Morning sickness

More about Morning Sickness

Morning sickness often begins 4 - 6 weeks after conception and may continue until the fourth month of pregnancy. Some women have morning sickness during their entire pregnancy. This happens most often for women who are carrying more than 1 baby.

It is called morning sickness because the symptoms are more likely to occur early in the day, but they can occur at any time. For some women, morning sickness lasts all day.

The exact cause of morning sickness is not known.

• Most experts think changes in the woman’s hormone levels during pregnancy cause it.
• Other factors that can make the nausea worse include a pregnant woman’s enhanced sense of smell and gastric reflux.

Morning sickness that is not severe does not hurt your baby in any way.

• It may even be a sign that all is well with you and your baby.
• You have a somewhat higher chance of having a girl if the nausea is more intense.
• Your symptoms probably show that the placenta is making all the right hormones for your growing baby.

If you’ve had bad morning sickness before, make sure to take prenatal vitamins before you get pregnant again. This seems to reduce the risk of severe nausea and vomiting.

When nausea and vomiting are severe, a condition known as hyperemesis gravidarum may be diagnosed.

Eating and Drinking

Changing what you eat may help.

• Eat a lot of protein and carbohydrates.
• Try peanut butter on apple slices or celery; nuts; cheese and crackers; and low-fat dairy products like milk, cottage cheese, and yogurt.
• Bland foods -- such as gelatin, frozen desserts, broth, ginger ale, and saltine crackers -- also soothe the stomach.

Avoid eating foods that are high in fat and salt.

Try to eat before you get hungry and before nausea occurs.

• Eat a few soda crackers or dry toast when you get up at night to go to the bathroom or before you get out of bed in the morning.
• Avoid large meals. Instead, have a snack as often as every 1 - 2 hours during the day. Don’t let yourself get too hungry or too full.

Drink plenty of liquids.

• Try to drink between meals rather than with meals so that your stomach doesn’t get too full.
• Seltzer, ginger ale, or other sparkling waters may help control symptoms.

Foods that contain ginger may also help. Some of these are ginger tea and ginger candy, along with ginger ale. Check to see that they have ginger in them rather than just ginger flavoring.

What Else Can I Try?

Try changing how you take your prenatal vitamins.

• Take them at night, since the iron they contain may irritate your stomach. At night, you might be able to sleep through this. Also take them with a little food, not on an empty stomach.
• You may have to try several different brands of prenatal vitamins before finding one you can tolerate.
• You can also try cutting your prenatal vitamins in half. Take half in the morning and the other half at night.

Some other tips are:

• Keep your morning activities slow and calm.
• Avoid poorly ventilated spaces that trap food or other odors.
• Do not smoke cigarettes or be in areas where people are smoking.
• Get extra sleep and try to lessen stress as much as possible.

Try acupressure wristbands that apply pressure to specific points on your wrist. Often these are used to ease motion sickness. You can find them at drug stores, health-food stores, travel stores, and online.

Try acupuncture. Some acupuncturists are trained to work with pregnant women. Talk to your health care provider beforehand.

Are There any Drugs to Treat Morning Sickness?

Vitamin B6 (100 mg or less daily) has been shown to ease symptoms of morning sickness. Many doctors and midwives recommend trying it first before trying other medicine.

There are no drugs currently approved by the Food and Drug Administration to treat morning sickness. Your health care provider may not advise medicines to prevent nausea unless your vomiting is severe and will not stop.

• The drug doxylamine (brand name Unisom) may be taken along with vitamin B6 to treat nausea and vomiting. Ask your health care provider before taking it.
• In severe cases, you may be admitted to the hospital, where you will receive through an IV (into your vein).

Call Your Health Care Provider if

• Your morning sickness does not improve after trying home remedies.
• You are vomiting blood or something that looks like coffee grounds.
• You lose more than 2 pounds in a week.
• You have severe vomiting that will not stop. This can cause dehydration (not having enough fluid in your body) and malnutrition (not having enough nutrients in your body).

References

Hark L, Catalano PM. Nutritional management during pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 7. 

Matthews A, Dowswell T, Haas DM, Doyle M, O'Mathúna DP. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev. 2010;9:CD007575.

Update Date: 8/23/2012

Updated by: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.