Why am I nauseous? Do I have morning sickness?
Morning sickness is one of the notable misnomers in medicine -- nausea during pregnancy can occur at any time of day. Although many women are queasiest when they wake up, others find that they suffer a daily bout of nausea in the late afternoon or just after dinner. As many women have found out, you can definitely experience morning sickness on an empty stomach.
If you have morning sickness, you've got lots of company: About 80 percent of pregnant women experience some nausea or queasiness. It usually begins between the fourth and eighth week of pregnancy and often continues until the 16th to 20th week. Things usually improve during the second trimester, but unfortunately some women continue to suffer bouts of nausea and vomiting throughout their entire pregnancy.
What causes morning sickness?
Some experts think that it results from elevated hormone levels. One theory is that increased levels of estrogen and a hormone called hCG (human chorionic gonadotropin), which is produced by the placenta, appears to cause nausea. In fact, women carrying multiples -- who tend to have higher levels of hCG than women carrying a single child -- often suffer a more severe form of morning sickness.
Other factors that may play a role in morning sickness include a more acute sense of smell and changes in the digestive system that accompany pregnancy; with your slowed digestion and more relaxed muscles, food can stay in your stomach longer and stomach acid may splash back into the esophagus, contributing to nausea and heartburn. Many women also find that increased fatigue and stress can trigger or exacerbate morning sickness.
Some experts believe that morning sickness evolved as a type of advantage for pregnant women. The idea is that a more sensitive nausea response keeps women from eating foods that are most likely to be toxic to the fetus during early pregnancy.
My nausea is really severe. What will happen if it doesn't go away?
Most women with morning sickness find they can get by if they can just manage to eat a few small snacks and drink fluids throughout the day. However, if you undergo a prolonged period when you really can't keep anything down, talk to your doctor.
Untreated, you may develop a rare condition called hyperemesis gravidarum (Latin for excessive vomiting in pregnancy). Your doctor will be particularly concerned if you are losing weight, vomiting frequently, vomiting blood, or becoming dehydrated. (Signs of dehydration include feeling unusually fatigued or lightheaded, producing very little urine, and excreting concentrated, dark urine.) Fortunately, excessive vomiting during pregnancy although serious -- is easily treatable.
Because dehydration can be risky for your baby, your doctor's first concern will be to replenish the fluids in your body. Your doctor may recommend that you be given fluids through an intravenous (IV) drip, prescribe an anti-nausea medication, or both. In severe cases, your doctor might also put you on bed rest or hospitalize you until your condition stabilizes.
Will my morning sickness affect my baby?
When constant queasiness is preventing you from eating the varied, balanced diet that most experts advise for pregnant women, it's natural to worry that your baby will suffer. However, unless your nausea is so severe that you can't keep anything down or become dehydrated, there's no need to worry about depriving your baby. Instead, concentrate on drinking plenty of fluids and eating small, healthy snacks throughout the day to keep your energy up.
What are the best ways to prevent morning sickness?
The American Congress of Obstetricians and Gynecologists has found that taking a multivitamin before conception appears to reduce your chances, and recommends treating morning sickness early with vitamin B6 or B6 plus the antihistamine doxylamine. ACOG also recommends seeking treatment for prolonged morning sickness right away, since the condition can cause excessive vomiting if it goes untreated too long.
Pregnancy-related nausea varies from person to person, and many women find they have specific triggers. For some it's a smell, for others a taste; for still others it's something unrelated to the senses, such as not getting enough sleep. As soon as you become aware of a particular trigger, do whatever you can to avoid it -- even crossing the street to avoid a particular sewer grate. If rushing seems to bring on nausea, leave yourself extra time to walk slowly, or ask for a lift to the bus in the morning. In other words, do whatever helps you get through your day.
Here are some more tips that moms-to-be have found helpful:
Eat early and often.Nothing keeps morning sickness at bay like a snack first thing in the morning. It may not seem logical, but an empty stomach can trigger nausea. Stash extra snacks in your desk and purse so you'll never have to go too long between meals. Try keeping a bag of snacks on your bedside table -- that way you can pop something in your mouth before your feet hit the floor.
Stock up on carbs. High-carb, low-fat foods are among the edibles best tolerated by pregnant women, according to the American Academy of Family Physicians. For many women, rice crackers and animal crackers are especially good at soothing a fretful stomach.
Find relief in bubbles. Many pregnant women swear by carbonated drinks. Try ginger ale, seltzer water, bitter lemon, and other carbonated drinks. Stay away from those with caffeine, though, such as colas. The March of Dimes advises that pregnant women avoid drinking too much caffeine during pregnancy, since some studies have linked very high caffeine intake to a higher risk of miscarriage and other adverse effects.
Stay hydrated. If water doesn't agree with you, try chewing ice chips or sucking on popsicles made from fruit juice.
Snack on citrus. One folk remedy that seems to work for many women is to use anything lemon-flavored (for certain women, anything citrus-flavored) to keep nausea at bay. For some, citrus drinks like lemonade or bitter lemon are a godsend; for others it's hard candy, like lemon drops or orange lifesavers. And, of course, there's the real thing: sucking on a slice of orange or a section of grapefruit works wonders for many moms-to-be.
Avoid unpleasant smells. You'd be surprised how quickly certain smells can trigger a bout of nausea. Cigarette smoke, certain foods, even perfume can make you dash for the toilet. Pregnancy gives you permission to be assertive; politely ask the nearby smoker to step outside, or mention to your coworker that you seem to have developed an aversion to patchouli oil.
Go easy on the iron. Iron can be hard on the digestive system, and many pregnant women blame iron supplements for increasing their nausea. Unless you're anemic, you may be able to skip or reduce iron supplements and try to get sufficient iron from your diet instead. If you find that your prenatal vitamin seems to be making you sick, check the label for iron. Ask your doctor whether you should switch to one without iron until you're further along and your nausea abates.
Be vitamin-smart. Try taking your prenatal multivitamin with food, and take it at night instead of in the morning.
Experiment with ginger. Ginger has long been thought to help with nausea associated with motion sickness and indigestion, and at least one randomized placebo-controlled study has found that ginger significantly reduced symptoms of nausea and vomiting in pregnant women, with no serious side effects. Ginger hasn't been proven safe during pregnancy, though, so use it to treat morning sickness only under a doctor's supervision. If your doctor approves, try drinking a cup of ginger tea after meals or chewing on crystallized ginger to get you through those tough midmorning slumps. No matter how well it's working, though, don't consume more than one gram of ginger per day.
Try acupressure bands. Some women favor Sea-Bands, which were developed to help with motion sickness, to help them stave off the nausea of morning sickness. These are knitted elastic wrist bands with plastic studs that work by applying pressure on particular acupressure points on your wrists.
There are also a number of prescription-strength medications that doctors customarily prescribe to women who are unsuccessful with over-the-counter remedies. Some are considered safe to use during pregnancy, and the small risks and potential benefits associated with them can often outweigh the risks of severe dehydration from vomiting. Talk with your doctor first, though, before you take any of them.
ACOG Issues Guidance on Treatment of Morning Sickness During Pregnancy. American Congress of Obstetricians and Gynecologists.
Medline Medical Encyclopedia. Morning Sickness. http://www.nlm.nih.gov/medlineplus/ency/article/003119.htm
Medline Medical Encyclopedia. Hyperemesis gravidarum. http://www.nlm.nih.gov/medlineplus/ency/article/001499.htm
The Mayo Clinic. Morning Sickness http://www.mayoclinic.com/health/morning-sickness/DS01150
The Mayo Clinic. The First Trimester: What to Expect
The Mayo Clinic. Working during your pregnancy: Dos and donts http://www.mayoclinic.com/health/pregnancy/WL00035
Yale-New Haven Hospital Maternity Services. Common Concerns, Your Body Changes. http://www.ynhh.org/maternity/concerns/body_changes.html
Quinlan, Jeffrey D. et al. Nausea and Vomiting of Pregnancy. American Family Physician. Vol 68/No.1
AskDrSears.com. Morning Sickness. http://www.askdrsears.com/html/1/t010102.asp
March of Dimes. Caffeine and Pregnancy. 2009.