MORNING SICKNESS

Morning sickness, a well-known but often misunderstood condition, affects many pregnant women, particularly in the early stages of their pregnancy. It refers to nausea and vomiting during pregnancy, affecting over half of pregnant women, primarily in the first trimester. Despite its name, morning sickness can occur at any time of day. It is not harmful to the baby and is often linked to hormonal changes in the body.

Causes of Morning Sickness

Morning sickness is primarily caused by the hormonal changes that occur during pregnancy. The surge in human chorionic gonadotropin (hCG) and estrogen levels are believed to play significant roles. Additionally, factors such as increased sensitivity to odors, an enhanced sense of smell, and gastrointestinal changes contribute to the onset of nausea and vomiting. The exact mechanism remains unclear, but these hormonal and physical changes collectively trigger the symptoms.

Prevalence

Morning sickness is highly prevalent, affecting up to 70-80% of pregnant women. It commonly begins around the sixth week of pregnancy and usually subsides by the end of the first trimester. However, for some women, it can persist throughout the entire pregnancy.

Symptoms

General symptoms of morning sickness include:

Nausea with or without vomiting: Often occurs during the first trimester and can feel similar to motion sickness.
Timing: Nausea typically occurs in the morning but can resurface at any time of the day or persist all day.
Triggers: Certain foods, odors, and even heat can provoke nausea.
After Eating: Spicy foods or meals can exacerbate nausea.
Severe Salivation: Excessive salivation can sometimes accompany nausea.

Severe Morning Sickness: Hyperemesis Gravidarum

Hyperemesis gravidarum is a severe form of morning sickness characterized by:

Severe Nausea and Vomiting: Leads to dehydration and significant weight loss (more than 5% of pre-pregnancy body weight).
Nutrient Deficiency: Can result in malnourishment.
Hospitalization: In severe cases, hospitalization may be required for intravenous fluids, medications, and possibly a feeding tube.

Risk Factors

Several factors can increase the likelihood of experiencing morning sickness:

Previous Pregnancy: Having experienced morning sickness in a previous pregnancy.
Sensitive Stomach: Pre-existing conditions such as motion sickness, migraines, or sensitivity to certain smells or tastes. Also, a history of nausea when using birth control pills.
Multiple Pregnancies: Being pregnant with twins or other multiples, which results in higher levels of hCG.

For hyperemesis gravidarum, the severe form of morning sickness, the risk factors include:

Expecting a Girl: Women carrying female fetuses have a slightly higher risk.
Family History: A family history of hyperemesis gravidarum increases the likelihood.
Previous Hyperemesis Gravidarum: Having experienced this condition in a previous pregnancy.

Diagnosis

Diagnosing morning sickness generally involves a review of symptoms. If hyperemesis gravidarum is suspected, doctors may order additional tests, such as:

Urine Tests: To check for ketones, which indicate dehydration and malnutrition.
Blood Tests: To assess electrolyte levels, kidney function, and to rule out other potential causes of severe nausea and vomiting.

Treatments

Medical Treatment

For moderate to severe morning sickness, medical interventions may include:

Vitamin B6 Supplements: Pyridoxine, a form of vitamin B6, can help alleviate nausea.
Natural Remedies: Ginger, whether in the form of supplements or ginger tea, is known for its anti-nausea properties.
Over-the-Counter Drugs: Doxylamine (Unisom) is an antihistamine that can be effective in reducing nausea.
Prescription Medications: If symptoms persist, your doctor may prescribe stronger anti-nausea medications.
Fluid Replacement: In severe cases leading to dehydration, intravenous fluids may be necessary.

Treatment for Hyperemesis Gravidarum

In cases of hyperemesis gravidarum, hospitalization may be required for:

Intravenous Fluids: To address dehydration and malnutrition.
Anti-nausea Medications: Prescribed to manage severe nausea and vomiting.
Corticosteroids: These may be used in some cases to alleviate symptoms.

Home Care Tips

You can also try these home remedies to manage morning sickness:

Frequent Small Meals: Eating five or six small meals instead of three large ones can help.
Multivitamins: Take them regularly, but avoid doing so on an empty stomach.
Avoid Triggering Smells: Stay away from odors that exacerbate nausea.
Bland Foods: Start your day with saltine crackers, dry toast, or dry cereal to ease stomach discomfort.
Hydration: Sip on water, tea, or clear sodas throughout the day to stay hydrated.
Fresh Air: Spending time outdoors or opening a window can provide relief.
Rinsing After Vomiting: Rinse your mouth with water (or a baking soda solution) to protect your teeth from stomach acid.
Acupressure Bands: Some women find relief from nausea by using acupressure wristbands.
Aromatherapy: Certain scents like lavender may help alleviate nausea.
Ginger Supplements: Herbal ginger supplements can be effective, but consult with your doctor first.
Essential Oils: Some women find relief from nausea through the use of calming scents like lavender.
Hypnosis: Hypnotherapy might offer relief from nausea in some cases.

Prevention

While morning sickness may not be entirely preventable, certain measures can reduce its severity:

Pre-pregnancy vitamin intake: Taking prenatal vitamins before conception.
Balanced diet: Maintaining a healthy diet rich in vitamins and minerals.
Stress management: Reducing stress through relaxation techniques can be beneficial.

When to See a Doctor

Seek medical advice if you experience:

Flu-like Symptoms: Such as fever, which may indicate an underlying illness.
Dizziness or Lethargy: Feeling unusually weak or lightheaded.
Persistent Severe Vomiting: Vomiting constantly or several times a day.
Inability to Retain Food or Fluids: Leading to weight loss or dehydration.
Iron-related Nausea: Suspect that iron in your prenatal vitamins is causing nausea.
Considering Treatments: Interest in anti-nausea medication or alternative treatments like acupuncture.

Outlook/Prognosis

The prognosis for morning sickness is generally positive. Most women find relief by the end of the first trimester. For those with severe symptoms, appropriate treatment and medical care can ensure a healthy pregnancy. Despite the discomfort, morning sickness does not usually pose a risk to the baby and is often considered a sign of a healthy pregnancy.

Sources

American Pregnancy Association. (n.d.). Morning Sickness.
Mayo Clinic. (2021). Morning Sickness.
National Health Service (NHS). (2020). Nausea and Vomiting in Pregnancy.
WebMD. (2021). Morning Sickness Overview.
The American College of Obstetricians and Gynecologists (ACOG). (2021). Nausea and Vomiting of Pregnancy.