Overview
Morning sickness is nausea and vomiting seen in early pregnancy. Although it is called "morning sickness," it can occur at any time of day. It affects 80% of pregnant women.
It usually begins at week 6, peaks at weeks 9-12, and resolves by week 14. It is not harmful to the mother or the baby; however, its severe form (hyperemesis gravidarum) requires treatment.
Symptoms
- Nausea (morning, throughout the day, or at night)
- Vomiting
- Loss of appetite
- Sensitivity to certain smells, foods
- Cravings for certain foods
- Fatigue
- Increased saliva
Hyperemesis gravidarum (severe form):
- Severe, persistent vomiting
- Inability to keep water down
- Weight loss of more than 5%
- Dehydration
- Ketosis
- May require hospitalization
Causes
The exact cause is unknown; however, the increase in pregnancy hormones (hCG, estrogen) is seen as the main factor. Low blood sugar, slow gastric emptying, and heightened sense of smell also play a role.
Risk Factors
- First pregnancy
- Multiple pregnancy
- Morning sickness in previous pregnancy
- Family history of morning sickness
- Migraine history
- Motion sickness history
- High hCG (molar pregnancy)
- Young maternal age
- Obesity
When to See a Doctor
- Severe, persistent vomiting
- Inability to keep water or fluids down
- More than one episode of vomiting in 12 hours
- Signs of dehydration (low urine output, dark urine, dizziness)
- Weight loss (over 5%)
- Rapid heartbeat
- Bloody vomit
- Severe abdominal pain
- Nausea starting after 14 weeks
Diagnosis and Treatment
Diagnosis: Clinical findings are sufficient. In severe cases, urine/blood tests (electrolytes, ketones).
Treatment:
1. Lifestyle:
- Small, frequent meals
- Avoid being hungry
- Dry crackers, toast (before getting out of bed in the morning)
- Avoid triggering smells
- Plenty of fluids (sip by sip)
- Ginger (tea, capsule, biscuits)
- Vitamin B6
- Avoid fatty, spicy foods
2. Medications:
- Vitamin B6 (pyridoxine)
- Doxylamine-B6 combination
- Antihistamines (meclizine, dimenhydrinate)
- Metoclopramide
- Ondansetron (severe)
- IV fluids, electrolytes in severe cases
Hyperemesis gravidarum:
- Hospitalization
- IV fluids, electrolytes
- Antiemetics
- Nutritional support if needed
Recommendations
- Get up slowly in the morning
- Eat crackers before getting out of bed
- Eat small and frequent meals
- Consume fluids between meals (not with meals)
- Stay away from triggering smells
- Get plenty of rest
- Manage stress
- You can try acupressure wristbands