Health Column
November 2, 2009
MEDIA CONTACT: Joyce Brennan
Public Information Officer
Southcoast Health System
Phone: 508-961-5270
Fax: 508-961-5876
Pager: 508-387-9605
brennanj@southcoast.org
www.southcoast.org/news/releases/
Christian S. Pope, DO, FACOG
Diplomate, American Board of Obstetrics and Gynecology
HealthCare for Women, Inc., New Bedford and Mattapoisett
Dr. Pope practices at St. Luke’s Hospital, the New Bedford site of Southcoast Hospitals
Group. He can be reached at 508-999-6245
What You Should Know About Morning Sickness
Nausea and vomiting of pregnancy is common and affects 80 percent of pregnant women. The
spectrum of symptoms ranges from mild nausea to unmanageable vomiting which can deplete the
body of vital nutrients resulting in hospitalization. It may simply be a nuisance to most women or
may be severe enough to affect the health of both the pregnant woman and her fetus.
What Causes morning sickness?
It has been theorized that nausea and vomiting of pregnancy is an evolutionary adaptation that
developed to protect the pregnant woman and her fetus from foods that might be potentially
dangerous. This theory may in fact explain the temporary aversions to tastes and smells that
pregnant women experience.
Hormones
Symptoms are a reaction to the changes your body is going through such as, high pregnancy
hormone levels (bBHCG) that are made from the placenta. These levels rising exponentially
during the first trimester and peak at 10 weeks pregnancy, a point when symptoms are at their
worst, then slowly decline over the remainder of the pregnancy.
Estrogen
Another hormone known to influence nausea and vomiting of pregnancy is estrogen. High
estrogen levels associated with pregnancy contribute to nausea.
Gastrointestinal
Your gastrointestinal symptom slows during pregnancy. It takes longer for food to empty from
your stomach into your small intestine, and it takes longer for food to digest. This slow down in
food travel also contributes to symptoms of fullness and nausea, especially early in pregnancy.
This is also why frequent small meals, rather than three large meals, are encouraged during
pregnancy for better absorption and tolerance.
Risk Factors
Women with more than one fetus (twins, triplets, etc), uncontrolled hyperthyroidism, or history of
nausea and vomiting in previous pregnancy, are at a higher risk of increased nausea in pregnancy.
Additionally, daughters and sisters of women who had severe nausea and vomiting, are more
likely to have similar symptoms, and having a history of motion sickness and migraines have also
been described as risk factors in some studies.
Is my baby okay?
The effect of nausea/vomiting on the fetus really depends on the severity of the condition. With
mild to moderate symptoms, there is usually nothing to worry about. However, in women with
severe symptoms, lower birth weights may occur. Severe symptoms relate to those patients whom
required long-term treatment with medications throughout their pregnancy and/or require multiple
hospital admission for rehydration with intravenous hydration.
In women who suffer from symptoms throughout their pregnancy, frequent fetal growth
ultrasounds are recommended to assure normal fetal growth and development.
Curiously numerous studies have shown a lower rate of miscarriage among women with nausea
and vomiting of pregnancy. This is thought to be due to vigorous placental synthesis in a healthy
pregnancy.
Are non-medicinal therapies effective for treatment?
Treatment begins with prevention.
Few studies have shown that women who were already taking a multivitamin at the time of
conception were less likely to need intervention for vomiting in pregnancy. Besides a
multivitamin, recommendations to alleviate signs of nausea/vomiting include rest and avoidance
of sensory stimuli that can provoke symptoms. For example, avoiding spicy or fatty foods, eating
mostly bland or dry foods, high-protein foods, and plenty of small volumes of liquids, especially
in the morning helps prevent symptoms. Ginger-ale may help some patients due to the mixed
sugar and carbonation content. Also, frequent small meals is encouraged.
Ginger capsules (250mg) four times daily has shown promise among some women in
improvement of symptoms. Additionally, pressure with wrist bands or electrical stimulation at
the P6 (Neguian) point on the inside of the wrist has shown improvement in symptoms in many
women. Also, never underestimate the power of acupuncture in preventing or improving the
worst cases of vomiting in pregnancy.
Are medical therapies effective for treatment?
Yes. Sometimes.
Here they are:
1. Vitamin B6 10-25mg four times daily
2. Phenergan 12.5-25mg four times daily
3. Reglan 5-10 mg four times daily
4. Zofran 8mg three times daily
5. Tigan 100mg three times daily ( rectal suppository….in severe cases where you cannot
keep anything down..at this point you’ll try anything)
6. Steroids in a tapering dose after 10 weeks of pregnancy only
Hyperemesis gravidarum
This is a severe form of nausea and vomiting of pregnancy that causes dehydration, electrolyte
imbalances, possible reversible kidney and liver insults, and warrants hospitalization with
intravenous and electrolytes replenishment. Rarely patient need IV nutrition for prolonged
periods of time, known as TPN (total parenteral nutrition), where liquid food is infused through
an intravenous line either in the hospital or at home. For more information on this severe form of
‘morning sickness’ you may visit the Hyperemesis Education and Research Foundation at
www.hyperemesis.org.
Final Thoughts
Your body goes through many changes in pregnancy, with nausea and vomiting being a frequent
normal result of these changes. Usually, passing of time results in improvement or complete
resolution of symptoms. If symptoms become severe, there are many treatment options available
which may help. And remember, every pregnancy is different and no one knows your body better
than you.
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