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Understanding Nausea and Vomiting During Pregnancy

Morning Sickness Can Happen Anytime: Day or Night

It is estimated that half of all pregnant women experience nausea and vomiting in pregnancy, twenty five percent of pregnant women will experience nausea only and the other twenty five percent are happily unaffected by any symptoms. In subsequent pregnancies symptoms recur anywhere from 15.2% to 81%. 

Because it is so common, many women suffer in silence, thinking there is nothing that can be done to alleviate it for fear that medications are unsafe.  It can start as soon as six weeks since your last menstrual period and often coincides with severe fatigue. 

If nausea and vomiting start after the ninth week, you must consider alternative diagnoses such as an infection, food poisoning, thyroid dysfunction, gallbladder, or an appendix attack and discuss with your Midwife or Doctor.

 

What Causes Nausea and Vomiting in Pregnancy?

The culprit is the pregnancy hormone called human chorionic gonadotropin (HCG) that surges in the bloodstream as soon as the placenta develops a good blood supply. The first-trimester surge is dramatic, but the levels stay high in the second and third trimester. Most women become accustomed to the high HCG levels, and the symptoms go away. 

It is considered a disease or serious medical condition when it becomes so severe that the woman cannot maintain body weight or take in fluids without vomiting. In that case, it is called hyperemesis gravidarum and often requires hospitalization for IV fluids and nutrition. Medications are needed to control the condition.

 

How to Minimise the Symptoms of Sickness in Pregnancy

There are simple measures to ease the symptoms of morning sickness, and the main one is eating small, frequent, and bland meals. Crackers, bread, broths, and lean meats are helpful. Stay clear of greasy and spicy foods. Avoid odors that trigger nausea. 

Drink plenty of water or some form of hydration because dehydration makes it worse.

Interestingly, it is recommended that before conceiving, a woman should start taking prenatal vitamins for both the prevention of nausea and vomiting and because the folate in the vitamin reduces the risk of a neural tube defect.

Ginger, peppermint, and sea bands have been advocated for women who do not want to take medications. Sea bands (a form of acupressure) are worn around the wrists and place pressure on the nerves that supply the hand. The brain receives this pressure signal via the nerves, and that signal acts to interfere with other nerve firings that are linked to nausea, thus tricking the body into not feeling nauseated. The problem is that the sea bands can actually hurt a bit due to the continued pressure, but most people would rather deal with mild pain than nausea.

Other unproven remedies include spices such as cinnamon, fennel powder, and cumin. Citrus odors from sliced lemons may help some women.

Other medications include the common OTC drugs for motion sickness, and prescription drugs called ondansetron and metoclopramide.  

The FDA has approved one drug for morning sickness that contains pyridoxine (vitamin B6) and doxylamine (an anti-motion sickness drug). OB/GYNs have been prescribing these two medications ‘off-label’ for years due to its safety profile that was in debate for some years. Now, it is available as Diclegis (formerly Bendectin from 1956 through 1983).

The study that supported FDA approval was based on 261 women experiencing nausea and vomiting who were randomized to treatment or placebo. After two weeks, the women on the drug did better than those not on it, and the only side effect was drowsiness.

 

How Sick is Too Sick When You Are Pregnant?

In rare cases, women cannot keep anything down and lose weight. As described above, it is called hyperemesis gravidarum. Hospitalization, IV fluids and steroids, and other medications may be needed. 

Although morning sickness is a common issue in the first trimester, there is no need to soldier on silence. Talking about it to friends and family won’t ease the feeling but their support will feel like a blanket of comfort especially when served with  TLC, ginger biscuits and fresh lemon tea!  And if symptoms become too much ask your healthcare provider to recommend treatment for you. |

 

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Author Bio:

Kimberly Langdon M.D.

Kimberly Langdon M.D.

Kimberly Langdon is a Doctor of Medicine and graduated from The Ohio State University in 1991. She completed her residency in Obstetrics and Gynecology at The Ohio State University Hospitals, Department of OB/GYN. Board-Certified in 1997, she is now retired from clinical practice after a long and successful career. Currently, she is the Founder and Chief Medical Officer of a Medical Device Company that is introducing a patented product to treat vaginal microbial infections without the need for drugs. She is an expert in Vaginal Infections, Menstrual disorders, Menopause, and Contraception.

References

https://www.medscape.org/viewarticle/849796

Dean E. Morning sickness. Nurs Stand. 2016;30(50):15. doi:10.7748/ns.30.50.15.s16

Practice Bulletin Summary No. 153: Nausea and Vomiting of Pregnancy. Obstet Gynecol. 2015;126(3):687-688. doi:10.1097/01.AOG.0000471177.80067.19

Quinla JD, Hill DA. Nausea and vomiting of pregnancy. Am Fam Physician. 2003;68(1):121-128.

Strong TH Jr. Alternative therapies of morning sickness. Clin Obstet Gynecol. 2001;44(4):653-660. doi:10.1097/00003081-200112000-00005

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Darcey Croft

Darcey Croft

Darcey Croft is a Registered Midwife with the Nursing and Midwifery Council of Great Britain. Since graduating from the Florence Nightingale School of Nursing & Midwifery she has worked in all areas of obstetrics, supporting mothers in their pregnancies and delivering countless babies. Her current role is Perinatal Mental Health team leader for the county of Buckinghamshire, England. She has undertaken a Masters degree in Advanced Clinical Practice and has a medical diploma in Clinical Hypnotherapy. Darcey is an expert in Perinatal Mental Health with a focus on reducing stress in pregnancy and birth.

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