you get with food and how much you sweat. Drink more if you notice symptoms of dehydration: thirst, dry mouth and lips, less than 200 mL of dark-colored urine in the morning, skin fold on the back of the hand that does not get flat immediately after you pinch and release the skin.
- Take few sips at the time, not full cups. Do not drink during and up to 30 minutes after meals to avoid bloating and gastric reflux (11).
- Chose what works for you: water, mineral water, lemonade, herbal teas, ginger ale, ginger soda, ginger beer.
- You may tolerate colder and clear drinks easier. You can try ice chips or popsicles.
- If you vomit a lot, drink sport drinks or rehydration fluids that contain sodium and potassium you have lost during vomiting.
Foods To Avoid in Morning Sickness
Limit or avoid (1,27,36,39):
- Foods that trigger nausea or smell bad to you; colder foods tend to have less smell.
- Fatty and fried foods, which may take longer to digest
- Sugary foods
- Spicy foods and acidic foods, which may upset your stomach
- Large amounts of foods and beverages, which may cause bloating: beans, peas, lentils, cabbage, fruits, carbonated beverages
- Drink only small amounts of fluid during meals, so you will not feel full and you will be able to eat enough food.
- Fruit juices and other sweetened beverages stay in the stomach longer than non-sweetened ones.
- Carbonated beverages may cause bloating in some women.
- Caffeinated drinks
- Alcoholic drinks
- Other foods to avoid during pregnancy from reasons other than nausea, such as risk of infection or poisoning.
Nausea After Eating
To prevent nausea after eating (11):
- Do not lie down after meals, because this may slow digestion.
- Brush your teeth and rinse mouth several times a day.
- Spit out excessive saliva.
General Tips to Prevent Nausea During Pregnancy
- Get fresh air. Avoid places with food, smoke, perfumes, chemicals and other heavy smells in the air; avoid cooking.
- Avoid excessive exercise and get enough rest. You may need at least 7-8 hours of sleep per night. If you constantly feel tired, you may consider having few short naps during the day. However, relaxation does not help to everyone; some women find relief in being active, visit someone, just to distract themselves from nausea (21,38).
- Avoid hot and humid places and noise.
- Wearing headphones and listening music while travelling may help to prevent motion sickness.
- When your fight with nausea does not seem to be successful, call a doctor.
How to cope with nausea at night?
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.
How to deal with nausea at work?
- Try to arrange that you will work at calm, cool place without strong odors.
- Have frequent snacks.
- Have frequent short breaks if possible, walk around and get some fresh air.
- Avoid bending over in the waist; kneel when you pick things from the floor.
- Avoid standing and heavy physical work.
- Sit properly to avoid tailbone pain or pelvic pain.
Natural Home Remedies for Morning Sickness Relief
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).
Can ginger ale help?
Ginger ale with real ginger may help ease nausea. Ginger ale in supermarkets usually does not contain real ginger, though.
Other Ginger Products
- Ginger tea
- Ginger candies
- Crystallized ginger
- Ginger pops
- Ginger gum
- Fresh or dried ginger with salt
- Various dishes with ginger root
- Ginger cookies may contain a lot of sugar and not enough ginger to be effective (37).
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).
- Chamomile tea or chamomile extract supplements. Speak with your physician before taking the herb in any form.
- Peppermint tea or peppermint candies, but these can upset your stomach.
Other home remedies
- Smelling a slice of fresh lemon or drinking warm lemon juice can provide instant relief from nausea (38).
- Baking soda (hydrogen carbonate) can help to soothe your stomach by neutralizing the stomach acid. Take one cup of water, add two tablespoons of baking soda and drink the solution slowly.
- Fennel seeds, like mint, contain certain anesthetic substances that help to reduce queasiness. Put one tablespoon of crushed fennel seeds in a cup before filling it with boiling water. Let it seep for about 10 minutes and then drink the mixture slowly like tea.
- Thyme and lavender
What Else Can Help You Survive Through Nausea During Pregnancy
- Vitamin B6. Doses up to 200 mg day are considered safe (15).
- Prenatal vitamins may cause nausea, mainly because of iron they contain. Discuss with your doctor if you can use folate alone or regular multivitamins that do not contain iron, or time-release formula. Try to take vitamins in the evening rather than the in morning.
Over-the-counter (OTC) anti-nausea medications safe in pregnancy:
- Antihistamines of the first generation (brompheniramine, chlorpheniramine, dimenhydrinate, diphenhydramine, doxylamine, hydroxyzine, meclizine and pheniramine) are considered safe to use in pregnancy (15,18,29).
- Antihistamines of the second generation (cetirizine, desloratadine, fexofenadine, and loratadine), which do not cause drowsiness, are also considered safe (18).
Doxylamine plus Vitamin B6
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.
- Phenothiazines are considered safe in pregnancy (11,19)
- Promethazine (Phenergan) is available as tablets, injectable solution, oral solution or a rectal suppository. Side effects may include dry mouth, drowsiness, muscle contractions leading to jerking movements. NOTE: Prochlorperazine and promethazine should not be taken together.
- Dimenhydrinate (11)
- Trimethobenzamide (41)
- Phenothiazines are considered safe in pregnancy (11,19)
- Acid-lowering drugs (11):
- Calcium, aluminum and magnesium antacids in usual prescription doses are considered safe in pregnancy (16). Magnesium trisilicate (prolonged use of high doses) increases the risk of kidney stones and respiratory distress in the baby (16). Bicarbonate antacids can cause metabolic acidosis (16). Calcium carbonate in doses higher than 1.4 grams calcium can cause milk-alkali syndrome (16).
- H2 blockers, such as cimetidine, ranitidine (Zantac), famotidine (Pepcid) and nizatidine, do not increase the risk of spontaneous abortion or preterm delivery (16,44).
- Proton pump inhibitors (PPIs), such as omeprazole, pantoprazole, lansoprazole, esomeprazole, and rabeprazole are considered safe in pregnancy (16,23).
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).
Treatment of H. pylori infection
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).
Possibly Unsafe Drugs for Pregnancy Nausea
Many doctors believe that below drugs are safe to use in pregnancy, but here are some possible dangers:
- Corticosteroids, such as methylprednisolone, should not be used in the first 10 weeks of pregnancy, since it may cause birth defects (11,19).
- Droperidol (19)
- Metoclopramide (Reglan) (11,19)
- Ondansetron (Zofran) was associated with increased risk of cleft palate in the babies and severe heart arrhythmia in mothers (11,12,19).
Other Treatment for Pregnancy Nausea
Acupressure Wrist Bands
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.
Summary: Cures That Work
Currently, there is no definitive cure for morning sickness, but the following was often reported as effective:
- Avoiding certain foods and smells
- Either additional rest or activity
- A combination of doxylamine and vitamin B6
- Prescribed antiemetics
- Morning sickness facts (babycenter.com)
- Pregnancy nausea and miscarriage (babycenter.com)
- Drugs that work in nausea of pregnancy (babycenter.com)
- Antihistamines and increased risk of premature birth in hyperemesis gravidarum (newsroom.ucla.edu)
- FDA-approved drug for morning sickness (fda.gov)
- Early signs of pregnancy (webmd.com)
- Morning sickness tips (webmd.com)
- Foods to eat in morning sickness (voices.yahoo.com)
- Morning sickness (medicinenet.com)
- Ginger capsules safety and effectiveness (motherisk.org)
- Treatment of nausea and vomiting in pregnancy (motherisk.org)
- Ondansetron safety (motherisk.org)
- Doxylamine plus pyridoxine information leaflet (duchesnay.com)
- Ginger powder side effects (nccam.nih.gov)
- Nausea of pregnancy facts (mothertobaby.org)
- Heartburn and safe antacids during pregnancy (motherisk.org)
- Preventative use of antiemetics (motherisk.org)
- Antihistamines safety during pregnancy (motherisk.org)
- Safety of drugs for nausea in pregnancy (ncbi.nlm.nih.gov/pubmed)
- About seabands (motherisk.org)
- Nausea related to rest and activity (motherisk.org)
- Ginger vs vitamin B6 (motherisk.org)
- Proton pump inhibitors safety (motherisk.org)
- Safety of breath test 14C-UBT (motherisk.org)
- Hyperemesis gravidarum – starting treatment before symptoms onset (nih.gov/pubmed)
- Calorie needs in pregnancy (eatright.org)
- Caffeine and pregnancy (marchofdimes.com)
- Ginger, peppermint and spearmint tea safety (motherisk.org)
- Meclizine is a category B drug (drugs.com)
- Emetrol safety in pregnancy (drugs.com)
- Emetrol facts (drugs.com)
- Doxylamine and sleepy baby (motherisk.org)
- Bad taste (motherisk.org)
- Nausea at first week (motherisk.org)
- Ptyalism in pregnancy (nih.gov/pmc)
- Alcohol and pregnancy (motherisk.org)
- Treatment options for morning sickness (babycentre.co.uk)
- How to cope with morning sickness (sogc.org)
- Nausea and vomiting in pregnancy — facts (uptodate.com)
- Early signs of pregnancy (mayoclinic.com)
- Trimethobenzamide information (drugs.com)
- Helicobacter pylori and dyspepsia during pregnancy (lww.com)
- Treatment of H. pylori infection during pregnancy (wiley.com)
- Over-the-counter (OTC) medicines safe in pregnancy (parentsconnect.com) [/ref]