Blog Post Morning SicknessFunny term, “Morning Sickness.” As if it really only ever happens in the mornings. Wouldn’t that be nice?

Pretty much every piece of literature that I’ve read out there warns women that “Morning Sickness” (aka NVP; Nausea and Vomiting during Pregnancy) peaks somewhere in the first trimester (around week 8-10) and usually ends around the 3rd to 5th month of pregnancy (only about half of women with NVP feel relief by the end of the 3rd month, actually. Ninety-percent of women finally felt relief by 22 weeks’ pregnancy!) <— that was me, no relief until week 21! 

If you never got morning sickness, consider yourself really lucky. (Kinda like those women who lost the baby weight quickly. It’s probably best not to brag about these enviable details 😆 ). About 75-80% of pregnant women experience morning sickness in some way, shape, or form.

So here are some things to know:

  1. Morning Sickness can come morning, day, or night. Or really even any combination or all of those.  According to the International Journal of Women’s Health, only 1.8% of women with morning sickness have it only in the morning. And, 80% of women experiencing NVP have all-day symptoms. If you’re lucky like me, you’ll have it all day! (And why can’t we call it something else, then?)
  2. It’s not dangerous to experience the average bout of morning sickness. Only about 1% of those who experience NVP experience hyperemesis gravidarum and require medical intervention. NVP is not not associated with birth defects, baby’s birth weight, etc. 
  3. Morning Sickness is not predictive of whether you’re having a boy or a girl. This is an old wives’ tale, and it’s not an indication of if your labor or remainder of pregnancy will be easy, if you’re having a girl versus a boy, or whatever else someone has dreamed up as rationale. Morning Sickness is pretty non-discriminatory!
  4. The real cause is actually unknown. According to the National Library of Medicine at the National Institutes of Health (and every other research article I could find, along with professional obstetrics publications and groups), it is proposed that hormonal elevation  namely, the hCG hormone – human chorionic gonadotropin – is the most likely reason for NVP. Even low blood sugar may cause the associated nausea. Other things that can worsen nausea: traveling, fatigue, emotional stress, certain foods, hunger. I remember that the sheer thought of chicken (raw, cooked, any chicken dish that I used to like) made me feel extremely nauseous.
  5. Medication formulated specifically to alleviate symptoms of morning sickness. If you have tried multiple non-medicinal methods to help morning sickness, discuss baby-safe options with your OB/GYN to address your discomfort. Some anti-nausea prescription medications can help. Diclegis is the only FDA approved drug that is designed to treat NVP and is intended for use in pregnant women, which means it’s Pregnancy Category A (case-controlled studies were done with pregnant women, to earn this badge, meaning it is the only drug to have shown effectiveness and safety for the fetus). Diclegis contains the active ingredient doxylamine succinate (an anti-histamine that indirectly affects the vomiting center in the brain) in a 10 mg dose along with vitamin B6 (pyridoxine hydrychloride, relatively unclear mechanism in its anti-nausea effect). For full info on Diclegis, read here.
    1. Remember, prescription and over-the-counter medications CAN AND DO have side effects, so make sure you discuss them with your doctor. I took oral disintegrating tablets of zofran (odansentron, pregnancy category B), which is generally regarded by many OB/GYN’s as “acceptable” and is commonly prescribed during pregnancy, but there are documented case-controlled studies in the US that have shown congenital heart defects and birth defects in women who took it during their 1st trimester. My OB/GYN never actually discussed Diclegis with me, and I never knew it was even available. I actually experienced really uncomfortable constipation from zofran, so I discontinued it after using it for 2 weeks, and asked if taking (over the counter) Unisom Sleep Tabs (doxylamine succinate 25 mg) was OK, and was given the green light. I felt similar relief and was able to sleep a little better, too! A nurse practitioner I worked with in the ICU had severe morning sickness where she was placed on IV fluids since she couldn’t even keep water down and was prescribed phenergan (promethazine, pregnancy category C) since zofran didn’t do the trick. Luckily our babies are healthy, but with what I know now, I can only imagine what could’ve happened!
    2. For an explanation on Pregnancy Categories, click here. Pregnancy Category A is the only category where well-controlled studies have not demonstrated any risk to the fetus. All other categories are not as safe, with B > C > D, etc. Important to emphasize: Category X drugs should not be used in pregnancy, since the demonstrated risks do not outweigh possible benefit to the pregnant woman.
    3. According to the American Journal of Obstetrics and Gynecology, besides Diclegis, no other medications should be prescribed for NVP since Diclegis is the only one that is classified as safe and labeled for use during pregnancy. As mentioned above, there have been reports of dysrhythmias (abnormal heart rhythms) and birth defects with the use of odansentron, but it is still very commonly prescribed in the U.S. because of its low cost. The AJOG points out that there are many medications that are prescribed during pregnancy, for pregnancy-related issues (such as magnesium sulfate with an off-label use for eclamptic events), since they have become “standard of care” despite not carrying an FDA-approval for pregnancy. (source below) So what this means is, given that Diclegis has been available on the market since April 2013, nothing else should be prescribed for NVP.

      **As with any supplement or medication (prescription or non-prescription medications, herbal supplements, vitamins, etc) always talk to your OB/GYN about its safety during pregnancy and nursing, prior to taking. Some herbal supplements, though they seem harmless, can hurt your growing baby. 

  6. Morning sickness sometimes needs medical attention. The following symptoms indicate medical intervention, so call your OB/GYN for further instructions, if: 
    1. You have lost more than 2 pounds
    2. You see blood in your vomit (especially if you see dark brown specks or what appears to be coffee grounds, this can mean you have a gastrointestinal bleed)
    3. You are having trouble/can’t keep liquids down (meaning, you try to drink water or any other liquid and continue to vomit), make sure to notify your OB/GYN right away. As mentioned, 1% of NVP cases are classified as hyperemesis gravidarum (excessive vomiting during pregnancy). If you can’t keep liquids down, intravenous fluids with thiamine would be administered, to restore fluid balance. 

Pointers/suggestions on how to make the nausea easier:

  • Since it happens most usually in the morning since mama is running on an empty stomach, it is recommended to eat something bland (the common suggestion are saltines/soda crackers and some water) before sitting up and getting out of bed, which can exacerbate nausea.
  • Eat small and frequent meals, rather than three large meals, every couple of hours. This will keep you from getting hungry, which tends to make nausea worse.
  • Avoid smoking or secondhand smoke.
  • Snack on foods that are high in protein and complex (healthy, unrefined, and natural – those found in fruits and vegetables) carbohydrates. Fiber (fruits and veggies) will help maintain feeling fuller, too.
    • cottage cheese and fruit
    • natural cheese slices with whole grain wheat crackers (the whole grains will keep you fuller longer too)
    • apple slices and peanut butter
    • trail mix and string cheese
  • Ginger is a natural and well-known root that helps keep nausea at bay. It is the the one alternative therapy to NVP that has the strongest statistically significant data (in a double-blind, case controlled study) for relief of NVP when compared to a placebo group. (I don’t have access to the article on the Wiley Online Library, but the link is below)There are lots of ginger candies, lollipops, sodas, etc. in for stores. I found a really good selection at World Market stores.
  • Acupressure – the vestibular nerve can be triggered by applying appropriate pressure in associated spots on the body, which may offer relief of nausea during pregnancy, but I couldn’t find compelling research that supported the claim. Since a lot of good, but complementary and alternative methods for relief of certain ailments are not published in traditional medical research journals, applying pressure on your wrist, if it settles your GI system, seems worth a shot! Here’s the link to vestibular.org if you’re interested in reading about it. 
  • Aromatherapy (place a few drops of ginger, spearmint, peppermint, and/or cardamom essential oil on a tissue and inhale or place drops in a diffuser). A randomized case-controlled trial published in Anesthesia & Analgesia in 2013 by Hunt et al. evaluated the effectiveness in post-anesthesia nausea by using these oils was published and found statistically significant results favoring a blend of peppermint, ginger, spearmint, and cardamom and also ginger oil alone, to be effective. Other oils that may help: lemon, grapefruit, and fennel. 
  • When you find something that helps control your nausea, BUY IT IN BULK!! A lot of medical research I found, referred to NVP as having a negative effect in the “quality of life” for pregnant women, so by all means, whatever helps, do it! Do it a lot! (as long as it’s safe! I loved Preggie Pop Drops (Sour Fruit). The sour and citrus flavors of the pop drops immediately soothed my nausea, but I had to keep popping them! My favorite were the sour raspberry ones, but the mixed sour fruits were good enough! I found they were (at the time) cheaper at Babies R Us or Buy Buy Baby vs. Amazon or eBay. I wanted a gigantic case of these suckers, but at around $5 per container of 21 pieces (wow that’s about 25 cents per drop!), I had to find some cheaper backups. (my mouth just started filling up with saliva as I type this) I also really loved popsicles (particularly the citrus variety), gummy candy, and really any hard candy that wasn’t mint flavored. 

Anyway, that’s all for me on the topic, I hope that this post helped answer some of your questions or concerns regarding morning sickness! What did you do to find relief? 

Sources:

National Institutes of Health National Library of Medicine – Morning Sickness https://www.nlm.nih.gov/medlineplus/ency/article/003119.htm

Koren, G. Treating morning sickness in the United States – changes in prescribing are needed. ACOG; December 2014. http://www.ajog.org/article/S0002-9378(14)00853-9/pdf

Diclegis Prescriber Information https://www.diclegis.com/pdf/Diclegis_Full_Prescribing_Information.pdf

FDA Pregnancy Categories A, B, C, D, X, N Explained. http://www.drugs.com/pregnancy-categories.html

Nuangchamnong N., Niebyl J. Doxylamine succinate – pyridoxine hydrochloride (Diclegis) for the management of nausea and vomiting in pregnancy: an overview. International Journal of Women’s Health. 2014 (6): 401-409. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990370/pdf/ijwh-6-401.pdf

Badell, M. L., Ramin, S. M. and Smith, J. A. (2006), Treatment Options for Nausea and Vomiting During Pregnancy. Pharmacotherapy, 26: 1273–1287. http://onlinelibrary.wiley.com/doi/10.1592/phco.26.9.1273/abstract

Hunt et al. Aromatherapy as Treatment for Postoperative Nausea: A Randomized Trial. Anesthesia & Analgesia. 2013; 117(3): 597-604. Link here (too long to paste)

4 Natural Remedies for Nausea – Everyday Health. http://www.everydayhealth.com/digestive-health/four-natural-remedies-for-nausea.aspx

Essential Oils for Nausea, Vomiting, and Diarrhea. http://www.essential-oils-work.com/essential-oils-for-nausea-vomiting-and-diarrhea.html (not a professional reference, but if you read it you’ll see why I listed this one)