Morning Sickness

also called NVP (nausea and vomiting of pregnancy)

What causes morning sickness?

Many articles link morning sickness to the pregnancy hormone hCg. Morning sickness tends to be worse with multiple gestation (a high hormone state) and it tends to be minimal in pregnancies that end in miscarriage (a low hormone state). It may not make any sense, but the sicker you are, the "better" the pregnancy. On the other hand, you can have absolutely no morning sickness with a perfectly normal pregnancy.

Why does morning sickness exist?
An evolutionary explanation

The best theory is that morning sickness is Mother Nature's built-in toxin avoidance mechanism. It is "biological radar", warning us when something potentially hazardous is coming our way. The evidence supporting this theory is extensive. For example, fetal organ development is usually completed by week 14 of pregnancy. During those first 14 weeks, the fetus is exquisitely sensitive to the damaging effects of toxins. The first trimester is also when nearly all miscarriages occur and coincidentally most cases of morning sickness resolve by the end of week 14. Interesting!

Severe morning sickness

About 1-3% of pregnant women experience severe morning sickness. It can lead to profound dehydration, mineral and electrolyte abnormalities and acid-base changes in blood chemistry. Treatment requires intravenous fluids and possibly hospitalization.

Contact the office right away if you have any of the following symptoms:

  • Throwing up everything, food and liquids, for more than a couple of days.
  • Losing more than 5% of your body weight (for example a 120 lb. woman loses 6 pounds) compared to your pre-pregnant weight. 
  • Feeling constantly dizzy, lightheaded, very weak and you have a dry, pasty mouth.

Management of mild morning sickness

First, trust your instinctive food aversions. If it doesn't smell good, look good, or "sound" good to you, then don't eat it. Below are two lists, the “things to avoid” list and the “things to try” list. Review these lists and try to incorporate as many suggestions as you can, and you should see some improvement in your symptoms.

Things to avoid that may help mild morning sickness

  • Avoid odors as much as possible. Have your husband/partner/significant other use breath mints. Use odorless hygiene and laundry products. Avoid odor-filled places (crowded public places, public restrooms, smelly gyms, etc.). Have your home cleaned to try and eliminate any musty or moldy household odors. Get rid of smelly stuff in the fridge and place opened boxes of baking soda inside.
  • Avoid most raw vegetables and canned fruits and vegetables. Stick with fresh, sweet, ripe fruits. 
  • Avoid greasy and high-fat foods (although dairy products are usually okay). 
  • Avoid burnt foods. Avoid barbecued food. 
  • Avoid raw fish (sushi)
  • Avoid nuts. 
  • Avoid spices, spicy foods and herbs: garlic, onion, dill, oregano, etc. But ginger can help.
  • Avoid food flavorings and condiments: ketchup, mustard, steak sauce, etc. Small amounts of salt are okay. 
  • If vomiting more than once a day, stop all vitamins (yes, even prenatal vitamins) except folic acid (400-800 mcg. daily) and B-6 (25-50 mg. daily). 
  • Avoid coffee, tea, chocolate, and any substance that is bitter in its native form (before sugar and fat have been added to it). 

Things to try 

  • Keep saltine crackers on your nightstand. Eat one as soon as you awake, while still lying down if possible. Then wait a few minutes before getting up. The crackers will absorb stomach acid that may have accumulated during the night. 
  • Eat things a baby would like (boring, bland stuff), like plain white breads, cereal, noodles, rice, and plain yogurt (sweet yogurt is better). 
  • Many patients love macaroni and cheese, grilled cheese sandwiches or quesadillas (warm flour tortillas with melted cheese). One patient just ate black bean and cheese burritos for weeks! Plain bagels with cream cheese are often well tolerated.
  • Eat sweet, ripe soft fruits.
  • Try a blender-shake made with ice, plain yogurt or milk, ripe fruit or fresh fruit juice and some honey. Whey or soy protein powder can be added if your diet is low in protein.
  • Eat white cheese (pasteurized!). It digests slowly and lessens stomach acid production. 
  • Dry, white meats like chicken or turkey breast are well tolerated. 
  • Drink reduced-carbonation Seven-up or Ginger Ale (pour into a cup, and then stir). 
  • If vomiting, drink Gatorade-type drinks rather than water to replace minerals. 
  • Drink liquids over crushed ice, using a straw. 
  • Eat small meals all day long, up to 10 times a day. 
  • If you have to cook, try to microwave, steam or boil foods. This lowers the "burned food" odors. 
  • Sea sickness acupressure-type wrist bands might help.

To help nausea try the following:

Emmetrol

I am not a big fan of this product, marketed to help nausea. It is a sweet, syrupy liquid, very safe to use, but many patients told me that they immediately threw up after taking Emmetrol. But, I have heard that it is effective for kids.