Morning sickness: is there a cure?

by Miriam Erick, MS,RD

Morning sickness is a serious condition of pregnancy for the one in seventy-seven women who ends up hospitalized for dehydration or malnutrition. Countless thousands of others lose significant amounts of work because of various on-the-job factors that increase the unpleasant sensation of nausea and make life unpredictable.

Morning sickness has been the subject of medical curiosity for over 1000 years. Treatments for severe cases ranged from the bizarre (injections of husband's blood) to the inhumane (isolation without a vomit basin). Occasionally, death occured-the most famous being Charlotte Bronte. While no "magic bullet" will eliminate morning sickness before its natural course expires, there are many simple changes that can provide a woman with the power to cope. Please remember that the information presented here is by no means a substitute for personal medical care.

Ask the random person what they know about "morning sickness" and you might hear "I hate to get up when the alarm rings!" Or if the respondee is vaguely familiar with pregnancy, expect some mumbling about crackers and getting out of bed. In most instances, it doesn't sound very serious.

However, morning sickness is hardly a casual matter for the more than fifty thousand women in the United States who are so severely stricken by this early pregnancy malady that they end up hospitalized for dehydration and malnutrition in any given year. Statistics suggest that even though 50%-90% of moms-to-be are affected to a much lesser degree, morning sickness can still affect overall productivity.

What is morning sickness?

The general presentations are queasiness, and vomiting. The symptoms may be mild and eventually go away, or may progressively get worse. No one knows for sure what causes morning sickness, but current theories suggest that it is related to the increase in various hormones that accompany pregnancy. More than thirty different hormones are required to maintain a pregnancy. Of these, three are suspected to precipitate morning sickness: progesterone, human chorionic gonadotropin (HCG), and estrogen.

Because each hormone has a distinct set of properties, it is difficult to pin down just one as the cause of morning sickness. For example, we know that progesterone decreases stomach emptying and relaxes muscle tone, allowing food to stay in the stomach longer. This delaying emptying sensation may be one cause of nausea. HCG rises immediately when conception takes place and seems to level off at the time most women end their queasies; women with more severe morning sickness have been noted to have significantly higher levels of HCG. And estrogen has many different influences, one of which is related to the sense of smell. Ask any pregnant women about the relationship of background smells to nausea and vomiting!

Symptoms of morning sickness

In addition to nausea and vomiting, some women complain of headache, dizziness, heightened sense of smell, irritability, increased salivation, dry mouth, parched lips, shivering and chills, difficulty focusing on small details, motion sickness, and a type of claustrophobia, either from very close contact with other people or tight-fitting garments. The more symptoms noted, the greater the correlation with severity.

Why do these symptoms occur?

They are primarily a result of nausea and vomiting -- women don't eat when they feel nauseated, and vomiting causes fluid loss. Dizziness, shivering, and chills can be explained by this lack of food and/or fluid, both of which are necessary for heat production. If significant weight loss has occurred, shivering and chills can be the result of a reduced tolerance to temperature differences. Headaches can also be the result of a decreased food intake due to intense nausea. Increases in saliva often reflect an increase in nauseousness and an enhanced sense of smell. Dehydration is the probable cause of the often-noted dry mouth and parched lips.

For years, the medical community maintained that nausea and vomiting of pregnancy was psychological, simply because the reasons for its occurrence were unknown. Let's face it -- women with morning sickness feel awful, and may prefer being at home near the bathroom. Since the 1920s, this self-imposed isolation has generated misplaced theories about morning sickness that run the gamut from weaknesses in psychological make-up and impaired maternal and spousal relationships to ambiguity about having children. As a matter of fact, in the 1930s, morning sickness was referred to as "a disease of theories"

Who gets morning sickness?

Available health data indicate that 50%-90% of all pregnant women have some degree of morning sickness. It's a global problem, as noted by reports from Kuala Lumpur, New Zealand, Ceylon, and Nigeria in addition to more industrialized countries such as Germany, France, Russia, Japan and the United States.

When are women most affected?

Judging from its name, many women are sick as soon as they wake up in the morning. However, morning sickness has been shown to crop up at mid-day, early evening, and may even be a problem in the middle of the night.

Factors triggering the nausea vary. In classic morning sickness, the trigger is often set off by a startle reaction from an alarm clock, made worse by the motion of a bed partner and a bed partner's breath. Mid-day sickness might be the result of smells from other origins, such as cooking smells next door, a lack of food and/or fluid, or increased motion. Early afternoon sickness might be the result of fatigue setting in, which worsens nausea. Evening sickness might be the result of all of the above. A more realistic name for morning sickness would be "pregnancy sickness," which is a term used by many other cultures.

How long does it last?

"Through the first trimester", according to most books and clinicians. However, one study suggests that the average is 17.3 weeks (40% of a pregnancy). A small percentage of women are sick until they actually deliver their babies!

What remedies work?

For dozens of years, crackers have been promoted as a panacea—and do work for some women. They are bland tasting, have no significant smell, and are easily digested, providing approximately 40 calories per cracker. But most crackers lack fluid and minerals such as potassium, sodium, and magnesium. These minerals are critical for proper muscle contractions and stomach emptying, especially in women who have been vomiting excessively. Potato chips, which are tolerated very well by many women, contain potassium and sodium but no fluid. Ginger ale is also well tolerated, due primarily to its ginger content, although the ginger content varies widely between brands. The stronger the "bite" to a ginger ale, the higher its ginger content. Lemonade is a popular, well-tolerated beverage as is water with a lime squeezed into it. Sometimes just sniffing or licking lemons or limes will do the trick.

Large amounts of vitamin B6 have often been suggested as a remedy for nausea and vomiting. In fact, several studies have shown inconclusive results from vitamin B6 supplementation. One researcher showed improvement in morning sickness symptoms using an all-purpose multivitamin containing nineteen different nutrients. Sometimes a child's chewable multivitamin is better tolerated than prenatal supplements. But remember that vitamins and minerals in supplement form do not provide energy or fluid, both of which are critical to successful pregnancy.

How to manage it

Some simple suggestions: keep track of when symptoms prevail and then remove the offending trigger. Smells, motion, noise, fatigue, and hunger are hard to differentiate because they are "invisible," but separately and collectively they are components that have an important impact on eating and drinking.

Although eating and drinking immediately upon rising often keep morning sickness at bay, some women feel worse, thus beginning a vicious cycle. Getting in the requisite ten (8-oz.) cups of fluid per day is sometimes made easier by eating foods with a high water content, such as watermelon, Granny Smith apples, or mashed potatoes. If you fall short of this fluid requirement for more than 3 days in a row, you could be headed for a serious setback. Talk to your doctor about home intravenous fluids and be sure to ask for a referral to a perinatal registered dietitian who will have experience in the nutrition management of morning sickness.

If your pregnancy sickness has become disabling and you are having trouble functioning, ask for a referral to a social worker or psychiatrist who has experience with severe morning sickness (also called hyperemesis gravidarum). If you are unable to advocate for yourself, have someone close to you do it. Although it's difficult to form support groups for active morning sickness, many women who've experienced it (and survived it) are willing to be "phone buddies" for women in need. The good news is: it doesn't last forever!

What to Eat When You Can\t...

lemons (to lick or smell)
lemonade
potato chips
crackers
fresh watermelon
dill pickles
Granny Smith apples
tangy gingerale
frozen grapes
mashed or baked potatoes