What it is What causes it How likely you are to get morning sickness What it does and could mean What you can do about it Medication When you should call a doctor Hyperemesis gravidarum Back to About...

What it is

Nausea and vomiting can be one of the first signs of pregnancy. It usually starts around week 6 of pregnancy, but it can even begin at 4 weeks. It tends to get worse over the next month. For most women it seems to stop around the 13th week of pregnancy but it may continue throughout the whole pregnancy if you’re unfortunate. For most women it is an annoyance. For some it can pose a risk of dehydration.

Morning sickness is not harmful to you or your baby, but if you experience excessive vomiting and you can’t keep any food down, you may have hyperemesis gravidarum. Hyperemesis gravidarum can cause harm to you and your baby if it’s left untreated, due to the lack of nutrients. The most important thing is to inform your doctor when these symptoms appear and discuss possible options for treatment.

Many doctors consider morning sickness as a good sign because it means the placenta is developing well.

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What causes it

• Rapidly increasing levels of hormones. The hormone human chorionic gonadotropin increase during early pregnancy. No one knows how this contributes to nausea, but the timing is right: nausea tends to peak around the same time as levels of the hormones. Estrogen is also considered a cause, and it's possible that other hormones may play a role as well.
• An enhanced sense of smell and sensitivity to odors. Pregnant woman often find themselves all-of-a-sudden overwhelmed by the smell of something you used to like; nasi lemak, for example. This may be a result of higher levels of estrogen also.
• A sensitive stomach. Some women's stomaches are simply more sensitive to the changes of early pregnancy.

Another thing no one knows: why vitamin B6 is helpful. There's some evidence that taking a multivitamin at the time of conception and in early pregnancy helps prevent severe morning sickness, but again, no one knows why.

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How likely you are to get morning sickness

• You're pregnant with twins. This may be from the higher levels of hormones in your system. You're also more likely to have a more severe case of morning sickness. But, some women carrying twins have little or no nausea.
• You had morning sickness in a previous pregnancy.
• You have a history of nausea or vomiting as a side effect of taking birth control pills. This is probably related to your body's response to estrogen.
• You have motion sickness.
• You have migraine headaches.
• If your mother or sisters had severe morning sickness, there's a higher chance you will, too.
• You're carrying a girl. Women with severe nausea and vomiting were 50% more likely to be carrying a girl.

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What it does and could mean

If nausea keeps you from eating a balanced diet, take a prenatal vitamin to make sure you're getting the nutrients you and your baby need.

If your baby or your placenta is not developing properly, you'd have lower levels of pregnancy hormones in your system, which will give you less reason to get nausiated. If you don’t feel any, or if you feel little nausia you might be afraid of havig a miscarriage. And it’s true that women who do have miscarriages are less likely to have had nausea. But, there are plenty of women with perfectly normal pregnancies who manage to escape nausea during their first trimester. Count yourself lucky and don't obsess about it if you're not suffering!

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What you can do about it

• Try to avoid foods and smells that trigger your nausea. It's okay to eat the few things that turn out to be appealing to you, even if this doesn't result in a balanced diet. Take some vitamin pills to get all you need. Try to eat food cold or at room temperature; it has less of an aroma than when it's hot.
• Carry a handkerchief with a few drops of a non nausea causing essential oil (lemon or mint for example) in it and breath through it if you can't get away from the smell that is bothering you.
• Keep snacks like crackers or dry cereal by your bed. When you wake up, eat some crackers and then rest for 20 to 30 minutes before getting up slowly. Snacking on something small can also help you feel better if you wake up in the middle of the night feeling sick.
• Eat what you want when you want it. Eat small things all the time throughout the day so that your stomach is never empty. High-protein foods are most likely to ease nausea.
• Avoid foods that take longer to digest. This is fat, spicy, acidic, and fried food. They can irritate your digestive system.
• Eat potato chips or a different salty snack before your meal. They settle your stomach for what’s coming.
• Try to drink between meals. Don’t drink with your meal and never drink so much that your stomach feels full, it will make you less hungry. If you've been vomiting a lot, try a sports drink that contains glucose, salt, and potassium to replace lost electrolytes.
• Take your prenatal vitamins with food or just before bed. Ask your doctor if you can switch to a prenatal vitamin with little or no iron for the first trimester, it can be hard on your digestive system.
• Take time to relax and nap if you can. But, don’t lie down immediately after eating. Tiredness plays a big part in morning sickness. Watching a movie or visiting with a friend can help relieve stress and take your mind off your discomfort.
• Eat ginger, an alternative remedy thought to settle the stomach and help quell queasiness. See if you can find ginger ale made with real ginger, make ginger tea, or see if ginger candies help.

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Medication

If your nausea and vomiting is getting worse, waiting too long to take medication may make it more difficult to treat.

Ask your doctor if the combination of doxylamine and vitamin B6 might work for you and what dose you should take. No one knows why vitamin B6 eases nausea in some expectant mothers, but research indicates that it works for some women and it's safe when taken in commonly recommended doses.

The usual dose for treating morning sickness is between 10 and 25 milligrams 3 times a day, but check with your doctor before taking anything. Don't take more vitamin B6 than he or she recommends. Too much can cause numbness and nerve damage and may not be safe for your developing baby.

If vitamin B6 isn't enough to do the job, there are other anti-nausea medications that are considered safe and effective during pregnancy. Emetrol is the only nonprescription nausea medication that's considered safe during pregnancy. Reflux medications such as Zantac or Pepcid sometimes work for women whose nausea and vomiting is triggered by gastrointestinal distress.

As for prescription medicine, your doctor may suggest nausea medications such as Compazine or Tigan or the antihistamine Phenergan. The drug Zofran, which was originally designed to control nausea in chemotherapy patients, may be effective for pregnant women, but it's very expensive and many insurers won't cover it.

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When to call a doctor

Also go to the doctor if:

• you are experiencing excessive nausea and vomiting that prevents you from keeping any food down
• vomiting is accompanied by pain or fever
• nausea and vomiting persists well into the second trimester (after 13th week)

When any of these are the case you could have a condition called hyperemesis gravidarum. This condition can be difficult to manage, but the sooner you're diagnosed and begin treatment, the more likely you'll be able to avoid severe symptoms. If your situation is severe, your doctor will most likely want to check you into the hospital and treat you with intravenous fluids and medications.

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Hyperemesis gravidarum

Your doctor will probably want to give you some intravenous fluids right away, since you’re likely to be seriously dehydrated. Then you’ll need to do some tests to check your electrolyte levels and make sure no underlying illness is causing your constant vomiting. Depending on your condition, you may need to be hospitalized for a few days so that you can continue to receive fluids and medication.

Many women feel much better after they're rehydrated and are able to control their symptoms with anti-nausea medication. As soon as your condition stabilizes, you should be able to go home, where you can continue taking oral medications. Your doctor may recommend a diet to reduce nausea and vomiting. Both dietary changes and medications may be necessary because many women who suffer from hyperemesis gravidarum continue to have some morning sickness well into their pregnancy, even if it's not as severe as before.

In rare cases, you'll need to continue to receive intravenous therapy in the hospital or at home.

If inadequately treated, hyperemesis gravidarum can result in chronic dehydration, weight loss, malnutrition, and other complications for you and your baby.

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