Health Column: What you should know about morning sickness

By 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.

Dr. Pope is a featured columnist for The Standard-Times on women's health topics. Check out Dr. Pope's column the first Tuesday of every month at www.southcoasttoday.com.

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.