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Bearing a child is one of the blessings every woman yearns for. Undoubtedly, what she does not wish for are the concomitant feelings of nausea and vomiting that coexist with being pregnant.
Morning sickness refers to nausea and vomiting experienced by expecting mothers during the first trimester of their gestational period. (1)(2) This is mostly due to the soaring levels of hormones in the body.
The smell of your favorite perfume or the lingering aroma of your favorite foods can force you to throw up. Almost anything can bring up an episode of morning sickness.
This queasy feeling called morning sickness may affect more than 50% of pregnant women. In some cases, the condition may extend to the second trimester. (3)
Some doctors opine that morning sickness is an indication that the placenta, a mass of tissue that connects the mother and the baby, is undergoing sound development. It is also believed that nausea comes from a response to the increased levels of hormones, including human chorionic gonadotropin (hCG) and estrogen, in pregnant women. (3)
Not limiting itself to the morning time, morning sickness may extend throughout the day and sometimes even into the night.
Possible Causes of Morning Sickness
Several factors contribute to morning sickness, including:
- Certain odors
- Certain foods
- Emotional stress and anxiety
- Vitamin or mineral deficiencies
- Bearing multiple children
Signs and Symptoms of Morning Sickness
The classic symptoms of morning sickness include nausea and vomiting, which often appear around the 5th or 6th week of your pregnancy.
Usually, the symptoms of morning sickness worsen around the 9th week of your pregnancy, but they may reduce by the 16th or 18th week. For nearly 15% – 20% of pregnant women, morning sickness lasts until the third trimester. It has also been observed that in 5% of pregnant women, the symptoms of morning sickness may persist until childbirth. (3)
Medical Treatment for Morning Sickness
While mild cases can be tended to with changes in the diet, a case of severe nausea requires medical intervention. Certain medications can be prescribed to a pregnant woman if she does not have any existing medical conditions.
- Vitamin B6 and doxylamine are safe medications that inhibit your morning sickness. These can be taken alone or in combination, according to your doctor’s recommendation. (3)
- If vitamin B6 and doxylamine fail to help you, antiemetic drugs may be prescribed to prevent nausea and vomiting. Keeping in mind the side effects, your doctor will choose a drug that best suits your situation.
Tips to Avoid Mild Morning Sickness
If you have been experiencing mild bouts of morning sickness, your doctor is likely to advise the following:
- Take adequate rest; fatigue can worsen nausea and vomiting.
- Drink plenty of fluids such as water.
- Avoid foods that have a smell that irritates your senses.
- Do not skip your breakfast. An empty stomach can lead to nausea and vomiting. Eat a bland breakfast, such as dry toast or crackers.
- Try the BRAT diet, which includes bland foods such as bananas, rice, applesauce, and tea.
- Avoid spicy and fatty foods.
- Take small meals high in carbs and low in fat at frequent intervals. These include rice, bread, and pasta.
- High-protein meals in the morning help with nausea.
- Prefer cold foods.
- Do not rush out of your bed in the morning. Instead, pull yourself slowly when getting up to avoid morning sickness.
- Avoid smoking. Restrict exposure to passive smoke.
- Expose yourself to fresh and airy environments.
- Practice light and relaxation exercises and techniques.
Ways to Relieve Morning Sickness
Morning sickness is a common problem that every pregnant woman is bound to face through the gestation period. However, mild morning sickness is not a very serious problem and can be easily dealt with. You can sail through the wind of nausea and vomiting with these simple remedies.
1. Include Vitamin B6 (Pyridoxine) in Your Diet
Eating foods rich in vitamin B6 can help resolve the symptoms of morning sickness in pregnant women.
The findings of a randomized controlled trial suggested that the combination of doxylamine and vitamin B6 may help alleviate the queasy and nauseous feeling during pregnancy. (6)
Another study indicated that a higher dose of vitamin B6 could help tame the symptoms of morning sickness more than a lower dose of the vitamin, prior to the 12th week of gestation. However, the results cannot be generalized due to the small sample size of the study. (7)
As suggested by a 2019 review, vitamin B6 is more effective in treating pregnancy-induced nausea and vomiting when compared with ginger. (8)
Vitamin B6 works similar to dimenhydrinate (an antiemetic prescription drug) and elicits significant improvements in nausea and vomiting experienced in early pregnancy. (9)
Vitamin B6 supplements have also been found to be a safe option for the mother and the fetus.
- Consume foods rich in vitamin B6 such as kidney beans, lentils, seeds and nuts, sweet potato, soybeans, and lean meats.
- It has been shown that women that start taking prenatal vitamins 1 month prior to pregnancy are less likely to suffer from severe nausea because of the increase in vitamin B6, so start taking prenatal vitamins at least 1 month prior to pregnancy.
Studies have shown that vitamin B6 is effective in the treatment of morning sickness. Consult your doctor for the supplement.
2. Soothe Your Nausea with Ginger
Ginger root contains compounds called gingerols and shogaols that may help provide relief from nausea and vomiting. (12)
Multiple researches have demonstrated the efficacy of the use of ginger in treating nausea and vomiting. Nevertheless, further research is recommended in this context to determine the dosage and preparation of intake.
3. Consider Acupressure and Acupuncture
Acupressure involves the application of pressure to specific pressure points in the body, and it has been part of therapeutic medicine since ages. Proponents of the therapy believe that acupressure can stimulate the release of chemicals that can help relieve the symptoms of certain illnesses.
Applying pressure to a point called P6 on the inner side of your wrist can help you overcome the symptoms of morning sickness.
A systematic review that included 43 studies concluded that acupressure was effective in dealing with nausea and vomiting experienced in pregnancy. However, there is a need for extensive clinical trials in this regard due to the limitations of sample size, language, and year of publication of the included studies. (14)
Acupuncture is another traditional therapeutic practice that may be utilized to get relief from morning sickness. With the use of specially designed needles, acupuncture therapy stimulates certain points in the body to alleviate certain health problems.
Another 2016 systematic review that pooled the results of 20 trials found that acupressure therapy was effective in reducing the symptoms of morning sickness. Although the therapy was effective, some participants experienced pain, swelling, and numbness in their hands. Further research is required in this area. (15)
Acupressure as a possible intervention to relieve morning sickness requires additional scientific research that takes into account the sample size, patient outcomes, and side effects.
4. Try Aromatherapy
Peppermint aromatherapy may be used to decrease mild, moderate, and severe symptoms of morning sickness experienced between 6 and 20 weeks of gestation. (16)
One study corroborated the application of peppermint oil aromatherapy as significantly useful in relieving the symptoms of nausea and vomiting. (16) However, the effects of peppermint oil and placebo were quite similar, mostly because of the psychological impact of aromatherapy on pregnant women.
Another study found that peppermint inhalation had no effects on reducing nausea and vomiting in pregnant women. (5)
Although a few studies have supported the efficacy of peppermint oil aromatherapy, these positive conclusions were similar to the effects of the placebo due to the psychological effect of the intervention method on pregnant women. Hence, more research is required to confirm the effectiveness of peppermint oil aromatherapy.
The natural calming effect of lemon essential oil may help reduce the discomfort associated with morning sickness.
One study reported that 40% of the pregnant female participants used lemon essential oil aromatherapy to get comfort from nausea and vomiting. However, there is a dearth of scientific evidence when it comes to using lemon essential oil aromatherapy for nausea; hence, further studies are required to get conclusive results. (13)
Although anecdotal evidence has encouraged several women to use lemon essential oil aromatherapy, further in-depth research is required to validate its antiemetic properties.
5. Drink Adequate Amounts of Water
Staying well-hydrated can help ward off dehydration-induced morning sickness in pregnant women.
- It has been found that women who keep themselves hydrated by drinking 1 glass of water every hour are much less likely to experience morning sickness. Make sure to drink 8 to 10 glasses of water every day. Adequate hydration is also needed in pregnancy to help combat constipation, dehydration, preterm contractions, and many other things, so water should be part of your daily regimen regardless.
- Additionally, you can choose to eat plenty of watery fruits and vegetables such as melons, grapes, apples, pears, squash, and oranges, carrots, tomatoes, and celery.
- You can also treat yourself to frozen fruit bars to keep your body hydrated.
What Happens if Your Morning Sickness Worsens?
If the morning sickness is debilitating to the extent that you cannot retain foods and drinks, you may have a condition called hyperemesis gravidarum. Seek professional help to avert the consequences of excessive nausea and vomiting.
Hyperemesis gravidarum is marked by severe nausea followed by vomiting, which may last even after the first trimester and at times throughout the pregnancy. This can entail a loss of fluids and electrolytes, resulting in an electrolyte imbalance in the body leading to weight loss. Weight loss and dehydration in pregnancy are red flags that require immediate medical attention. (4)
Mild cases of hyperemesis gravidarum can be cured by implementing changes in the diet, having adequate rest, and taking medications such as antacids. Severe cases can take a serious turn and often require hospital admission so that nutrition and fluids can be administered intravenously. (17)
Risk Factors Associated with Morning Sickness
A number of different factors are associated with an increased risk of developing morning sickness. These include: (2)
- Previous pregnancy with nausea and vomiting
- Female fetus
- Family history of morning sickness
- History of motion sickness or history of nausea while using contraceptives that contain estrogen
- Young maternal age
- Conceiving twins or triplets
- First pregnancy
- Migraine headaches
Myths and Facts
1. Morning sickness is limited to the early hours of the morning.
False. Contrary to popular belief, the symptoms of morning sickness and nausea may occur at any time, extending itself from the morning to the entire day and even into the night.
2. Morning sickness is experienced only when bearing your first child.
False. Morning sickness is the outcome of the hormonal imbalances that occur during pregnancy and, hence, it can be experienced during every pregnancy.
3. A severe case of morning sickness indicates that you will probably give birth to a baby girl.
False. The severity of morning sickness cannot determine the sex of your unborn child. Morning sickness is a natural occurrence during the first trimester of pregnancy.
4. Morning sickness lasting for more than 3 months is an alarming condition.
True. A persistent case of morning sickness that continues after the first trimester or lasts throughout the pregnancy is a serious cause of concern. This may be a severe case of morning sickness called hyperemesis gravidarum. Consult with your doctor for professional help.
5. Nausea and vomiting associated with morning sickness may harm your unborn child.
False. Morning sickness does not pose a threat to your unborn child unless it takes a severe form where the mother may be at risk of losing a considerable amount of weight as well as fluids from the body.
6. Severe morning sickness is associated with twins or triplets
True. Although pregnancy itself can cause morning sickness, bearing multiple children may increase the risk of experiencing the condition.
When to See a Doctor
Morning sickness is usually mild and passes over time for most women. However, it is imperative to seek professional consultation if:
- You have lost weight of more than 2 pounds or 5% of your pre-pregnancy weight.
- Your heartbeat is irregular.
- You are vomiting more than three times a day, making it difficult for you to retain body fluids or food.
- You experience fatigue and confusion.
- You have been experiencing morning sickness even after the first trimester.
- You urinate less.
If your vomit has blood or is brownish in color, call your doctor immediately.
After going through a lot, your efforts will be rewarded once you see your bundle of joy. Until that time, keep a check on possible triggers and irritants to help treat your morning sickness.
To ease the symptoms, take your vitamins, rest properly, eat your breakfast, and use aromatherapy.
However, persistent nausea and vomiting during pregnancy can be alarming as these can lead to dehydration and weight loss. Seek immediate medical review to ensure your health and that of your baby.
Expert Answers (Q&A)
Answered by Dr. Sherif Daoud, MD (Obstetrics and Gynecology)
There is some truth to the commonly-held belief that pregnant women who experience vomiting and nausea during their gestation period are less likely to suffer a miscarriage as opposed to those who don’t.
As per some studies, morning sickness can be taken as an indicator of optimal fetal growth, but it does not guarantee it. (18)
That said, one cannot generalize these findings to all pregnancies. Every woman is built differently and goes through her own experience while bearing a child.
So, even if you don’t have morning sickness or any other symptom which is typically associated with a pregnancy, it does not necessarily mean that you will have a negative outcome.
Conversely, women who do exhibit such symptoms are not immune to pregnancy-related complications as well. Thus, morning sickness in and by itself does not ensure a successful pregnancy but is generally regarded as a positive sign.
Morning sickness is thought to be triggered by certain pregnancy-related hormones, but its severity can vary from woman to woman. Some women experience only mild symptoms, while others have it far worse.
The exact reason as to why that remains unclear, but the following factors can make you more susceptible to morning sickness:
– If you experienced morning sickness during your previous pregnancies
– If you are expecting more than one baby (twins or triplets)
– If you happen to have a rare condition known as a molar pregnancy in which the placenta overgrows impeding the development of the baby
You need to consult your OBGYN to rule out other causes of vomiting if your morning sickness is particularly bad and is taking a toll on your general wellbeing.
More so, if it is accompanied by pain in your stomach or if it begins late into the pregnancy, i.e., 10 weeks after the onset of pregnancy.
Yes, most pregnant women have periodic episodes of morning sickness that typically begin somewhere between the fourth and seventh weeks of pregnancy.
In 90% of the morning sickness cases, the symptoms tend to be most pronounced around the ninth week and usually subside by the 20th week. In the remaining 10% cases, the symptoms may follow an unconventional trajectory.
There is no set pathological pattern when it comes to such atypical cases, which can be marked by persistent sickness throughout the course of the pregnancy or fluctuating symptoms (on/off periods).
Morning sickness refers to nausea and vomiting brought on by pregnancy, which can flare up at any time of the day. For most women, the symptoms tend to come and go throughout the course of the day.
But in some cases, the feeling of sickness may persist for the entire day.
Prolonged spells of morning sickness can hamper your energy levels and disrupt your day-to-day life but are unlikely to jeopardize the health of your baby.
The obvious discomfort aside, morning sickness is rarely a cause of concern and usually resolves by the time your pregnancy enters its 20th week. However, keep your OBGYN informed about any new symptom to prevent any undue complications later.
A serious form of morning sickness known as hyperemesis gravidarum is known to trigger particularly intense and prolonged episodes of vomiting and nausea.
This kind of severe morning sickness affects approximately 1 to 3 in every 100 pregnant women and makes it impossible for them to stomach any food or fluid without being sick.
Since you throw up anything you consume, your body may become deprived of water and sufficient nutrition over time. What’s worse is that this condition is usually unresponsive to the standard anti-sickness medications.
Thus, the continued dehydration and malnourishment can make you lose as much as 5% of your pre-pregnancy weight. To keep that from happening, you must seek prompt medical assistance the minute you feel that your morning sickness is becoming unmanageable.
The following symptoms should warn you about a possible risk of dehydration:
– Your mouth may feel increasingly ‘dry.’
– You may feel unusually thirsty all the time
– Your urine output may get reduced
– You may experience frequent headaches, dizziness, and confusion
– Your vision may turn blurry or distorted
– Your urine may turn an unusually dark color
– You may experience constant lethargy or drowsiness
– You may feel generally unwell
– Your muscles may begin to cramp more than usual
If you’re having a hard time coping with your morning sickness, it is recommended that you seek professional advice from a Midwife/GP/OBGYN to make the experience a little less uncomfortable.
The doctor will take into account your medical history, inquire about your symptoms, and may even conduct a thorough medical examination before deciding upon the appropriate treatment strategy.
You may be asked the following questions:
– Whether you experienced similar symptoms in your past pregnancies?
– For how long have you had your symptoms?
– If you are able to keep anything down without throwing up?
– Have you tried any anti-sickness medications?
– Have you been losing weight?
The medical examination will most likely involve:
– A general health check-up which typically includes an assessment of your body temperature, blood pressure, your pulse, and respiratory rate
– Weight measurement
– Urine and blood tests to make sure that your body isn’t dehydrated
– An ultrasound scan to see how far along you are in the pregnancy, as well as to check for twins and molar pregnancy
Yes. Not all women suffer from morning sickness. In fact, some women are lucky enough and don’t suffer any sickness at all.
This doesn’t mean their pregnancy is at any higher or lower risk. Always remember, every woman is different, and pregnancy is a very individual experience.
Bizarre as it may sound, but yes, men can also go through many of the pregnancy symptoms without actually bearing a child. This phenomenon is referred to as the couvade syndrome or sympathetic pregnancy.
Researchers suggest that an otherwise healthy male may mimic the behavior and symptoms of his pregnant female partner, which includes some degree of morning sickness, as well as other symptoms like food cravings, backache, increased irritability, depression, cramps, fainting spells, and fatigue.
In fact, some men even undergo noticeable physical changes that are akin to the expectant mother, like weight gain and increased fat accumulation around the abdomen which resembled a “baby bump.”
Most cases of morning sickness are easily manageable at home without the need for any medical intervention.
Although there are anti-sickness drugs available, you should try a few simple self-care measures before resorting to medication.
When you are having trouble keeping down your food, its best to consume small-sized meals that are high in carbohydrate and low in fat. Potato, pasta, and rice are all good options. You can even munch on plain biscuits or crackers if you are not in the mood for anything heavy.
You should steer clear of strong-smelling foods that can send your gag reflex into overdrive. This usually includes hot and spicy foods. Identify any other food or smell that repeatedly aggravates your nausea and vomiting, and stay away from it.
Have your dinner at least a few hours before bedtime, so that your body gets enough time to process it before it goes into slumber mode.
Consuming ginger products may help relieve some of the symptoms associated with morning sickness, but some women have reported experiencing digestive trouble as a result of it.
You can even speak to your doctor about trying complementary therapies like acupressure or acupuncture, and see if they are suitable for your particular case.
If your symptoms fail to subside despite adequate self-care and keep you from accomplishing your daily activities, you must consult your Midwife/GP/Doctor for appropriate treatment.
In all probability, the doctor will prescribe an anti-sickness medication that is safe to take during pregnancy.
About Dr. Sherif Daoud MBBch, MSc, MD, MRCOG: Dr. Daoud is currently a Senior Registrar at Southmead Hospital – North Bristol Trust – UK. He is a former Lecturer/Consultant of Obstetrics and Gynecology at Ain Shams Maternity Hospital.
Dr. Daoud moved to the UK and received his Membership degree from the Royal College of Obstetricians and Gynecologists. After completing his MD degree, he completed his Advanced Labor ward training module and started his advanced training in Endoscopic surgery.