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Morning sickness

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•	Nausea and vomiting
•	Hyperemesis gravidarum
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Morning sickness

Definition

Morning sickness refers to nausea and vomiting that can actually occur at anytime of the day during pregnancy.

For severe, persistent vomiting during pregnancy, see hyperemesis gravidarum. For general information on pregnancy, see pregnancy care.

Alternative Names

Considerations

Morning sickness is very common. Most pregnant women have at least some nausea, and about a third have vomiting. Morning sickness usually begins during the first month of pregnancy and continues until the 14th to 16th week. Some women have nausea and vomiting through their entire pregnancy.

Morning sickness does not hurt the baby in any way unless persistent weight loss occurs, such as with the severe vomiting of hyperemesis gravidarum. The degree of morning sickness during one pregnancy does not predict how you will feel in future pregnancies.

Causes

The exact cause of morning sickness is unknown. It may be caused by hormonal changes or lower blood sugar during early pregnancy. Emotional stress, traveling, or some foods can aggravate the problem.

Home Care

Try to maintain a positive attitude. Remember that morning sickness usually stops after the first 3 or 4 months of pregnancy. To minimize nausea, try:

• A few soda crackers or dry toast when you first wake up, even before you get out of bed in the morning.
• A small snack at bedtime and when getting up to go to the bathroom at night.
• Avoiding large meals; instead, snack as often as every 1-2 hours during the day and drink plenty of fluids.
• Eating foods high in protein and complex carbohydrates, such as peanut butter on apple slices or celery; nuts; cheese; crackers; milk; cottage cheese; and yogurt; avoid foods high in fat and salt, but low in nutrition.
• Ginger products (proven effective against morning sickness) such as ginger tea, ginger candy, and ginger soda

Here are some more tips:

• When you feel nauseated, bland foods like gelatin, broth, ginger ale, and saltine crackers can soothe your stomach.
• Take your prenatal vitamins at night. Increase vitamin B6 in your diet by eating whole grains, nuts, seeds, and legumes. Talk to your doctor about possibly taking vitamin B6 supplements.
• Keep rooms well-ventilated to reduce odors.
• Avoid smoking and secondhand smoke.
• Avoid taking medications for morning sickness. If you do, consult a doctor first.
• Acupressure wrist bands or acupuncture may help. You can find these bands in drug, health food, and travel stores. If considering acupuncture, talk to your doctor and seek an acupuncturist trained to work with pregnant women.

When to Contact a Medical Professional

Call your doctor if:

• Morning sickness does not improve, despite trying home remedies.
• You vomit blood or material that looks like coffee grounds. (Call IMMEDIATELY.)
• You lose more than 2 pounds.
• You vomit more than 3 times per day or you cannot keep food or liquid down.
• Nausea and vomiting continue beyond your 4th month of pregnancy. This happens to some women and is usually normal, but have it checked out.

What to Expect at Your Office Visit

Your doctor will perform a physical examination, including a pelvic exam, and look for any signs of dehydration.

Your doctor may ask the following questions:

• Are you only nauseated or do you also vomit?
• Does the nausea and vomiting occur every day?
• Does it last throughout the day?
• Can you keep down any food or fluid?
• Have you been traveling?
• Has your schedule been disrupted?
• Are you emotionally stressed?
• What foods have you been eating?
• Do you smoke?
• What have you done to try to feel better?
• What other symptoms do you have -- headaches, abdominal pain, breast tenderness, dry mouth, excessive thirst, unintentional weight loss?

Diagnostic tests that may be performed include:

• Blood tests including CBC and blood chemistry (chem-20)
• Urine analysis for ketones and severity of dehydration

References

Heinrichs L. Linking olfaction with nausea and vomiting of pregnancy, recurrent abortion, hyperemesis gravidarum, and migraine headache. Am J Obstet Gynecol. 2002; 186(5 Suppl Understanding): S215-S219.

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

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