All About Morning Sickness – And Tips For Finding Relief

It is not uncommon for women to experience nausea and vomiting in pregnancy. It is so common that it is considered to be a sign of pregnancy. Nausea (without vomiting) in pregnancy is referred to as "morning sickness," but the term is misleading due to the fact that for most women, the symptoms last throughout the entire day. It may also be worse in the morning because your stomach is empty. Most women begin to experience nausea and vomiting between the 5th and 6thweek of pregnancy. The nausea and vomiting usually comes to an end by the 16th week, but for some women, it continues. Research has also shown that women who experience nausea and vomiting with their first pregnancy are more likely to experience it in future pregnancies.¹ The exact cause is unknown, but hormones and slower peristalsis (food moving through your digestive system) most likely play a role. There are several measures that may help relieve the feeling of nausea, and the vomiting that oftentimes comes with it:

• Avoid eating solid foot and drinking liquids at the same time. If your stomach becomes distended, it may trigger nausea and vomiting.
• Suck on hard candy between meals. Some women find that they do better with sucking on hard candy that is sweet, while others gain more relief by sucking on candy that is sour or tart.
• Eat foods that are low in fat. Foods that contain a lot of fat may cause foods to be digested more slowly. The food remains in your stomach for a longer period of time, which may lead to nausea and vomiting.
• Sip on carbonated drinks such as ginger ale. Ginger ale that is made using real ginger may work best.
• Wait a while after you are finished eating to brush your teeth. Brushing your teeth right after eating may affect your gag reflex.
• Eat small, frequent meals throughout the day.
• Avoid smells that you find trigger your nausea.

If you continue to experience frequent nausea and vomiting, talk to your physician, or midwife, about other options. There are nonprescription (over the counter), as well as prescription, medications available, but do not take any medication without first asking your physician.

What You Should Know About Hyperemesis Gravidarum

In some cases, the nausea and vomiting is so severe that it can lead to dehydration and electrolyte disturbances (especially potassium and sodium). This is entirely different than occasional nausea and vomiting in pregnancy. If the pregnant woman is so nauseated that she cannot retain (keep down) anything that she eats or drinks, she may be suffering from what is called hyperemesis gravidarum. Although there is no definite list of symptoms² that a woman must have to be diagnosed with hyperemesis gravidarum, key symptoms include:

• Vomiting that occurs every day (in many cases, several times a day) that started before the 9th week of pregnancy
• Presence of ketones in urine
• Electrolyte imbalances
• Weight loss that is more than 5 percent of the first weight that is recorded.² Example: If a pregnant woman's weight at her first prenatal visit was 150 pounds, a weight loss greater than 5 percent equals more than a 7.5lbs loss.

Hyperemesis gravidarum can be so severe for some women that it interferes with their daily lives, affecting their ability to go to work or continue with their normal daily routines. It may even lead to depression.³

Treating The Condition

Treatment for hyperemesis gravidarum may include admission to the hospital for intravenous fluids to correct any electrolyte imbalances and dehydration, as well as medications to decrease the severity of the nausea and vomiting. You may go home with IV fluids. If you go home with an IV, a nurse may come to your house to check on you to change your IV site. Medications may be given to help control the nausea and vomiting. In the most severe cases of hyperemesis gravidarum, the pregnant woman vomits so frequently that she is not receiving enough nutrition for her and her baby. When this occurs, the important nutrients are provided through total parenteral nutrition or TPN. It may be given through special devices such as central lines. A woman who suffers from severe hyperemesis gravidarum may be at a greater risk for complications in her pregnancy, such as premature labor and delivering her baby weeks before her due date. Researchers have found that a woman who is diagnosed with severe hyperemesis gravidarum and received TPN developed less complications in her pregnancy.⁴

Determining Your Level Of Nausea

As a way to determine when a pregnant woman's nausea and vomiting may be severe enough that she needs medical treatment, or needs treatment, a questionnaire may be used. This questionnaire is called the PUQE index (Pregnancy-Unique Quantification of Emesis/Nausea), and it may be given to you by your physician if you are experiencing symptoms of hyperemesis gravidarum. It is not a scientific test, but rather a method to determine if you need specific treatments or medications. Based on your answer to each question, a point value is given. For example, if you report that you have felt nauseated greater than six out of the last 12 hours, 5 points will be assigned to that question. After all of the questions are answered, the total points are added together. The higher the score, the more severe your symptoms are.^{5 https://www.injuryverdicts.com/wp-contentimg.medscape.com/article/712/662/712662-fig1.jpg} In August of 2015, the American College of Obstetricians and Gynecologists (ACOG) published an update regarding medications used to treat nausea and vomiting in pregnancy. The new recommendation is the combination of doxylamine and vitamin B6. Both vitamin B6 and doxylamine (found in sleep aids) are available over the counter. A combination of the two is available by prescription (Diclegis). They are currently recommended by ACOG to be used as the initial (first) medications given to women who are experiencing nausea and vomiting in pregnancy. This drug combination was discontinued in 1983 due to safety concerns, but has now been determined to be safe.⁶ Most women with hyperemesis gravidarum will see a decrease in episodes of both nausea and vomiting by the 18th week of pregnancy; however, for a small percentage of women, the symptoms will continue throughout the pregnancy.² Researchers have reported that most babies born to mothers who suffered from hyperemesis gravidarum have no long-term effects. Babies born to mothers who did not gain weight during pregnancy weighed less at birth than babies born to mothers who did not experience nausea and vomiting.⁷

A Quick Note About Pica

Pica involves the eating of substances other than food on a regular basis for the period of one month or longer.⁸ It often involves eating substances such as dirt, clay, cornstarch, frost from a freezer or ice. The exact cause of Pica has not been identified. Depending on what substance is consumed, it may lead to lead poisoning. There is a link between Pica that involves eating ice, or frost from a freezer, and iron-deficiency anemia, but it is not clear whether or not the ice causes the anemia, or if the anemia triggers the craving for the ice. There is no clear-cut treatment for Pica. If iron-deficiency anemia is identified, treating the anemia may end the cravings.⁹ At the end of the day, here's all you have to remember: if you feel nauseated or cannot stop vomiting, call your OB/GYN or midwife immediately. It might be morning sickness, but it could also be the sign of something more significant. It's better to find out fast and get the treatment you need than to wait.

1. King, T., & Murphy, P. (2009). Evidence-based approaches to managing nausea and vomiting in early pregnancy. Journal of Midwifery & Women's Health, 54(6), 430-444. doi:10.1016/ j.mwh.2009.08.005
2. Lacroix, R., Eason, E., & Melzack, R. (2000). Nausea and vomiting during pregnancy: A prospective study of its frequency, intensity, and patterns of change. American Journal of Obstetrics & Gynecology, 182(4), 931-937. Retrieved from https://www.ncbi.nlm.hih. gov/pubmed/10764476
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5. Lacasse, A., Rev, E., Ferreira, E., Morin, C., & Berard, A. ((2008). Validity of a modified pregnancy-unique quantification of emesis and nausea (PUQE) scoring index to assess severity of nausea and vomiting of pregnancy. American Journal of Obstetrics & Gynecology, 198(1), 71.e1-7. doi: 10.1016/j.ajog.2007.05.051
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8. Santos, A., Benute, G., Nomura, R., Santos, N., DeLucia, M., & Francisco, R. (2015). Pica and eating attitudes: A study of high-risk pregnancies. Maternal and Child Health Journal, 20(3), 557-582. doi: 10.1007/s10995-015-1856-1
9. Rabel, A., Leitman, S., & Miller, J. (2016). Ask about ice, then consider iron. Journal of the American Association of Nurse Practitioners, 28(2), 116-120. doi: 10.1002/2327- 6924.12268