Morning Sickness

October 31, 2011
Bradley G. Goldberg, MD
Bradley G. Goldberg, MD

Of all the aches, pains, and discomforts of pregnancy, morning sickness is probably one of the most dreaded. Up to 80% of all pregnancies will be affected by some degree of nausea and vomiting. Although this can happen at any time during the day, the mornings tend to be especially troublesome for most pregnant women. Although the exact cause is not known for sure, most likely it is related to the rising levels of hormones associated with the pregnancy.

Of all the aches, pains, and discomforts of pregnancy, morning sickness is probably one of the most dreaded. Up to 80% of all pregnancies will be affected by some degree of nausea and vomiting. Although this can happen at any time during the day, the mornings tend to be especially troublesome for most pregnant women. Although the exact cause is not known for sure, most likely it is related to the rising levels of hormones associated with the pregnancy.

The condition is usually temporary ending close to the 16th week (4th month) of pregnancy, although some unfortunate souls must endure for much longer. Fortunately, the majority of women who experience this condition are affected only mildly. Even so, up to one-half of employed women feel that their work is adversely affected, and 25% will actually require time off from work. One out of twenty women are affected so severely that they experience weight loss, dehydration, and electrolyte disturbances to such a degree that hospitalization may be required. This severe condition is referred to as hyperemesis gravidarum. If it persists, your doctor may want to run tests on your gallbladder, thyroid, pancreas, stomach or liver.

But please do not let this disturb you, because treatment is available. For women experiencing only mild symptoms it is recommended that you eat several small meals per day, instead of the usual three big meals. Also avoid fatty, or fried foods, and avoid smells that can sometimes trigger the nausea. It is a good idea to carry saltines or graham crackers in your purse. Munch on these during the day to prevent your stomach from becoming totally empty, which could also increase the nausea. If these measures do not work then your doctor can prescribe some anti-nausea medications, but these usually cause drowsiness and should only be used under close physician supervision.

There are also "alternative" therapies which are currently being discussed in the media. These include acupressure, vitamin B6, and hypnosis. The acupressure therapy involves putting pressure on the "Neiguan" point which is located about three inches below the wrist. This can be done manually four times a day, for 5-10 minutes at a time, or through the use of special wrist bands which are also popular for sea-sickness (Sea-Bands, Sea Band International, Greensboro, NC). One good aspect of this technique is that there is no risk involved for the fetus.

The use of vitamin B6 is controversial, but it does appear that a short course of 25mg every 8 hours for 3 days does improve symptoms in some women, although I wouldn’t recommend its use without your physicians approval. Another interesting herbal remedy is ginger. Ginger does appear to relieve nausea in some people, however there is a theoretic possibility that it could affect certain steroids in the fetal brain, and I can not recommend its use during pregnancy until further studies are done.

In summary, although most women will experience some degree of nausea and vomiting with their pregnancies, the vast majority of these cases are mild and temporary. For those women experiencing severe symptoms, your physician can provide therapy. "Alternative" therapy also exists, but, with the exception of acupressure over the Neiguan point, further studies need to be performed before they can be considered safe. Please discuss these treatments with your doctor before using them.

 

References:

Bibliography

1. Williams Obstetrics, 20th Edition, F. Gary Cunningham,M.D. et.al., Appleton & Lange, Stamford, Connecticut, 1997.

2. Alternative Therapies For Nausea And Vomiting of Pregnancy, Murphy, P.A., Obstet Gynecol 1998;91:149-55.

3. Acupressure For Nausea and Vomiting of Pregnancy: A Randomized, Blinded Study, Belluomini, J. et. al., Obstet Gynecol 1994;84:245-8.