Why do they call it morning sickness when I feel nauseated all day long?
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"Morning
sickness" is a misnomer. (In fact, the technical medical term is
"nausea and vomiting of pregnancy.") For some pregnant women, the
symptoms are worst in the morning and ease up over the course of the day, but
they can strike at any time and, for most women, last all day long. The
intensity of symptoms can vary from woman to woman, too.
Overall, this condition
affects about three quarters of pregnant women during the first trimester.
About half of all pregnant women suffer from both nausea and vomiting, one
quarter has nausea alone, and one quarter lucks out altogether. The nausea
usually starts around 6 weeks of pregnancy, but it can begin as early as 4
weeks. It tends to get worse over the next month or so.
About half of the women
who get nausea during pregnancy feel complete relief by about 14 weeks. For
most of the rest, it takes another month or so for the queasiness to ease up,
though it may return later and come and go throughout pregnancy. Unfortunately,
for a small percentage of women symptoms persist continually (or nearly so)
until delivery.
Of course, just because
morning sickness is common – and likely to last "only" a few months –
doesn't mean it's not a challenge. Even a mild case of nausea can wear you
down, and bouts of round-the-clock nausea and vomiting can leave you exhausted
and miserable. Talk with your caregiver about your symptoms and the
possibilities for relief.
What causes nausea and vomiting during pregnancy?
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's a prime suspect because the timing is right: Nausea tends
to peak around the same time as levels of hCG. What's more, conditions in which
women have higher levels of hCG, such as carrying multiples, are associated
with higher rates of nausea and vomiting.
·
Estrogen: This hormone, which also rises
rapidly in early pregnancy, is another suspect. (It's possible that other
hormones play a role as well.)
·
An enhanced sense of smell and
sensitivity to odors. It's not uncommon for a newly pregnant woman to feel
overwhelmed by the smell of a bologna sandwich from four cubicles away, for
example. Certain aromas instantly trigger the gag reflex. (Some researchers
think this may be a result of higher levels of estrogen, but no one knows for
sure.)
·
A tricky stomach. Some women's
gastrointestinal tracts are simply more sensitive to the changes of early
pregnancy. Also, some research suggests that women with a stomach bacterium
called Helicobacter pylori are more likely to have severe or
long-lasting nausea and vomiting. Not all studies confirm this link, though.
Some
researchers have proposed that certain women are psychologically predisposed to
having nausea and vomiting during pregnancy as an abnormal response to stress.
However, there's no conclusive evidence to support this theory. (Of course, if
you're constantly nauseated or vomiting a lot, you certainly may begin to feel
more stressed!)
Are some pregnant women more likely than others to feel nauseated?
·
You're more likely to
have nausea or vomiting during your pregnancy if any of the following apply:
·
You're pregnant with
twins or higher multiples. This may be from the higher levels of hCG, estrogen,
or other hormones in your system. You're also more likely to have a more severe
case than average. On the other hand, it's not a definite thing – some women
carrying twins have little or no nausea.
·
You had nausea and
vomiting 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 a history of
motion sickness.
·
You have a genetic
predisposition to nausea during pregnancy. If your mother or sisters had severe
morning sickness, there's a higher chance you will, too.
·
You have
a history of migraine headaches.
·
You're carrying a girl.
One study found that women with severe nausea and vomiting in the first
trimester were 50 percent more likely to be carrying a girl.
Will my nausea affect my baby?
The mild to moderate
nausea and occasional vomiting commonly associated with morning sickness won't
threaten your baby's well-being. If you don't gain any weight in the first
trimester, it's generally not a problem as long as you're able to stay hydrated
and aren't starving yourself. In most cases, your appetite will return soon
enough and you'll start gaining weight.
If nausea keeps you from eating a balanced diet, make sure you're getting the nutrients
you need by taking a prenatal
vitamin. Choose one with a low dose of iron or no iron if that
mineral makes your nausea worse.
Severe and prolonged vomiting, however, has been linked to a greater risk of
preterm birth, low birth weight, and newborns who are small for their
gestational age. However, a large study of women who were hospitalized with
severe vomiting found that those who were able to gain at least 15.4 pounds (7
kilograms) during their pregnancy had no worse outcomes than other women.
If I don't have morning sickness,
does that mean I'm more likely to have a miscarriage?
Not necessarily. It's
true that a number of studies have shown that women who havemiscarriages are less likely to have
had nausea. (If your baby or your placenta were not developing properly, you'd
have lower levels of pregnancy hormones in your system, so if that's what
causes nausea, it follows that you'd have less.)
But there are plenty of women with perfectly normal pregnancies who have little
or no nausea during their first trimester. Count yourself lucky and don't
obsess about it if you're not suffering!
What can I do to get relief?
If you have a
mild case of nausea and vomiting, some relatively simple measures may be enough
to help. (If not, there are safe and effective medications you can take.) Many
of the following suggestions are not supported by hard evidence, but
obstetricians and midwives commonly recommend them, and many women swear by
them.
·
Eat small, frequent meals and snacks
throughout the day so your stomach is never empty. Some women find that
carbohydrates are most appealing when they feel nauseated, but one small study
found that high-protein foods were more likely to ease symptoms.
·
Keep simple snacks, such as crackers, by
your bed. When you first wake up, nibble a few crackers and then rest for 20 to
30 minutes before getting up. Snacking on crackers may also help you feel
better if you wake up nauseated in the middle of the night.
By the way,
getting up slowly in the morning – sitting on the bed for a few minutes rather
than jumping right up – may also be helpful.
·
Try to avoid foods and smells that
trigger your nausea. If that seems like almost everything, it's okay to eat the
few things that do appeal to you for this part of your pregnancy, even if they
don't add up to a perfectly balanced diet.
·
It might also help to stick to bland
foods. Also try to eat food cold or at room temperature, because food tends to
have a stronger aroma when it's hot.
·
Avoid fatty foods, which take longer to
digest. Also steer clear of rich, spicy, acidic, and fried foods, which can
irritate your digestive system.
·
Try drinking fluids mostly between
meals. And don't drink so much at one time that your stomach feels full, as
that will make you less hungry for food. A good strategy is to sip fluids
frequently throughout the day. You might find cold, carbonated beverages
easiest to keep down.
·
Aim to drink about a quart and a half
altogether. If you've been vomiting a lot, try a sports drink that contains
glucose, salt, and potassium to replace lost electrolytes.
·
Watch for non-food triggers, too. A warm
or stuffy room, the smell of heavy perfume, a car ride, or even certain visual
stimuli, like flickering lights, might set you off. Avoidance of triggers can
become an important part of your treatment.
·
Nausea can become worse if you're tired,
so give yourself time to relax and take naps if you can. Watching a movie
(preferably not one about food!) or visiting with a friend can help relieve
stress and take your mind off your discomfort.
·
Try hypnosis – while there's no
definitive evidence that it helps with morning sickness, it has been shown to
be effective in combating nausea during chemotherapy.
·
Try taking your prenatal
vitamins with food or just before bed. You
might also want to ask your healthcare provider whether you can switch to a
prenatal vitamin with a low dose ofiron or no iron for the first trimester, since this
mineral can be hard on your digestive system.
·
Try ginger, an alternative remedy
thought to settle the stomach and help quell queasiness. See if you can find
ginger ale made with real ginger. (Most supermarket ginger ales aren't.) Grate some
fresh ginger into hot water to make ginger tea, or see if ginger candies or
crystallized ginger helps.
Research
shows that taking powdered ginger root in capsules may provide some relief.
Unfortunately, there's no way to be sure how much of the active ingredient
you're getting in ginger supplements, so be sure to talk to your provider
before taking them. (As with many other things that are helpful in small
amounts, the effects of megadoses are unknown.)
·
Try an acupressure band, a soft cotton
wristband that's sold at drugstores. You strap it on so that the plastic button
pushes against an acupressure point on the underside of your wrist. This simple
and inexpensive device, designed to ward off seasickness, has helped some
pregnant women through morning sickness – although research suggests that it
may be largely a placebo effect.
·
Ask your provider about a device that
stimulates the underside of your wrist with a mild electric current. This
"acustimulation" device is safe, though it can cause local skin irritation.
(Be sure to use the gel that comes with it to help prevent this from
occurring.)
There is some
research showing that acustimulation may help. That said, there's certainly no
guarantee it will work for you, and these devices cost between $60 and $140 and
are generally not covered by insurance.
If
you've been unable to find relief from your nausea, talk with your provider
about options for medication. There's no need to continue to suffer, and
waiting too long to take appropriate medication may make your condition more
difficult to treat.
Your
provider will likely suggest that you try taking vitamin B6. No one knows why B6 eases nausea in some expectant
mothers, but research indicates that it works for some women, and it's
consistently been shown to be safe when taken in commonly recommended doses.
The usual dose for treating morning sickness is 10 to 25 milligrams three times
a day, but check with your provider before taking anything. She can tell you
how much to take and whether the amount in your prenatal vitamin should count
as one of the doses. (The amount of vitamin B6 in prenatal supplements varies
by brand.)
Don't take more vitamin B6 than your caregiver 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.
By the
way, while it won't help you now, if you plan to get pregnant again, make sure
to be taking a multivitamin at the time of conception and in early pregnancy.
It may help prevent severe morning sickness, though no one knows why.
What if I
just can't keep anything down?
Call
your provider if you haven't been able to keep anything (including fluids) down
for 24 hours – or sooner if your urine is dark and strong smelling and you're
peeing very infrequently (less than every 4 to 6 hours).
You
should also contact your caregiver if you vomit blood, have a fever or
abdominal pain, or if you feel extremely weak or faint. (If you're newly
pregnant and don't yet have a doctor or midwife, go to the emergency room.)
About
1 percent of pregnant women suffer from a condition called hyperemesis gravidarum —
literally, "excessive vomiting in pregnancy." 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.
Your caregiver will probably want to give you some intravenous fluids right
away, since you'll most likely be seriously dehydrated. Then she'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 IV fluids
and medication.
Many women feel much better after they're rehydrated and are able to control
their symptoms with anti-nausea-medication. In
rare cases, you'll need to continue to receive intravenous therapy on and off
either 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. For more information, visit theHyperemesis Education and Research Foundation website.
