US Pharm. 2013;38(9):17-18.
Morning sickness commonly manifests during the first trimester of
pregnancy, usually improving or vanishing completely by the fourth
month, although it can continue throughout pregnancy. As its name
implies, this condition often is worse upon awakening, when the stomach
is empty; however, symptoms can occur at other times of day. Vomiting is
a less common symptom than nausea. Women carrying two or more babies
are at higher risk for morning sickness.
There are several theories as to the cause of morning sickness. The
symptoms could result from hormonal fluctuations, increased sensitivity
to strong odors, or acid reflux caused by delayed stomach emptying.
Mild morning sickness is not harmful to the mother or the developing
baby. It is not unusual for the mother to lose a few pounds during the
first trimester. Some women find relief by changing their diet, eating
small meals throughout the day, and keeping dry crackers or cereal handy
to eat at night or upon awakening. Ginger ale and other
ginger-containing products can help settle the stomach. Acupressure, a
treatment that uses elastic wristbands to put pressure on specific
nerves, also may be helpful for nausea. Acupuncture treatments may work
in the same way.
A more serious form of morning sickness, hyperemesis gravidarum,
occurs far less commonly. A patient with hyperemesis gravidarum becomes
seriously ill from nausea and persistent vomiting, which result in
dehydration and significant weight loss. Often, IV fluids, electrolyte
supplements, and even tube feeding or IV nutrition are required to keep
mother and baby healthy until delivery.
Simple Lifestyle Modifications Can Relieve the Symptoms
Morning sickness, a term that refers to nausea and vomiting
during pregnancy, affects most pregnant women. Nausea is more common
than vomiting. The symptoms usually are worse when the woman awakens in
the morning with an empty stomach, but they can occur at any time of
day. Most cases of morning sickness are mild and improve or disappear by
the end of the first trimester, but symptoms may be experienced
throughout pregnancy. A mild case of morning sickness can result in a
maternal weight loss of a few pounds, but this does not harm the mother
or the baby. In fact, women with mild morning sickness have a healthier
pregnancy and fewer complications. Morning sickness does not necessarily
occur with all of a woman’s pregnancies.
What Causes Morning Sickness?
The cause of morning sickness is not completely understood. One
theory is that the symptoms are linked to hormone fluctuations early in
pregnancy. The nausea may be a reaction to certain odors, or it may
begin as a gag reflex when the woman brushes her teeth. Pregnancy also
can cause the stomach to empty slowly, resulting in nausea and reflux
symptoms. Morning sickness is more common in women carrying twins or
Lifestyle Modifications Can Help
In the case of mild morning sickness, a few simple lifestyle changes
can be helpful. Keeping rooms well ventilated can prevent nausea
triggered by strong odors. Dietary recommendations include eating dry
crackers or toast at bedtime, upon waking during the night, and before
getting up in the morning. Large meals should be avoided; having several
small meals or snacks daily usually works best. Tart liquids such as
lemonade may be more palatable than plain water. High-protein foods and
complex carbohydrates are better choices than high-fat and fried foods.
Gelatin, broth, and frozen fruit bars are effective for settling an
upset stomach, as are foods containing real ginger (for example, ginger
ale, ginger tea, and ginger candy).
Prenatal vitamins should be continued despite morning sickness when
possible, because they are high in B vitamins. Some doctors prescribe
vitamin B supplements for their patients with morning sickness to help
If Symptoms Remain or Worsen
If lifestyle changes do not improve morning sickness, or if mild
symptoms worsen or fail to improve after the first trimester, a doctor
or other health care professional should be contacted for evaluation and
treatment recommendations. In April, the prescription medication
Diclegis (doxylamine [an antihistamine] and pyroxidine [vitamin B6])
was approved to treat nausea and vomiting of pregnancy that has not
improved with more conservative measures. Drowsiness is the most common
side effect of this medication.
Hyperemesis gravidarum, a severe form of morning sickness
characterized by persistent vomiting and dehydration, is much less
common. A woman suffering from hyperemesis gravidarum has more problems
with her pregnancy, and it is important to seek professional health care
early to ensure the safety of mother and baby. First, IV fluids are
given to the patient to prevent or treat dehydration. Afterward, the
patient may receive anti-inflammatory medication or IV drugs that
prevent nausea or hasten stomach-emptying time.
If you have questions about the treatment of morning sickness, ask
your pharmacist. Your pharmacist can also advise you about the use of
medications during pregnancy.