Morning Sickness
Will this feeling ever end? Understanding (and treating!) Nausea and Vomiting in Pregnancy
Written by Dr. Fiona Callender, ND
As anyone who has experienced this phenomenon will tell you, morning isn’t exactly an accurate term for the nausea and vomiting that often accompanies pregnancy. Nausea and vomiting can happen at any time of day, and many people experience it throughout the entire day. This symptom is really common and is estimated to impact 50-90% of pregnant people to some degree. For many people, the symptoms start around weeks 5-6, they peak around week 9, and then improve by 16 to 18 weeks. For a smaller portion of people, it can linger until delivery. Very intense or severe nausea and vomiting may actually be related to a completely distinct condition called hyperemesis gravidarum. This is a serious condition that we have to be able to distinguish from the more common (though still challenging!) nausea and vomiting in pregnancy. Hyperemesis gravidarum is often associated with vomiting multiple times per day, the inability to consume any food or liquid, and fairly significant weightloss (>5%). The dehydration and nutrient deficiencies associated with this condition can become severe and life threatening for mom and baby if not treated.
What is the cause of this nausea in pregnancy?
Though the cause of morning sickness isn’t totally clear, there are several theories that have been suggested. One of the more common theories is related to hormonal changes. The most commonly discussed factor is the rise in human chorionic gonadotropin (hCG) - what we measure on a pregnancy test! This relationship, and theory, is largely based on the timing of this hCG rising and the typical peak of nausea. The peak of both tends to be around 12-14 weeks. Nausea also tends to be worse in pregnant women who have higher hCG levels, like in those with molar pregnancies and twins/triplets. Other theories suggest a genetic predisposition - we know that pregnant people who’s mothers had morning sickness tend to have a higher risk of having morning sickness themselves.
We do know some risk factors that make morning sickness more likely:
You’ve had these symptoms in a previous pregnancy
You experienced nausea when taking birth control
You have had menstrual migraines
You experience motion sickness
A family member has had these symptoms in pregnancy
You have a history of digestive concerns like heartburn.
You are pregnant with multiple babies
Should I be worried? How does nausea and vomiting impact my baby?
The good news? Mild nausea and vomiting in pregnancy is actually associated with fewer miscarriages. You many have higher risk of having pelvic pain and high blood pressure, but reduced risk of most unfavourable birth outcomes like low birth weight infants.
Hyperemesis gravidarum, which impacts about 3-4% of pregnancies, does tend to have more risks associated with it. As mentioned above, risk of dehydration and weight loss are big concerns, but we also have increased risk of anxiety and depression as well as anemia, preeclampsia, deep vein thrombosis, pulmonary embolism and preterm birth. Complications due to specific nutrient deficiencies are also a major concern.
You should speak with your care provider immediately if you are experiencing one (or more) of the following symptoms:
Signs of dehydration - infrequent urination, dark urine, dizziness
Repeated daily vomiting - especially if you notice blood
Abdominal or pelvic cramping/pain
Inability to keep food down for more than 12 hours.
You have lost more than 5lbs
Additional symptoms such as fever or diarrhea
Feelings of hopelessness or self-harm or wanting the pregnancy to end due to symptoms
For more typical nausea and vomiting, this can still deeply impact your day to day - especially as it is during a time when many people are not openly discussing their pregnancy with their wider social circles. Thankfully, for many cases, there are some lifestyle shifts that we can make that may support you.
Dietary:
Try to eat before, or as soon as, you feel hungry to avoid an empty stomach - which can aggravate nausea. A snack before getting out of bed in the morning and snacks during the night may also be helpful (eg, crackers with peanut butter or cheese taken prior to getting up for nighttime bathroom trips). Meals and snacks should be eaten slowly, and in small amounts, every one to two hours to avoid an overly full stomach, which can also aggravate nausea for some people. Identify which foods are best tolerated and try to consume those foods.
Dietary manipulations that help some people include eliminating coffee and spicy, odorous, high-fat, acidic, or very sweet foods. Instead, include snacks/meals that are protein-dominant, salty, low-fat, bland, and/or dry (eg, nuts, pretzels, crackers, cereal, toast). Sucking on peppermint candies may reduce nausea after meals.
Cold solid foods are often tolerated better than hot solid foods because they have less odour and require less preparation time (ie, shorter exposure to the trigger if the patient is preparing their own meal).
Fluid intake:
Try to consume fluids at least 30 minutes before or after solid food to minimize the effect of a full stomach. Fluids are better tolerated if cold, clear and carbonated or sour (eg, ginger ale, lemonade, popsicles) and taken in small amounts; using a straw or very small cup sometimes helps. Some people find aromatic liquids, such as lemonbalm or peppermint tea more tolerable and helpful in reducing nausea. Small volumes of electrolyte-replacement sports drinks, if tolerated, can be used to replace both fluids and electrolytes.
Avoid triggers:
Along with dietary changes, avoidance of environmental triggers is a key intervention for reducing nausea. Examples of some triggers include stuffy rooms, odours (eg, perfume, chemicals, food, smoke), heat, humidity, noise, and visual or physical motion (eg, flickering lights, driving).
Spitting out saliva and frequently rinsing the mouth can also be helpful. Switching to a different toothpaste may help those for whom strongly flavoured toothpaste is a trigger.
*Note* Rinsing your mouth with baking soda in water (1 cup water with 1 tsp baking soda) after vomiting may reduce dental erosion. Brushing your teeth should be delayed as the acidity of vomit combined with friction may worsen erosion.
There are also some supplements that can help support you. We can chat about these and which ones make the most sense for you alongside the lifestyle supports. If the nausea persists and you are really struggling, there are also medications that can be prescribed by your doctor. There are a few options that they can discuss with you that have been shown to be safe in pregnancy. Helping you advocate for yourself and your needs in the medical system is part of our role in your care!
Have more questions about symptoms in pregnancy? You can book with Dr. Fiona, our naturopathic doctor with a focus in perinatal health. She has additional training in pelvic health and can be a support throughout your pregnancy and the postpartum period.
* This should not be construed as medical advice. Always consult your medical team regarding your individual case and symptoms *