Nausea and vomiting are common complaints, and often experienced by most patients during the first part of pregnancy. This is also called “morning sickness”, although it can occur at any time of the day and for some special cases, these can last the entire pregnancy. Most cases of “morning sickness” are not harmful. However, when these symptoms are severe and persistent, they can affect your health hence may require hospitalization.

What Causes Nausea?

When you get pregnant, nausea and vomiting can occur as your body goes through many changes. It is believed that the increase in the pregnancy hormones especially Human Chorionic Gonadotropin (HCG) and the women’s bodies ability to adapt to these changes are the cause of the symptoms.

I frequently tell my patients to be happy when they experience morning sickness because it can be used as a gauge that your pregnancy is doing well. The fetal movement is not felt till 16-20 weeks age of gestation. Until the mother can feel the baby move inside her there is no way she can be sure her baby is fine unless she have herself checked daily by her obstetrician. In most women, symptoms of nausea and vomiting are mild and go away around 18-20 weeks age of gestation because at this time the level of the HCG hormone plateaus and the patient has finally adjusted to the level. This coincides with the time they can feel their baby move hence a “new” way to be assured of the baby’s health.

Unfortunately, I do encounter severe nausea and vomiting and this condition is called hyperemesis gravidarum. This can lead to loss of weight and body fluids and hence require hospitalization.

Effects on pregnancy

In mild morning sickness, I believe its God’s way of assuring you that your pregnancy is fine. Morning sickness does not mean that your baby is sick. It actually means the opposite, because a healthy pregnancy should have an increasing HCG levels till it levels up around 18-20 weeks.

Morning sickness can become a problem if you can’t keep any foods or fluids down and begin to lose weight; you have a small amount of urine and it is dark in color; you feel dizzy or faint; there’s blood in your vomit; and your heart is beating too fast. If any of these happens, call your doctor immediately.

What You Can Do

I usually advise my patient to:

  • To take it slow in the morning. Don't stand up abruptly. Sit up first then eventually sit while dangling legs on the side of the bed till one has adjusted to the changes in position.
  • Eat crackers or toast before getting out of bed in the morning.
  • Keep well hydrated. Water is still best, cold or hot. Drinks with ginger (e.g. salabat) have been helpful. Herbal teas are good too.
  • Small frequent feedings (5-6 small meals) each day. Make sure food are low fat and easy to digest. May have a cold sweet drink (the rare times, I do allow this)
  • Have walks and enjoy the fresh air before sleeping.
  • Avoid smells that bother you.

One of the many questions I am often asked is why I don't give prenatal vitamins and Iron in the first trimester; it is because these medications cause nausea. Although I do give Folic acid 5mg a day, besides ensuring neurologic health of the growing fetus, this can help with the nausea when taken at the end of the day. Talk with your doctor before taking any medication or trying any treatment.

Medical Management and Treatment

When your morning sickness is severe, you may need medical treatment. If your doctor suspects that you have hyperemesis gravidarum, you may need to stay in the hospital for a while.

Various blood tests may be requested to find out any diseases that you may have that could cause the grave symptoms. A Transvaginal ultrasound would be requested to find out if you are having twins. Twinning increased HCG levels and cause excessive symptoms.

Your doctor will give you fluids through an intravenous (IV) line to hydrate you and replace any electrolytes and nutrients you may have lost since most of the time you wont be allowed to eat any food till vomiting stops. You also may be treated with anti-emetic (anti-nausea) medications. Your doctor may suggest that you rest in a dimly lit room where it is quiet and private. This type of treatment in the hospital often relieves symptoms.

On a final note:

Know that during pregnancy your body goes through many changes and morning sickness is a common complaint. Relax and allow your body to adjust to these changes during the first part of your pregnancy. Call your doctor right away if your nausea and vomiting become severe.