During the first trimester of pregnancy, many women have the bouts of nausea and vomiting known as morning sickness.
Despite its name, morning sickness can happen day or night. It usually starts around the 6th week of pregnancy, is at its worst around week 9, and stops by weeks 16 to 18. Although unpleasant, morning sickness is considered a normal part of a healthy pregnancy.
What’s Severe Morning Sickness?
Severe morning sickness is when nausea and vomiting get so serious that a pregnant woman vomits several times a day, loses weight, and gets dehydrated or is at risk for dehydration.
If this rare pregnancy-related condition isn’t treated, it can affect a woman's health and her baby's ability to thrive.
The medical term for severe morning sickness is "hyperemesis gravidarum" (hi-per-EM-eh-sis grav-ih-DARE-um), which means "excessive vomiting during pregnancy." It usually follows a similar timeline to normal morning sickness. But it can go longer, sometimes lasting for the whole pregnancy. Often, the symptoms get less severe as the pregnancy continues.
Most cases of hyperemesis gravidarum affect a woman's first pregnancy. But women who have it in one pregnancy are more likely to have it in future pregnancies.
What Causes Severe Morning Sickness?
The cause of severe morning sickness isn’t known. But it might be related to the hormone changes of pregnancy. A hormone called human chorionic gonadotropin, or HCG, might be to blame because severe morning sickness most often happens when HCG levels are at their highest in a pregnant woman's body.
Severe morning sickness also might run in families. It’s more common in women whose close family members (such as mothers and sisters) have had it.
Other things that can increase a woman's chances of having severe morning sickness include:
- carrying multiples (twins, triplets, etc.)
- history of motion sickness
- migraine headaches with nausea or vomiting
What Problems Can Happen?
The nausea and vomiting that happen in severe morning sickness are so extreme that they can harm the mother and the baby. Not being able to keep down food makes it hard for the mom to meet her nutritional needs. So she might lose weight. And a loss of fluids, combined with the loss of stomach acid from vomiting, can cause dehydration and electrolyte imbalances.
If severe morning sickness isn’t treated, it can cause many problems, including organ failure and the early birth of her baby.
When Should I Call the Doctor?
Call the doctor right away if you’re pregnant and have any of these symptoms:
- nausea that lasts throughout the day, making it impossible to eat or drink
- vomiting three to four times per day or not being to keep anything in the stomach
- brownish vomit or vomit with blood or streaks of blood in it
- weight loss
- fainting or dizziness
- peeing less than usual
- a fast heart rate
- a lot of headaches
- unpleasant, fruity mouth or body odor
- extreme tiredness
- confusion
How Is Severe Morning Sickness Treated?
Treatments used for morning sickness, such as eating dry crackers in the morning or a bland diet, may be recommended for women with extreme morning sickness. But these might not help with severe symptoms.
Medical treatment can include:
- a short period of not eating to rest the gastrointestinal system
- intravenous (IV) fluids
- vitamin and nutritional supplements
Some women might get medicine to stop the vomiting, either by mouth or through an IV. The doctor might recommend eating foods with ginger or taking vitamin B6 supplements to help ease nausea. It can also help to:
- Eat a bland diet.
- Eat frequent small meals.
- Drink plenty of liquids when not feeling nauseated.
- Avoid spicy and fatty foods.
- Eat high-protein snacks.
- Avoid sensory stimuli that can act as triggers (like specific smells or noises).
If a woman feels anxious or depressed about her condition, talking to a therapist or counselor might help her cope with her feelings.
What Else Should I Know?
With treatment, women with severe morning sickness can feel better and get the nourishment they need so they and their babies thrive. And lifestyle changes can help ease nausea and vomiting and make the pregnancy more enjoyable.
With time, symptoms usually do improve. And, of course, they stop by the time a woman's next journey starts: parenthood.
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Most women will not experience excessive vomiting, but many will have some discomfort due to nausea.
Here are some tips for minimizing the unpleasant symptoms of nausea during pregnancy.
1) Get plenty of rest
It is important to get a good night´s sleep. Napping during the day may help too, but not straight after a meal, as this can increase nausea.
For those who work night shifts, it may help to wear a sleep mask or use blackout curtains to block out as much light as possible.
As time goes on and the body changes shape, a maternity body pillow may help your back and abdomen.
Go to bed early and wake up early, so you can take time to get out of bed.
Do not use sleeping pills unless a doctor prescribes them.
2) Eat with care
Fatty and spicy foods and caffeine increase the chance of triggering the release of stomach acid, especially as the pregnancy progresses and the fetus pushes against the digestive tract. Bland foods may be less aggravating.
Small portion sizes can help reduce the chance of vomiting but keep something in the stomach. Having an empty stomach can worsen the feelings of nausea. The stomach produces acids, but they have nothing to work on, except for the stomach lining. This adds to the feelings of nausea.
Having some salty crackers or a protein snack before getting out of bed in the morning may help.
At breakfast, cold apple sauce, pears, bananas or any citrus fruit will help you feel satisfied early. The fruit’s potassium may help prevent morning sickness.
Carbohydrates can help. Baked potatoes, rice, and dry toast are often suitable options.
At night, eating a high-protein snack before going to bed will help regulate your blood-glucose levels during the night.
Eat food cold to reduce the smells experienced when eating.
3) Keep physically and mentally active
Being physically active has been found to improve symptoms in women who experience nausea during pregnancy.
Keeping busy can help take your mind off the feelings of nausea. Reading a book, doing puzzles, watching television, playing cards, or going for short walks around the block will help to keep you preoccupied.
4) Ensure good fluid intake
It is important to stay hydrated for good health, especially during pregnancy.
It may be hard to consume eight glasses of water a day while experiencing nausea, but dehydration can aggravate feelings of nausea.
Adding apple cider vinegar and honey to water may make it more palatable.
Sucking ice cubes made from water or fruit juice is also an effective method.
5) Ginger and peppermint teas
Ginger has long been used to aid digestion and reduce abdominal discomfort. Studies show that it may also help relieve the symptoms of nausea.
Other options are to sip cold ginger ale or to add a slice of raw ginger to water or tea.
Snacks such as gingerbread, or ginger cookies may also help.
Peppermint tea may also help settle the stomach.
6) Wear loose and comfortable clothing
Restrictive or tight clothing may worsen the symptoms of nausea. Women who experience nausea during pregnancy have fewer symptoms of nausea when they wear loose-fitting clothes.
7) Vitamins and supplements
Supplements should only be used under a doctor’s supervision. If you are taking vitamins, it may be best to take them before bed and with a snack.
Vitamin B6 may help reduce nausea.
Iron supplements that are prescribed during pregnancy can sometimes lead to nausea. A doctor may recommend a slower-release form or a lower dosage. Take iron supplements with orange juice or another drink with Vitamin C to increase absorption.
8) Avoid computer monitor flicker
A computer monitor flickers rapidly and almost unnoticeably. This may contribute to morning sickness.
If it is not possible to avoid using a computer monitor, it may help to adjust the screen by making the fonts bold and larger and changing the background to a soft tan or pink color. This will help reduce eye strain.
9) Avoid triggers
Morning sickness is linked to an increased sensitivity to smell.
Some strong smells can worsen the symptoms, but scents such as lemon extract and rosemary may help.
An individual will learn to recognize which triggers bring on an episode of nausea, and they can avoid these as far as possible.
10) Help for acid reflux
Sometimes, the nausea and vomiting may be due to acid reflux.
A doctor may be able to recommend antacid medication to take before going to bed to reduce stomach acid levels, and the subsequent morning vomiting.
Always check with a doctor before taking any medication during pregnancy.
Alternative therapies such as acupressure may help. Applying pressure on specific points on the body may help control symptoms. It may involve wearing a motion-sickness band on the forearm.
The feelings of nausea do not happen only in the morning. Most women find they ease as the day goes on, but, for some women, they may continue all day.
Nausea during pregnancy is normally associated with an increase in estrogen levels, low blood sugar counts, and a greater susceptibility to some smells.
The exact reason is unknown, but factors may include:
- a rise in hormones, especially estrogen, progesterone, human chorionic gonadotrophin (HCG), and cholecystokinin, leading to changes in digestive activity
- a fall in blood sugar, resulting from the placenta’s need for energy
Another theory on what contributes to nausea in early pregnancy is related to the sense of smell. A woman’s sense of smell is more sensitive in pregnancy, and this could increase the feelings of nausea.
It is most likely to occur during the first 3 months of pregnancy, and it often subsides once into the second trimester.
Research has suggested that nausea and vomiting during pregnancy are a good sign, and they are associated with a lower risk of pregnancy loss.
Excessive vomiting during pregnancy is known as hyperemesis gravidarum. It can lead to dehydration, malnutrition, and weight loss.
It affects around 1 in every 300 women during pregnancy, usually only during the first 20 weeks of pregnancy.
A woman should see a doctor if:
- she loses more than 2 pounds in weight
- she vomits blood, which may be red or black
- she vomits more than four times in one day
- she is unable to keep fluids down for more than one day
The doctor may recommend dietary changes, plenty of rest and the use of antacids. In severe cases, the patient may need to receive fluids and nutrition intravenously.
The American Pregnancy Association (APA) suggest eating:
- Cold foods
- Plain fruits and vegetables
- Bland foods, such as chicken soup
As snacks, the APA recommend:
- pretzels
- Jell-O
- flavoured popsicles
- Preggie Pops, a kind of candy in different flavors such as mint, lemon, and ginger, designed to reduce the sensation of nausea
Medications are not recommended as they may have unexpected adverse effects during pregnancy. Speak to a doctor about non-medicinal remedies for morning sickness.