US Pharm. 2013;38(9):17-18.

Nausea Gravidarum

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 triplets.

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 reduce symptoms.

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.