Morning Sickness

Morning Sickness

What is morning sickness?

Morning sickness, also known as nausea / vomiting of pregnancy (NVP), pregnancy sickness, nausea gravidarum, or emesis gravidarum is one of the key signs of pregnancy in women.

Although unpleasant to experience, morning sickness is a pregnancy symptom that affects at least 80% of women during early pregnancy (first 12 weeks). For the vast majority, when morning sickness strikes it is most bothersome during a woman’s first trimester. For some women, morning sickness may continue in waves throughout the duration of pregnancy.

The name of this pregnancy symptom is a bit of a misnomer. Waves of nausea, with or without vomiting can occur at any time of the day or night. For the most part, morning sickness is a normal part of the pregnancy journey and doesn’t typically require medical intervention.

It can happen, although rarely, that bouts of illness become severe. If serious, a woman will need to consult her doctor, who may very well diagnose a severe form known as hyperemesis gravidarum. If necessary, a woman may be hospitalised for treatment with intravenous (IV) fluids and other medications to alleviate discomfort.

In general, there has been no known evidence showing that morning sickness poses any risk to either a pregnant woman or a growing foetus. It is also not an indication that there is something medically wrong with a growing baby or a woman’s pregnancy.

Some clinical studies that have been conducted suggest that morning sickness is actually a sign of a healthy pregnancy, and may also lower risk rates of miscarriage and stillbirth (in comparison with those women who have not been very ill during pregnancy).

In most instances, bouts of queasiness are reasonably mild and subside towards the mid period of pregnancy. For most women, home remedies are sufficient in quelling the queasies and bringing back some level of comfort as the body goes through the changes of pregnancy.

Did you know? Similar symptoms can also be experienced by women who use hormonal treatments such as HRT (hormone replacement therapy) or hormonal contraception (birth control pills or oral contraceptive pills).

Why does morning sickness happen?

Causes of morning sickness

There is a theory that suggests that morning sickness is actually an evolutionary adaptation which protects an expectant mom and her growing baby from food poisoning. Nausea and vomiting is thus the body’s way of expelling contaminated foodstuffs which would affect the survival changes of both herself and her baby. To some extent, this makes sense. A developing baby does not have sufficient protection against toxins like a grown adult has. Adult humans have a wide range of detoxification enzymes in the body which are produced in the liver.

For a growing baby, developing organs are at their most vulnerable to toxins between 6 and 18 weeks (usually about the time that morning sickness takes effect in early pregnancy). A baby is thus vulnerable to any amount of toxins present in the body, however small.

Most in the medical profession, however, associate waves of illness with the dramatic hormonal changes a woman goes through during pregnancy. Hormones certainly play a role.

  • Oestrogen: Levels of oestrogen can increase up to 100 times the normal amount during pregnancy. However, a direct causal link between morning sickness and elevated oestrogen levels has yet to be determined.
  • Progesterone: Levels of this hormone also increase. This has a relaxing effect on the uterus muscles (womb), which prevents early childbirth. As a side-effect, it may also relax the body’s intestines and stomach, which can lead to excess stomach acid (acid reflux or gastroesophageal reflux disease / GERD) that causes nausea.
  • Human chorionic gonadotropin (hCG): Once an embryo develops in the womb, this hormone develops. More of the hormone develops as the placenta grows. Some studies suggest that this may be another reason morning sickness occurs.

Other influencing factors may include:

  • Low blood sugar levels (hypoglycaemia): As placenta drains energy from an expectant mom’s body, low blood sugar can occur. A direct link has not yet been able to prove that this influences bouts of queasiness.
  • Heightened sense of smell: Pregnancy does appear to trigger heightened sensitivity to various smells and odours. This can stimulate normal triggers and result in bouts of queasiness too.

Factors which may aggravate morning sickness include:

  • Multiples (twins, triplets or more)
  • Stress (emotional)
  • Excessive fatigue
  • Frequent travel

Typical symptoms of morning sickness

Young woman struggling with nausea and vomiting.

Morning sickness as a symptom can be:

  • Nausea (on its own)
  • Nausea and vomiting

When should you worry?

It is best to consult your doctor when nausea and vomiting becomes severe (i.e. occurs constantly or several times a day) or you experience any of the below additional symptoms:

  • The inability to keep any amount of liquid down
  • Passing a small amount of urine
  • Passing urine that is dark in colour
  • Dizziness or feeling faint
  • An increased heart rate (or racing heart)
  • Vomiting blood
  • Unexplained weight loss

Potential risks or complications

A mild case of morning sickness is generally not harmful to either an expectant mom or her baby. In general, a mild case of queasiness is not intense enough to cause any problems with the growth and development of a baby. Waves of nausea and vomiting can lead to a loss of appetite, however. A woman should only really be concerned if her queasiness extends beyond the first 3 or 4 months of her pregnancy or if it is noted that no weight is being gained.

General risk of experiencing morning sickness is higher if:

  • A woman has experienced symptoms of nausea and vomiting from migraine headaches, oral contraceptive pills (exposure to oestrogen), motion sickness and certain tastes or smells.
  • A woman experienced similar queasiness during a previous pregnancy.
  • A woman is experiencing pregnancy for the very first time.
  • A woman is expecting more than one baby during her pregnancy.
  • A woman is obese and has a body mass index (BMI) of 30 or more.
  • A woman is highly stressed.

Hyperemesis gravidarum explained

Severe morning sickness can develop in about 1 to 2% of pregnancies, around about the 6th week. For most expectant mom’s morning sickness usually subsides around the 12th week. It can sometimes persist in waves throughout the full 9-month pregnancy period. The thing to remember is that morning sickness, even if severe, is temporary and will pass following the birth of a baby.

When morning sickness becomes intense, it can be quite debilitating for a pregnant woman, making it difficult to comfortably continue with daily activities.

Risk for hyperemesis gravidarum is higher if:

  • A woman is expecting a female baby.
  • Other women in the family history have experienced this intense form of morning sickness.
  • A woman has experienced intense morning sickness during a previous pregnancy.

Constant vomiting is usually the most distinguishable way to assess whether a pregnant woman has a case of hyperemesis gravidarum. This can lead to severe dehydration and weight loss (about 5% is common), which can place the body under intense stress and cause serious complications for an expectant mom and her growing baby. A severe case of morning sickness can persist for at least 9 to 13 weeks, but may only ease off by the 20th week of pregnancy. In some cases, a severe case can even persist further.

Other complications which can develop as a result include:

  • Impaired kidney function – this can lead to a reduction in the amount of urine being passed.
  • Low levels of electrolytes (sodium and potassium) – this can lead to hypokalaemia, body weakness, dizziness and blood pressure changes.
  • Alkalosis – a dramatic drop in normal acidity levels in the blood.
  • Increase in the production of saliva – this can lead to an increase in swallowing which can aggravate nausea.
  • Muscle weakness – this is usually as a result of low levels of electrolytes and malnutrition.
  • Tears in the oesophagus – as a result of constant vomiting.

There is no cure for hyperemesis gravidarum, but on the plus side, it is as temporary as pregnancy, and it can be managed. There is also currently no known way to prevent morning sickness or avoid it intensifying to this level.

A medical doctor does need to treat a woman in this condition. Aside from her own discomfort, there is an increased chance that the effects will extend to a growing baby. Potential complications in this instance include premature birth and a low birth weight. This can place a fragile new-born at higher risk of further health complications.

Treatment for hyperemesis gravidarum includes:

  • Ginger root in a basket.Meals and beverages: Not all cases of intense morning sickness will require immediate hospitalisation. If some foodstuffs or liquids are able to be ingested, a doctor may recommend smaller, more frequent intake. Liquids can be drunk in smaller quantities, more often and through a straw. For many women, warm or hot foods may trigger bouts of nausea, and thus cold foods may stay down for longer. An electrolyte liquid (replacement sports drink) may also help. Ginger can also have a calming effect on the body and help to alleviate nausea. Several, small doses (around 1 to 1 and a half grams) can be taken as a supplement or in tea. Nutritional supplements, especially thiamine (vitamin B1) in doses of about 1 and half milligrams can also ease discomforts of nausea and vomiting, although these should be discussed with a doctor before being administered.
  • Medications: These may be recommended or prescribed by a doctor in oral, suppository, or intravenous (IV) form as a way to alleviate morning sickness. IV steroids or over-the-counter antacids may also provide some relief. Any medications that are recommended or prescribed will be safe for you to take with no direct impact on a growing baby.
  • Hospitalisation: If necessary, a woman may be admitted to hospital for care and treatment. This will involve the administering of intravenous fluids (usually saline, electrolytes and vitamins) to help restore hydration, tube feeding (nutritious foodstuffs are given through a tube through the nose, down the oesophagus and into the stomach), or IV feeding (if the digestive tract is impaired or unable to function properly). Once able to hold down food and hydration to the body has been restored, a woman will be discharged with care instructions to be implemented at home.

Is it necessary to have morning sickness diagnosed or tested?

Pregnant woman in consultation with her doctor.

Unless, symptoms of nausea and vomiting are intense, it is not normally necessary to have morning sickness diagnosed. If bothersome and accompanied by other symptoms, diagnosis is generally fairly straightforward.

A woman is at risk of dehydration and malnourishment if she is struggling to keep anything down for a period of time (for 24 hours or longer). If a woman displays any symptoms associated with hyperemesis gravidarum, as well as experiences abdominal pain (stomach ache or pain) and a high fever, it is strongly advisable to consult a doctor for assessment.

It can happen that a woman may have a urinary tract infection (UTI), which affects both the bladder and kidneys, resulting in nausea and vomiting too. If a woman experiences pain when passing urine, notices any blood in her urine, or spotting, she will need to seek medical treatment within 24 hours.

Whether intense nausea and vomiting is as a result of an UTI or hyperemesis gravidarum, a diagnosis by a medical doctor will need to be made. This will require a consultation and potentially a series of tests as well.

During a consultation, some questions a doctor may ask include:

  • For how long have symptoms of nausea and vomiting been experienced?
  • How often do waves of nausea, or nausea and vomiting occur?
  • Are these bouts of queasiness mild or severe?
  • Do these symptoms occur at roughly the same time of day or constantly?
  • Does anything appear to trigger or aggravate nausea and/or vomiting?
  • Have you tried anything to try and alleviate symptoms?
  • Have your efforts made you feel better or worse?

If necessary, the following tests may be recommended:

  • Urine sample: This will be ordered to test for any signs of dehydration. A doctor will also check a woman’s ketone levels in her urine. If these are found to be high, she may have become malnourished.
  • Blood chemistry test: A CBC (complete blood count), comprehensive metabolic panel and Chem-20 (to measure the level of electrolytes in the blood) may be requested. All tests will be checked for signs of dehydration, anaemia, vitamin deficiency and malnourishment.
  • Ultrasound: Sounds waves which deliver a visual image of the inside of a woman’s uterus and a growing baby will be carefully looked at to assess whether he or she is developing at a healthy rate. Sounds will also be carefully assessed during an ultrasound for any potential problems. If need be, an ultrasound can also be done to confirm whether or not a woman is expecting more than one baby, as well as check for any other potential underlying medical conditions which would explain overall symptoms.

Pregnant woman having an ultrasound scan.

Treating morning sickness

A doctor will likely recommend various homecare remedies which have shown to improve mild cases of morning sickness. If it is noted that a woman’s symptoms of nausea and vomiting are persistent, vitamin B-6 supplements may be recommended, as well as antihistamines, antacids and anti-nausea medications safe to take during pregnancy.

Intense bouts of morning sickness may be alleviated with a combination of doxylamine and pyridoxine (Declegis) which is safe to take during pregnancy (approved by the FDA – Food and Drug Administration). A side-effect is drowsiness and impaired alertness which a woman will be warmed about if this medication is prescribed by her doctor. Severe morning sickness may require hospitalisation and appropriate treatment and monitoring.

How to cope with and alleviate bouts of morning sickness

Ways morning sickness may be alleviated include:

  • Ripe seedless watermelon cut into wedges.Food selection: Some of the better foods to eat include those that are high in carbohydrates and protein, as well as low in fat. These should be easier to digest. Foods which are salty or contain ginger are great to nibble on and help alleviate nausea (settling the stomach). Foods to avoid are those that are spicy, fatty or greasy. Sweet foods may not be tolerated well either. Bland foods such as rice, chicken broth, bananas or gelatine are easier to digest and may be better tolerated. Snacking frequently can also help. Many women have found some relief by nibbling on a few crackers or dry toast first thing in the morning, as well as snacking throughout the day instead of eating three large meals. Snacking helps to keep the stomach fuller for longer. An empty stomach can aggravate nausea and make it a little worse too. There may be certain foods (especially warm or hot foods which tend to have more of an odour) that a woman will find aggravates symptoms due to their taste and/or smell – these can be avoided, especially while nausea and vomiting is at its worst. A good solid food to nibble on which also helps with hydration is watermelon.
  • Hydration and fluids: Plenty or water, ice chips (made of water of frozen juice) or ginger ale can also help to keep nausea at bay, settle the tummy and also keep an expectant mom sufficiently hydrated. Small intake amounts at regular intervals throughout the day work better than larger quantities less often. This not only helps alleviate nausea, but can considerably reduce rounds of vomiting. It may help to avoid drinks that are particularly cold, tart or sweet, including citrus juice, as well as milk and caffeinated beverages such as coffee and tea. For some women, water just doesn’t sit well with them, doing little to alleviate nausea. This is when ginger ales can help. Some women find some relief with herbal and flavoured teas such as chamomile, lemon, peach, raspberry or spearmint.
  • Pregnant woman taking medication / supplements at home. Prenatal vitamins and supplements: Some women find that taking their prenatal vitamins aggravates nausea. It can help to rather take them at night with a meal or along with a snack during the day. Alternatively, chewing gum or sucking on a hard sweet after taking these pills can also help keep nausea to minimum. Prenatal vitamins are important to take to ensure that an expectant mom gets enough iron, vitamins and minerals during her pregnancy. Iron can make nausea worse, so it is best to follow intake guidelines from a doctor. A ginger supplement can also be taken if preferred, instead of in hot tea, as a syrup or in crystallised form.
  • Fresh air: It’s a good idea for an expectant mom to ensure that her home or place of work is well ventilated. An environment that is free of odours (and cigarette smoke) which aggravate nausea can be helpful. Fresh air can help in more ways than one. Regular walks outside are not only good for the body, but can also help ease the queasies.
  • Plenty of rest: If a pregnant woman is very tired and fatigued, this will not help her body to cope with the nasty effects of nausea and vomiting. It can make it worse. For more reasons than just morning sickness, an expectant mom needs adequate rest during her pregnancy.

Some alternative remedies include:

  • Acupressure wristbands
  • Acupuncture
  • Aromatherapy

Before trying any alternative remedies, it is wise to consult your doctor to ensure that there is no medical reason why it may not be safe to do so.

Is morning sickness a good or bad sign during pregnancy?

Since an exact cause is not yet something that is fully understood, it is not entirely accurate to say that morning sickness during the pregnancy is a good or bad sign. A severe case can have adverse effects on both the mom-to-be and her developing baby, but it has not been proved to be as debilitating as it can sometimes feel.

Certainly, a spike in hormone production, evolutionary adaptation and psychological influences are agreed to play some kind of role, but have not been independently linked as a cause, nor found to be distinctively good or bad.

Studies have surmised that morning sickness may merely be the body’s natural way of reducing the risk of early pregnancy loss (miscarriage), especially in women over the age of 30.

Does a lack of or very little morning sickness during pregnancy indicate a problem?

A lack of, or extremely mild bouts of morning sickness, does not appear to increase a woman’s risk for losing her baby during early pregnancy either. A lack of morning sickness does not necessarily mean that a woman cannot have a healthy pregnancy and baby, even though women who have miscarried typically have lower levels of hCG (human chorionic gonadotropin) at the time.

For some women, morning sickness can be fairly frequent or constant. For others, it comes and goes. Morning sickness fades at some point during pregnancy, usually towards the end of the first trimester. Fading morning sickness is not a red flag for an increased risk of miscarriage either.

Fluctuations are normal, and even though there can be large variations of morning sickness among expectant moms, doctors will generally not raise any alarm bells unless it is severe enough to begin causing distress to the body and develop complications.

When in doubt, consult a doctor for clarification and understanding about pregnancy symptoms, as a whole. A doctor can best advise on what is normal, and when to worry. It’s also important to keep in mind that every woman and every pregnancy is different. What works for one woman (or pregnancy) may not work in another.

 

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