Morning sickness, which does not limit itself only to the morning, is the most common medical condition of pregnancy. In medicine, it is referred to as nausea or vomiting of pregnancy (NVP). It affects between 60 and 90 percent of all pregnant women and has been found to be equal to the nausea/vomiting that occurs as a result of chemotherapy used to treat cancer. It is most common in the first 12 weeks of pregnancy, and is usually limited to 16 to 18 weeks’ gestation. Rarely, it lasts for much longer (only five percent of pregnant women experience morning sickness until the end of pregnancy). It can cause great discomfort for the pregnant mom, for the family and for coworkers at the workplace.
Risks and Prevention
There is a higher risk of NVP when you are pregnant with twins or a female baby, have had it before in a previous pregnancy, have a family history of NVP or have a history of motion sickness or migraines. The good news is that it may be prevented to some extent by starting vitamins at conception or before (as is recommended to prevent neural tube defect or spina bifida). And a woman who experiences NVP is less likely to have a miscarriage or stillbirth.
Serious cases of pregnancy-related nausea and vomiting occur in only a few pregnancies (0.5 to two percent). When it is severe, for example, when the pregnant woman cannot keep any liquids or food down and is losing weight, it is called hyperemesis gravidarum and the pregnant woman must be hospitalized.
Causes of NVP
No clear cause of NVP has been found. One thing that has become clear is that it is neither a condition of the mind nor a psychological problem. NVP can, however, be a symptom of a more serious illness and if persistent should not be treated lightly; you should see your doctor.
Treatment of Nausea/Vomiting of Pregnancy
There are now many safe treatments for NVP so women no longer need to suffer. It is more effective to start treatment when symptoms are mild as opposed to waiting until they are intolerable.
First, make sure you are getting enough sleep and rest, as early pregnancy is exhausting. Eat only foods that appeal to you. Don’t live on crackers and dry toast if you don’t like them. Small, frequent meals may be helpful. Proteins seem to be better tolerated than carbohydrates or fat. It also may help to avoid the smells of cooking and to eat cold foods. If your prenatal vitamins are making you sick, talk to your doctor or midwife and find an alternative. Iron is especially irritating to the stomach.
Ginger has been found to work sometimes for NVP, however it should only be used in doses such as 250 mg every six hours. Larger doses have not been proven to be safe.
Acupuncture/acupressure near the wrist, has been explored, but there has been no consistent evidence that these treatments work. However, there is no known risk, so if you are inclined try accupressure wristbands that you can purchase at a pharmacy or travel shop. There has also been some evidence that hypnosis may help.
Studies have shown that pyridoxine or vitamin B6 at 10 to 25 mg three to four times per day improves mild to moderate nausea. There are no safety concerns at these doses.
Reflux can be a part of NVP and antacids can help. There have been no safety concerns for these preparations in pregnancy when used appropriately.
Diclectin is a combination of pyridoxine or vitamin B6 and an antihistamine–doxylamine succinate. It is the most studied prescription drug for safety in pregnancy and has been found to be safe. It requires a prescription and proper dosing—usually two tablets at bedtime; one in the morning and one in the afternoon to start. It is a delayed-action drug and must be taken on a regular basis, not on an as-needed basis. The dose may be adjusted as required by your doctor or midwife.
There are numerous other anti-nauseants that can be used and that have a good safety record. They should only be used when needed and under the guidance of your doctor or midwife. Some of these are: dimenhydrinate (Gravol), promethazine (Phenergan), and meclizine (Bonamine).
Acid-neutralizing medications are helpful in some cases and so far no safety issues have been identified. As in all medications, they should only be taken when necessary and under a doctor’s guidance. Some of these include: cimetidine and ranitidine (Zantac).
Ondansetron (Zofran) is an expensive medication that is used commonly in chemotherapy-related nausea. It may be used in severe cases of NVP and so far has been safe for the infant and mother, but data is limited.
If you are experiencing nausea/vomiting in pregnancy that you cannot relieve through rest and diet, you should visit your doctor or midwife and discuss the options for managing this problem before it becomes severe. You can take heart that having NVP reduces the chance of miscarriage and stillbirth and can be successfully treated in most cases. If you have had NVP in a previous pregnancy or you have motion sickness or migraines, be sure to start prenatal vitamins prior to attempting to get pregnant. For more information check out the Toronto Sick Kids Motherisk website ( www.motherisk.org) or helpline 1-800-436-8477.