"Morning sickness": nausea and vomiting of pregnancy
Morning sickness is extremely common, affecting 70% of pregnant women. The most severe form, called “hyperemesis gravidarum” can require hospitalization and is more rare, affecting somewhere between 0.3 to 10.8% of women who are pregnant. While referred to as nausea and vomiting of pregnancy (NVP) in the medical community, it is typically called “morning sickness”, which is actually a misnomer: only 1.8% of women experience nausea or vomiting only in the morning, 80% report that they have it all day long[i].
NVP usually begins around the sixth week of pregnancy, sometimes earlier. Most women begin seeing relief by the 14th week and are usually no longer having symptoms by Week 17. About half of women with NVP experience nausea, and half experience both nausea and vomiting.
Women who have experienced NVP know very well how disruptive it can be, causing missed days at work or school, challenges in looking after younger children, and difficulty continuing normal functioning. Being nauseous all the time also feels just awful!
While difficulty keeping food or liquid down can be scary for a pregnant woman, it is assuring to know that uncomplicated NVP is actually associated with a lower risk of pregnancy loss (miscarriage), preterm delivery, stillbirth and low birth weight.
What causes nausea and vomiting of pregnancy?
As all women who have experienced NVP know, massive physiological changes occur very early in pregnancy. The causes of NVP are unknown, but there are thought to be many: hormonal factors, Helicobacter pylori (the bacteria that can cause stomach ulcers), issues with the bowels “not moving”, placenta-related factors, psychosocial factors, and new factors identified by genetics.
Hormonal changes occurring in early pregnancy appear to hold the most promise for explaining NVP. One of these is the GDF15-GFRAL axis, a complex mechanism associated with food intake and energy metabolism, now thought to be the most important contributor.
Also occurring in early pregnancy is a steep rise in HcG (Human chorionic gonadotropin), which is released by the placenta and has long been thought to be associated with NVP, however, research confirming this is not conclusive. It is thought that thyroid hormones, which increase during pregnancy, might also contribute, but the mechanism is not well understood.
Who is most at risk?
Not all women are susceptible to NVP, there are several risk factors that make it more likely[ii]:
- a history of motion sickness
– experienced nausea/vomiting with the birth control pill
– a family history on the female side
– a history of migraine headaches
– are pregnant with twins / multiples
– had morning sickness with a prior pregnancy
– inadequate nutrition prior to conception
Hyperemis gravidarum
The more serious condition of hyperemis gravidarum is diagnosed if the following symptoms are present:
- severe nausea
- vomiting more than three times per day
- vomiting blood
- losing more than 5% of your pre-pregnancy weight
- not being able to keep food or liquids down
- dehydration (signs include dark urine, dry mouth)
- fainting, or feeling dizzy or lightheaded
- peeing less than normal
- extreme tiredness
Hyperemis gravidarum can have serious consequences, such as electrolyte balance changes, neurological disorders, liver damage, retinal hemorrhage and kidney damage.
A pregnant woman whose nausea and vomiting is severe, includes any of these symptoms, or lasts into the second trimester should seek medical care.
Conventional medical treatment of NVP
Drugs that prevent vomiting called “antiemetics” as well as Vitamin B6 can be prescribed for women with NVP.
Pregnant women who have experienced weight loss or become dehydrated as a result of NVP or hyperemesis gravidarum may need hospitalization that could include intravenous fluids and even tube-feeding.
Self-care
Many women are afraid to take over-the-counter or prescription drugs when pregnant and are therefore motivated to investigated natural or home remedies. If NVP is not severe and does not last past the first trimester in the pregnancy, these measures can often be sufficient to “get over the hump”[iii].
Ginger is well supported by research as being safe and effective in relieving nausea caused by NVP, though it doesn’t seem to work for vomiting. It can be taken as a supplement; as well, foods that contain ginger may also help ease nausea, including ginger ale, ginger lollipops and ginger tea.
Other strategies for keeping nausea and vomiting at bay:
· eat several small meals a day, which can keep your stomach from getting empty
· choose foods high in complex carbohydrates (e.g. whole wheat bread, pasta, bananas, and green, leafy vegetables)
· avoid greasy and spicy foods
· sip on liquids that are cold, clear, and carbonated in between meals
· since nausea can be worse in the morning, keep crackers near your bed and munch on them before getting up in the morning
· don’t shift positions too quickly
· since nausea can be triggered by smells, try sucking on a peppermint or sniffing sliced lemon if an odor bothers you
· try an acupressure wristband (also used for motion sickness)
Homeopathic care
Homeopathic medicines have been used safely during pregnancy for more than 200 years and are therefore an excellent option.
There are many remedies with a good track record for NVP. Choosing the one that is appropriate depends on matching the pattern of your symptoms with the correct remedy. For example, some remedies are given for women whose nausea is strongly triggered by smells, others are given for women who immediately feel nauseous after eating, or 2 hours after eating, etc..
If you are pregnant and suffering from nausea and vomiting that is not severe (but still extremely bothersome!), call me for a free 15-minute consultation or schedule one on the online scheduler to learn more about how I can help.
[i] Liu, C, G Zhao D Qiao L Wang Y He M Zhao Y Fan E Jiang (2022) “Emerging progress in nausea and vomiting of pregnancy and hyperemesis gravidarum: challenges and opportunities” Frontiers in Medicine (8): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8785858/
[ii] Herrell, H (2014) “Nausea and Vomiting of Pregnancy” American Family Physician 89(12): https://www.aafp.org/pubs/afp/issues/2014/0615/p965.pdf
[iii] Nationwide Children’s (2016) “Ease nausea with natural remedies” https://www.nationwidechildrens.org/family-resources-education/family-resources-library/ease-nausea-with-natural-remedies