Morning sickness and nausea during pregnancy

What is morning sickness?

Morning sickness is a feeling of nausea, sometimes accompanied by vomiting, that many women have during pregnancy – usually in the first trimester. In fact, at least 70 percent of pregnant women have morning sickness during pregnancy.

The condition is common and, unless very severe, does not pose a threat to you or your baby. But it can make life miserable and become a problem if you can't keep food or fluids down and begin to lose weight.

Morning sickness usually starts around the fifth or sixth week of pregnancy and tends to get worse during the next month or so. It goes away for most women by around 14 to 20 weeks of pregnancy.

Scientists believe that morning sickness may be the body's way of protecting a fetus in early pregnancy from toxins and potentially dangerous foods. This theory makes sense because the first trimester – when most women have the strongest morning sickness – is the crucial period of development when all of a baby's organs and physical structures form.

Morning sickness symptoms

Women with morning sickness can experience:

• Nausea (a feeling of queasiness)
• Vomiting
• Retching (dry heaving without bringing anything up)
• Excessive salivation

If your nausea and vomiting are so severe that you can't keep anything down – including water, juice, food, prenatal vitamins, or medications – you may have hyperemesis gravidarum. In this case, you may need to be treated with IV fluids and medications in the hospital.

Talk to your doctor or midwife immediately if:

• You lose 2 pounds or more.
• You develop nausea and vomiting after 9 weeks of pregnancy.
• You have nausea and vomiting after 20 weeks of pregnancy.
• You vomit blood.
• You feel dizzy when you stand.
• You have signs of dehydration, including dark urine or infrequent urination.
• You have abdominal pain, fever, headache, or swelling in the front of the neck.
• You can't keep down any liquids for 12 hours or any solids for 24 hours.

Is it normal to have morning sickness all day?

Yes, morning sickness can happen anytime and, for many women, lasts all day. There's a wide range of normal: Some women with morning sickness feel symptoms constantly, while for others morning sickness is worse in the morning and eases up later. And some women feel okay during the day and have morning sickness at night.

Is it normal to have morning sickness all through pregnancy?

It's uncommon, but a small number of expecting moms have morning sickness that lasts into the second – and even third – trimester.

Talk to your healthcare provider if your nausea or vomiting lasts beyond 20 weeks of pregnancy. Lingering morning sickness can make you miserable, and a very severe case can lead to dehydration and prevent you from gaining a healthy amount of weight.

Occasionally nausea and vomiting can be a sign of another medical problem, not pregnancy, so it's a good idea to get unusually long-lasting morning sickness checked out. (This is especially important if your morning sickness has started back up again after being gone for a few weeks.)

What causes morning sickness?

No one knows for sure what causes nausea during pregnancy, but it's probably some combination of the many physical changes taking place in your body. Some possible causes include:

• Human chorionic gonadotropin (hCG). This hormone rises rapidly during early pregnancy. No one knows how hCG contributes to nausea, but it seems especially likely that it does because the timing is right: Nausea tends to peak around the same time as levels of hCG. What's more, other conditions that cause a higher level of hCG, such as carrying multiples, are also associated with higher rates of nausea and vomiting.
• Estrogen. Estrogen is another possible cause because it also rises rapidly in early pregnancy. A surge in estrogen may be responsible for the enhanced sense of smell and sensitivity to odors (and resulting food aversions) that many women experience in the first trimester.
• A sensitive stomach. Some women's digestive tracts are more sensitive to the changes of early pregnancy. Also, some research suggests that women with Helicobacter pylori bacteria in their stomach are more likely to have nausea and vomiting. However, not all studies confirm this link.
• Genetics. Two genes involved in the development of the placenta (GDF15 and IGFBP7) have been linked to hyperemesis gravidarum, the most severe form of morning sickness. Researchers at UCLA found that women with hyperemesis gravidarum had abnormally high levels of proteins expressed by these genes. They're now trying to figure out if these protein levels can be changed as a way to treat severe morning sickness.
• Pregnant with multiples. If you're pregnant with twins or higher multiples, you're more likely to experience nausea or vomiting during pregnancy. This may be from the higher levels of hCG, estrogen, or other hormones in your system. You're also more likely to have severe morning sickness. On the other hand, it's not definite – some women carrying twins have little or no nausea.

Is morning sickness a good sign?

It may be. A number of studies have found a lower rate of miscarriage among women with morning sickness or hyperemesis gravidarum. But plenty of women with perfectly normal pregnancies have little or no nausea during their first trimester.

If your baby or your placenta wasn't developing properly, you'd have lower levels of pregnancy hormones in your system. So if hormones are what causes nausea, morning sickness could be a sign that your body is doing what's needed to support your pregnancy. That doesn't make it any more enjoyable, though!

Morning sickness remedies

Simple changes and strategies may help to relieve morning sickness symptoms, especially if you have a mild case. But if they don't work for you, let your healthcare provider know. Some women hesitate to seek treatment for morning sickness because they're concerned that medications could harm their baby. But there are many morning sickness remedies that are safe and effective – dietary and lifestyle changes as well as medications.

Home remedies and alternative therapies for morning sickness

If you have a mild case of nausea and vomiting, these strategies may help:

• Avoid triggers such as heat, strong food odors, and fragrances. Fried, fatty, and spicy foods can also trigger nausea.
• Eat small meals often: An empty stomach can make nausea worse, so eat five or six small meals a day. Before you get out of bed, eat a small snack such as dry toast or crackers.
• Sip cold, fizzy beverages. Use a straw if that helps. Ginger ale made with real ginger can ease nausea. Some women also find sour drinks, such as lemonade, appealing.
• Try peppermint or ginger hard candy. Sucking on hard candies may help. Some women also get relief from ginger or peppermint tea, which is usually safe in pregnancy.
• Take your vitamin at night. Taking your prenatal vitamin with food right before you go to sleep may reduce nausea. If you still get nauseated, ask your provider to recommend a different prenatal vitamin.
• Aromatherapy: Scents such as citrus or peppermint may ease your nausea. Use a diffuser to fill the room with the scent of citrus or mint essential oil, or place a drop or two on a handkerchief that you carry with you to sniff whenever you start to feel queasy. (Essential oils are very strong, so use very little.)
• Acupressure bands: This soft cotton wristband is often sold at drugstores. When you put it on, a plastic button pushes against an acupressure point on the underside of your wrist. Designed to prevent seasickness, these have helped some pregnant women through morning sickness, although research suggests that it may be largely a placebo effect.
• Acupuncture: Consider seeing an acupuncturist who has experience treating nausea during pregnancy.
• Acustimulation: Ask your provider about this therapy, which uses a device to stimulate the underside of your wrist with a mild electric current. The device is safe for pregnant women, though it can cause irritation where it touches the skin. (It often comes with gel to prevent this.) Though acustimulation isn't widely used, there is some research showing that it may help.
• Hypnosis: Although there's no definitive evidence that it helps with morning sickness, it has been shown to be effective in combating nausea during chemotherapy.

Morning sickness medicine

If natural morning sickness remedies don't help, ask your provider about anti-nausea medicines. Several supplements and medications are considered safe to take for morning sickness.

Over-the-counter (OTC) medicines:

• Vitamin B6. Taking vitamin B6 (also known as pyridoxine) has been shown to relieve nausea in some pregnant women. It's safe and available over the counter. But before taking vitamin B6, check with your provider to find out how much to take and whether the amount in your prenatal vitamin counts as one of the doses. Your provider may suggest that you start by taking 10 to 25 mg, three or four times a day.
• Doxylamine is found in over-the-counter sleep aids like Unisom, and it's also used to treat nausea and vomiting during pregnancy.
• Combination vitamin B6 and doxylamine is often recommended as an initial treatment for morning sickness. Your provider can recommend an OTC dose, or may prescribe prescription versions sold under the brand names Diclegis and Bonjesta (extended release).
• Reflux medicines such as Pepcid sometimes help if your nausea is triggered by heartburn.

Prescription medicines:

Your provider may prescribe one of the medications below if other treatments aren't effective.

• Metoclopramide (Reglan)
• Promethazine (Phenergan)
• Prochlorperazine (Compazine)
• Trimethobenzamide (Tigan)
• Ondansetron (Zofran): Safety data on ondansetron has been inconsistent. Some studies suggest it's linked to a slight increase in the risk of cleft palate or heart defects in babies born to women who took the drug during early pregnancy. Other studies have found an overall low risk. Given this data, many doctors prescribe ondansetron after 10 weeks, when the above structures have formed.

Foods for morning sickness

Certain types of food may help reduce your nausea – or at least be less likely to make you feel sick:

• High-protein foods: Foods high in protein such as nuts, lean meat, eggs, tofu, and yogurt may help settle your stomach.
• Complex carbohydrates: Think whole-grain breads, brown rice, whole-wheat pasta, and starchy vegetables.
• Foods with vitamin B6: Nuts, green beans, carrots, cauliflower, potatoes, lean meats, and fish are good sources of this vitamin, which has been shown to ease nausea in some women.
• Bland foods: Try the BRATT diet – that's bananas, rice, applesauce, toast, and tea. Not only are these foods mild in flavor, they're also easy to digest. (Bananas are also high in nausea-fighting B6.)
• Cold food: Cooking smells can bring on bouts of nausea, so cold meals may be more appealing until your morning sickness passes.
• Food made by others: Again, because cooking can bring on nausea, some women find it easier to eat food they haven't prepared themselves. Get takeout from a market or restaurant, or ask a loved one to make your meal.