Tag: Morning Sickness

What is Morning sickness

Morning sickness is a complaint that usually occurs during pregnancy and includes symptoms such as vomiting and nausea. It does not necessarily occur in the morning, but at any time of the day or night. It is most common in pregnancy during the first trimester but, in a few cases, it may occur during the whole pregnancy period. It is usually the first sign a woman observes at the start of pregnancy, distressing more than 80% of women during their pregnancy period. Women taking hormone replacement therapy or hormonal contraceptives may also experience morning sickness.

Morning sickness can be relieved by home remedies such as sipping ginger ale, over-the-counter medications, and taking healthy snacks throughout the day. In rare cases, morning sickness takes a much more serious form known as hyperemesis gravidarum. In hyperemesis gravidarum, vomiting and nausea result in severe dehydration and weight loss, which may be more than 5 percent of the weight of the woman before the start of pregnancy. If it reaches emergency level, hyperemesis gravidarum may require hospitalization during pregnancy to receive intravenous fluids to combat dehydration, medications, and sometimes a feeding tube[1].

Morning sickness is an uncomfortable and irritating condition, but it poses no health risk to the mother or fetus. It is a physiological process of pregnancy and some researches have proven that it is a sign of a normal and healthy pregnancy.

Some studies show that pregnancies in which morning sickness occurs have less risk of stillbirths and miscarriages[2].

What causes morning sickness?

The common cause of morning sickness in pregnancy is a change in the levels of hormones in the body. The most common hormones include progesterone, estrogen, and human chorionic gonadotropin (hCG). Other causes may include changes in blood sugar levels and sense of smell.

Estrogen levels increase by approximately one hundred percent in pregnant women as compared to non-pregnant women. However, there is no evidence of a difference in the levels of estrogen circulating in pregnant women who have morning sickness and those who do not have morning sickness. Additionally, one of the main roles of increased progesterone levels during pregnancy is to relax the muscles of the uterus to prevent preterm labor and early childbirth. An increase in progesterone levels may also relax the muscles in the stomach and bowel, causing more acid secretion from the stomach cells and acid reflux. HCG is produced by the developing embryo and placenta at different stages of pregnancy. Some experts propose that morning sickness has an association with HCG.

Hypoglycemia, caused by increased transport of glucose from the mother’s body to the fetus via the placenta, may cause decreased energy levels. A decrease in energy levels can also cause nausea and vomiting in pregnancy. Pregnancy may cause an increase in sensitivity to odors that may overstimulate normal nausea stimulus[3].

Causes of Morning Sickness Other Than Pregnancy:

• Insomnia and fatigue may disturb sleep patterns and change the neuroendocrine response, resulting in vomiting and nausea.
• If a person sleeps for more than 12 hours without having a meal before sleep, low levels of glucose in the body can make you feel weak, nauseous, and dizzy upon waking.
• Any health condition that causes increased acidity in the stomach or acid reflux to the esophagus may cause symptoms similar to morning sickness.
• Sinus congestion puts pressure on the inner part of the ear, causing dizziness, nausea, vomiting, and stomach upset.
• When post-nasal drip drains mucus from the sinuses to the throat and stomach, it can cause symptoms similar to morning sickness[4].
• Due to emotional disturbances like anxiety, stress, and excitement, you may feel nausea.
• Vomiting and nausea in the morning can be caused by excessive alcohol consumption the previous night. Alcohol can also cause hypoglycemia and dehydration.
• Morning sickness may be caused by a food allergy or intolerance. Overeating can also cause nausea and vomiting.
• A stomach disorder known as gastroparesis may also result in nausea. It is a condition in which the muscles in the wall of the stomach become weak, obstructing the transport of food to the intestines.
• Morning sickness may occur in the case of gallstones. These are formed due to high cholesterol levels which accumulate and harden in the bile ducts to form stones. It attaches gallbladder to the intestine via tubes that can cause pain and nausea[5].
• Vomiting and nausea are side effects of many medications that include opioids, antibiotics, and some other drugs. Drugs used in chemotherapy also stimulate the part of your brain that controls nausea and vomiting. Occasionally, such medications disturb the cells in the lining of the intestine and stomach and may result in vomiting and nausea[6].

Symptoms of Morning Sickness:

Symptoms of morning sickness typically include vomiting and nausea, commonly during the early months of pregnancy. In some cases, symptoms of morning sickness may become severe and may also be associated with other symptoms, including:

• Severe nausea, vomiting, or both
• Decreased urinary output with dark-colored urine
• Dizziness or fainting while standing up
• Unable to keep liquids down
• Palpitations
• Vomiting blood

Usually, symptoms of morning sickness improve after twelve weeks of pregnancy, but in some cases may persist for the whole duration of the pregnancy[7]

How long does morning sickness last?

Morning sickness starts in the 6^th week of pregnancy and lasts until about the 12^th week. Symptoms of morning sickness are at a peak between 8 to 10 weeks. According to many studies, almost 50 percent of pregnant women feel free from morning sickness at about the 14^th week of pregnancy or at the beginning of the second trimester. The same studies also revealed that 90 percent of pregnant women had settled morning sickness by 22 weeks. Additionally, pregnant women who experience nausea and vomiting during the eighth week have a decreased risk of miscarriage by about 50 percent.

Morning sickness is not restricted to the morning only; it may also occur throughout the whole day or night. Only two percent of pregnant women feel morning sickness only in the morning. However, if you went to sleep hungry, there is an increased risk of vomiting and nausea in the morning after waking up. Some health professionals have changed the name of morning sickness and now call it NVP, or nausea and vomiting during pregnancy[8].

If morning sickness does not last a typical amount of time or symptoms become severe, it may be a complication of morning sickness known as hyperemesis gravidarum. This usually occurs in about 0.5 to 2 percent of pregnancies. This condition is the second most common reason for hospitalization in pregnant women. Most cases of hyperemesis gravidarum recover at the 20^th week of pregnancy, but 22 percent of cases resolve after the termination of pregnancy.

Women who suffer from hyperemesis gravidarum once have increased risk in future pregnancies. Other risk factors include:

• Family history of hyperemesis gravidarum
• Pregnancy at a younger age
• At first pregnancy, the risk is more
• Twin or multiple pregnancies
• Obese women[9]

How to Diagnose Morning Sickness

If you have symptoms of morning sickness, your physician may ask for some investigations to confirm the diagnosis. In the case of pregnant women, the doctor may order some tests to rule out any maternal or fetal disorder. All the investigation that may be required include:

• Urine Tests

  Urine tests help to determine dehydration, normal amounts of specific hormones that are secreted in urine during pregnancy, and creatinine levels.

• Blood  Tests

  Blood chemistry tests include a complete blood count and comprehensive metabolic panel (Chem-20). These tests will check out the electrolytes in the blood, malnourishment, dehydration, deficiency of certain vitamins, and anemia[10].

• Ultrasound

  Ultrasound is used to investigate the normal growth and development of your baby with the help of images produced by sound waves.

What are the best remedies for morning sickness?

Morning sickness can be relieved with lifestyle measures and home remedies. Medical treatment is also available for treating morning sickness.

Lifestyle and Home Remedies:

• Food items that are low in fat and high in protein can help to prevent or treat symptoms of morning sickness. Pregnant women should avoid eating spicy, fatty, and greasy foods. Eat foods that are easy to digest and do not harm the digestive tract. Food items such as rice, bananas, applesauce, and toast are high in energy and easy to digest. Foods containing ginger, such as ginger lollipops and other salty foods, can also prevent nausea.[11]

• Eat a piece of dry toast or a few soda crackers after waking up in the morning. Eat small meals with plenty of snack foods throughout the day. Larger meals are not helpful during pregnancy because they cause acidity and nausea. The empty stomach worsens the symptoms of morning sickness; that is why frequent snacking is preferred during pregnancy.

• High fluid intake can help in pregnant women with mild or severe morning sickness and in pregnant women with dehydration as a complication of morning sickness. Sipping ginger ale and water are good for reducing symptoms. During pregnancy, more than six cups of non-caffeinated fluids are helpful.

• Avoid smells and foods that increase symptoms of morning illness. Certain smells and foods trigger nausea in pregnant women.

• Keep the windows or doors open at home or the workplace for fresh air. Go outdoors for a walk in the morning or evening.

• Prenatal vitamins are essential during pregnancy. If a woman feels nauseous or queasy, she should take vitamins with a snack or at night before going to bed. If these measures do not help to prevent the symptoms, ask your doctor for other ways to fulfill your dietary needs.

• Use mouthwash and properly clean your mouth after vomiting. The acid produced in the stomach can be damaging to the teeth. Baking soda mixed in water is a good choice because it neutralizes the acid and protects the enamel of your teeth[12].

Alternative medicine

Several alternative remedies can help protect you against morning sickness, including:

• Wristbands are available without prescriptions and may prove helpful to women with morning sickness due to their acupressure properties.

• Acupuncture is another way to treat morning sickness in some pregnant women. In this procedure, a trained practitioner uses needles that are inserted into the skin – or deeper – and provide relief from symptoms of morning sickness.

• Herbal ginger supplements help to lessen nausea and vomiting in some women. Most research proposes that ginger is safe for consumption during pregnancy, but according to some studies, ginger may affect fetal sex hormones.

• In some women, morning sickness can be relieved by hypnosis. Aromatherapy can also help some women deal with morning sickness[13].

Medical Treatment:

In mild cases, medical treatment is not required. However, in case of severe symptoms or extreme discomfort, your doctor may prescribe B-6 supplements (pyridoxine), ginger, and over-the-counter medications such as doxylamine. Anti-nausea drugs such as ondansetron and promethazine are safe to use during pregnancy and commonly prescribed by the doctors.

Diclegis is an FDA-approved medication for use in pregnancy. One clinical study determined that Diclegis relieved nausea completely in more than 40 percent of pregnant women with morning sickness. Another trial concluded that about 70 percent of women showed improvements in morning sickness symptom[14].

In moderate or severe vomiting and nausea, dehydration may occur causing the loss of electrolytes such as potassium and sodium. In such cases, oral or intravenous fluids, along with prescription drugs, may have a significant role in relieving the symptoms.

Your doctor will ask about how many times you have vomited, the frequency of nausea, whether you have consumed extra fluids, and whether you have practiced home remedies. Your doctor will recommend medications for symptoms of morning sickness that are safe in pregnancy.

Also, consult your physician before taking any supplement or over-the-counter medications during pregnancy. If you have hyperemesis gravidarum, you may need emergency treatment or hospitalization. Treatment involves intravenous fluids and anti-nausea medications[15].

Best Foods for Dealing With Morning Sickness

Every pregnant woman has different reactions to different foods. But when it comes to the health and safety of the fetus as well as the mother, there are a few things you need to remember when consuming food that will not only ensure good health but also keep your morning sickness at bay.

• Go for easy to digest foods
  When feeling sick, look for light foods such as avocado, ripe bananas, applesauce and toasts.

• Drink fluids
  Try nutritious fluids such as herbal teas, almond milk, soups, smoothies and lemon water. These are light and fulfilling drinks that will help with upset stomach, heartburn and other symptoms of morning sickness.
• Include some ginger in your diet
  Ginger is an amazing thing for reducing nausea and vomiting. You can consume it grated, with tea, like ginger ale or even as ginger candies.
• Peppermint and citrus can help
  Peppermint and citrus are two magical foods that are scientifically proven to help soothe heartburn, upset stomach and improve digestion. Besides adding them to your tea or smoothie, try peppermint and citrus candies or even sniff a lemon if you like.

Besides changing your diet, you also need to change your routine. Keep a track of the following things during your mealtime:

• Never stay empty stomach as it can increase acidity and develop nausea and heartburn.
• Avoid sleeping on an empty stomach. This doesn’t mean you munch on heavy foods. Try light snacks and as discussed earlier- easy to digest foods.
• Always keep a small bag of snacks with you.
• Let go of foods that trigger nausea.
• Stick to smaller portions and more 5 to 6 meals a day.

Do You Need to Consult a Doctor for Your Morning Sickness?

Generally, morning sickness is a part and parcel of pregnancy. It’s not considered a serious situation that needs medical attention. However, you must contact your healthcare provider if the following situations occur:

• You are losing weight.
• You are vomiting blood.
• You vomit more than 3 times a day.
• It’s impossible to eat or drink.
• You are experiencing extreme fatigue.

References:

[1] Lee, N. M., & Saha, S. (2011). Nausea and vomiting of pregnancy. Gastroenterology clinics of North America, 40

(2), 309–vii. https://doi.org/10.1016/j.gtc.2011.03.009

[2] Bustos, M., Venkataramanan, R., & Caritis, S. (2017). Nausea and vomiting of pregnancy – What’s new?. Autonomic neuroscience : basic & clinical, 202, 62–72. https://doi.org/10.1016/j.autneu.2016.05.002

[3] Gadsby, R., Barnie-Adshead, A. M., & Jagger, C. (1993). A prospective study of nausea and vomiting during pregnancy. The British journal of general practice : the journal of the Royal College of General Practitioners, 43(371), 245–248.

[4] Singh, P., Yoon, S. S., & Kuo, B. (2016). Nausea: a review of pathophysiology and therapeutics. Therapeutic advances in gastroenterology, 9(1), 98–112. https://doi.org/10.1177/1756283X15618131

[5] Frese, T., Klauss, S., Herrmann, K., & Sandholzer, H. (2011). Nausea and vomiting as the reasons for encounter in general practice. Journal of clinical medicine research, 3(1), 23–29. https://doi.org/10.4021/jocmr410w

[6] Mosa, A., Hossain, A. M., Lavoie, B. J., & Yoo, I. (2020). Patient-Related Risk Factors for Chemotherapy-Induced Nausea and Vomiting: A Systematic Review. Frontiers in pharmacology, 11, 329. https://doi.org/10.3389/fphar.2020.00329

[7] Chan, R. L., Olshan, A. F., Savitz, D. A., Herring, A. H., Daniels, J. L., Peterson, H. B., & Martin, S. L. (2011). Maternal influences on nausea and vomiting in early pregnancy. Maternal and child health journal, 15(1), 122–127. https://doi.org/10.1007/s10995-009-0548-0

[8] Chan, R. L., Olshan, A. F., Savitz, D. A., Herring, A. H., Daniels, J. L., Peterson, H. B., & Martin, S. L. (2010). Severity and duration of nausea and vomiting symptoms in pregnancy and spontaneous abortion. Human reproduction (Oxford, England), 25(11), 2907–2912. https://doi.org/10.1093/humrep/deq260

[9] McCarthy, F. P., Lutomski, J. E., & Greene, R. A. (2014). Hyperemesis gravidarum: current perspectives. International journal of women’s health, 6, 719–725. https://doi.org/10.2147/IJWH.S37685

[10] Teasdale, S., & Morton, A. (2018). Changes in biochemical tests in pregnancy and their clinical significance. Obstetric medicine, 11(4), 160–170. https://doi.org/10.1177/1753495X18766170

[11] Viljoen, E., Visser, J., Koen, N., & Musekiwa, A. (2014). A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting. Nutrition journal, 13, 20. https://doi.org/10.1186/1475-2891-13-20

[12] Matthews, A., Dowswell, T., Haas, D. M., Doyle, M., & O’Mathúna, D. P. (2010). Interventions for nausea and vomiting in early pregnancy. The Cochrane database of systematic reviews, (9), CD007575. https://doi.org/10.1002/14651858.CD007575.pub2

[13] Khorasani, F., Aryan, H., Sobhi, A., Aryan, R., Abavi-Sani, A., & Ghazanfarpour, M. et al. (2019). A systematic review of the efficacy of alternative medicine in the treatment of nausea and vomiting of pregnancy. Journal Of Obstetrics And Gynaecology, 40(1), 10-19. https://doi.org/10.1080/01443615.2019.1587392

[14] Einarson, A., Maltepe, C., Boskovic, R., & Koren, G. (2007). Treatment of nausea and vomiting in pregnancy: an updated algorithm. Canadian family physician Medecin de famille canadien, 53(12), 2109–2111.

[15] Ebrahimi, N., Maltepe, C., & Einarson, A. (2010). Optimal management of nausea and vomiting of pregnancy. International journal of women’s health, 2, 241–248. https://doi.org/10.2147/ijwh.s6794