Nausea and vomiting during pregnancy - How to manage morning sickness
Most expectant mothers, around 75%, go through the challenging experience of nausea and occasional vomiting during their first trimester. These symptoms typically begin around week 4 and usually improve after week 16, although certain food aversions, cravings, or sensitivity to smells might persist longer (sometimes even after pregnancy) until hormone levels normalize. It's important to note that about 10% of mothers experience nausea beyond week 20, and 1-3% develop Hyperemesis Gravidarum, a severe form of pregnancy sickness that often requires medical attention and hospital care.
What happens during pregnancy sickness?
After conception occurs, your body undergoes significant hormonal changes in ways that medical science is still working to fully understand.
Key pregnancy hormones - estrogen, progesterone, and Human Chorionic Gonadotropin (HCG) - experience dramatic fluctuations, which helps explain why pregnancy comes with various physical responses.
Recent scientific research has identified another important hormone called GDF15, produced by your developing baby, as a significant factor in pregnancy sickness. The research suggests that the larger the difference between the mother's natural GDF15 levels and the baby's production, the more intense the nausea becomes. Scientists are working on developing treatments to help mothers cope with nausea, especially in severe cases, though this research is still in its early stages.
Let's examine this table showing hormone changes during pregnancy:
As illustrated, HCG levels rise significantly during the first trimester, which may explain many of the uncomfortable symptoms you're experiencing.
Hormone level fluctuation during pregnancy and postpartum.
Why do we have to deal with morning sickness?
Medical researchers continue to study why our bodies react so strongly to pregnancy, particularly since proper nutrition is crucial for both mother and baby. One theory suggests that your body (and in the case of GDF15, your baby) is trying to protect itself from potential harmful substances during this sensitive period.
When does pregnancy sickness occur?
While commonly called "morning sickness," this term can be misleading since nausea and vomiting can occur at any time. You might feel most sensitive when your blood sugar is low, often after waking up. Having a light snack before getting out of bed and eating small, frequent meals throughout the day might help. Remember that every mother's experience is unique - some have no morning issues but might feel queasy around cooking odors. Various factors can trigger discomfort, including scents, tastes, temperature changes, or humidity. You might notice familiar smells - your home, foods, pets, or even your partner - suddenly seem different. Sometimes, nausea can appear without any obvious trigger.
Remember that pregnancy sickness affects each person differently, and your triggers may change from day to day.
Is morning sickness dangerous for my baby?
Mild to moderate morning sickness, while uncomfortable, won't harm your precious little one. However, if you find yourself unable to eat or drink, experiencing dehydration, losing weight, or fainting, it's important to take these symptoms seriously. When severe nausea and vomiting go unmanaged, they can prevent you from getting essential nutrients for both you and your baby, potentially affecting long-term health and your baby's growth. Trust your instincts - if you're concerned about your condition, please reach out to your healthcare provider!
Is there medication for pregnancy sickness?
Due to ethical considerations regarding testing new medications during pregnancy, treatment options are carefully limited and reserved for severe cases. If morning sickness is significantly impacting your daily life, your healthcare provider can guide you through available safe options.
Many healthcare providers recommend Pyridoxine (Vitamin B6) as a first-line treatment, as it helps balance hormonal fluctuations. In cases where weight loss becomes concerning, your doctor might prescribe a combination of doxylamine and B6 to help manage symptoms until your morning sickness improves.
What is the difference between morning sickness and Hyperemesis Gravidarum?
It is still unclear why some mothers experience more intense pregnancy symptoms, though promising research involving the hormone GDF15 offers hope, especially for women with Hyperemesis Gravidarum (HG). The key distinctions between typical morning sickness and HG lie in severity (vomiting more than 3 times daily) and duration (symptoms persisting beyond week 20).
When to see a doctor:
Experiencing severe nausea with vomiting more than 3 times daily
Symptoms continuing past week 20
Noticeable weight loss
Signs of dehydration (dark urine)
Episodes of dizziness or fainting
Presence of fever
Extreme fatigue or confusion
Remember, your healthcare team wants to support you through this challenging time. Keeping them informed about your pregnancy sickness helps them monitor both your and your baby's well-being effectively.
How to deal with morning sickness?
Focus on avoiding triggers that make you feel unwell, whenever possible (understanding that this isn't always feasible).
Be mindful of environmental factors that might trigger nausea, including scents, temperature changes, humidity levels, and air quality.
When you can eat, choose nutrient-rich foods, but don't stress if you can only manage certain foods - something is better than nothing.
Consider gentle movement like walking or prenatal yoga to help ease nausea.
Prioritize rest and quality sleep.
After being sick, rinse your mouth with water rather than brushing immediately to protect your tooth enamel from acid damage.
Listen to your body - eat what and when you can.
Keep taking your prenatal vitamins, especially if your diet is limited (but contact your healthcare provider if severe nausea prevents eating and drinking for over 24 hours).
If you're taking iron supplements, try taking them before bedtime with a light snack to prevent stomach upset.
When confronted with triggering smells, try applying soothing essential oils like peppermint or lavender under your nose or on your hand.
Foods that can help ease your morning sickness:
Simple, gentle foods like plain bread, steamed rice, mashed potatoes, unsweetened applesauce, and natural nut or seed butters
Easy-to-digest options such as light broths or mild smoothies
Fresh ginger root (note: be cautious with dried ginger or capsules as they can be too strong)
Soothing herbal teas
Fresh citrus fruits (helpful tip: keep a small piece of lemon or orange peel with you - a quick sniff when feeling queasy can help. Fresh ginger works similarly)
Stay hydrated with water or calming herbal teas (peppermint and lemon balm are particularly soothing)
What to be mindful of during pregnancy sickness:
Foods that are heavily spiced, greasy, or high in fat.
Large, overwhelming meals.
Going too long without eating (this can worsen nausea).
Excessive sugar intake. When blood sugar spikes and crashes, it often intensifies nausea. If you're craving something sweet, try pairing it with foods that digest slowly like whole grains, nuts, or yogurt, or enjoy it after a balanced meal.
Any foods that trigger your nausea.
High-stress situations when possible. Stress hormones can amplify pregnancy sickness. Try to find moments of calm throughout your day.
Remember, pregnancy sickness is uniquely personal and can change throughout the day. Don't be too hard on yourself. If you're suddenly craving unusual combinations like pickles and french fries, that's perfectly okay! Pregnancy is a remarkable journey filled with unexpected moments, and the most important thing is to trust your body's signals, especially when they seem unusual.
References:
https://www.aafp.org/pubs/afp/issues/2003/0701/p121.html (2024)
Kumar, P.: Hormones in Pregnancy. 2012. https://pmc.ncbi.nlm.nih.gov/articles/PMC3640235/ (2024)
Fejzo, M. et al.: GDF15 linked to maternal risk of nausea and vomiting during pregnancy. 2023. https://www.nature.com/articles/s41586-023-06921-9 (2024)
Sahakian, V. et al.: Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study. 1991. https://pubmed.ncbi.nlm.nih.gov/2047064/ (2024)
Jayawardena, R. et al.: The effects of pyridoxine (vitamin B6) supplementation in nausea and vomiting during pregnancy: a systematic review and meta-analysis. 2023 https://pubmed.ncbi.nlm.nih.gov/36719452/ (2024)
Youchun, H. et al.: Effect of ginger in the treatment of nausea and vomiting compared with vitamin B6 and placebo during pregnancy: a meta-analysis. 2020. https://pubmed.ncbi.nlm.nih.gov/31937153/ (2024)
Fejzo, M. S. et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat. Rev. Dis. Primers 5, 62 (2019). https://pubmed.ncbi.nlm.nih.gov/31515515/ (2024)
