Morning sickness: What's normal and what's not

Posted June 07, 2021 by Christine Arnold, M.D.

One of the most common symptoms of early pregnancy is nausea and vomiting. Although it is common, it can have a significant impact on patients' quality of life, especially when it is severe or prolonged. Nausea and vomiting is an unpleasant reality for many women in their early weeks of pregnancy, but for some it can extend into the second and third trimester as well.

There is a wide variation amongst women who experience pregnancy induced nausea. Some women experience very little nausea and vomiting for short amount of time, while some patients can suffer from a severe form of nausea called hyperemesis gravidarum. Despite its name, it isn’t always restricted to the morning, and can occur any time of the day. Up to 80 percent of women experience some degree of nausea and vomiting during pregnancy.

Symptoms can range from mild to severe and include:

A nauseous, queasy feeling that many women describe as motion or carsickness.

Strong aversions to certain smells and foods that are so powerful it can make you sick to your stomach.

Nausea that leads to vomiting.

Typically, symptoms start on average in the sixth week of pregnancy, and usually subside at the end of the first trimester around 14 weeks. Some patients will have symptoms extend through about 20 weeks, and a small minority of patients will have nausea until they deliver.

The cause of nausea in pregnancy is not well understood, and is likely due to multiple factors, including genetics. The hormonal fluctuations that occur during early pregnancy are also implicated.

Morning sickness relief

You don’t have to suffer through nausea that interferes with being present at work or with your family. There are many safe and effective strategies to keep your symptoms in check:

Keep crackers or dry toast by your bed to nibble on before getting up in the morning.

Eat frequent small meals to keep your stomach from becoming empty. Also, drink frequent small amounts of fluid to avoid dehydration.

Avoid eating foods that are fatty, greasy, spicy or acidic. Instead try the B.R.A.T. diet: bananas, rice, applesauce and toast. When you feel better, you can eat more well-rounded meals.

Add ginger to your diet, such as putting fresh ginger in your tea, drinking ginger ale or even snacking on ginger candy.

Take your prenatal vitamins with food, instead of on an empty stomach

Common OTC /first line remedies include "sea bands" (acupressure wrist bands) commonly used for motion sickness, as well as Vitamin B6 supplements and Doxylamine

If the over the counter remedies don't work, talk to your physician about available prescription options to control your symptoms

When morning sickness isn’t normal

It’s normal for women to experience morning sickness, even occasional vomiting. However, if morning sickness becomes so severe that you’re vomiting multiple times a day and you can’t stay hydrated, it's important to seek immediate medical care.

About 2 percent of women will experience hyperemesis gravidarum (HG), which is an extreme form nausea and vomiting of pregnancy. It is defined as nausea and vomiting that leads to a weight loss of 5% or more of a woman's body weight. It is important to identify this condition early, as it can lead to dehydration, electrolyte imbalance and malnourishment.

Signs that you’re experiencing HG include:

Vomiting more than four times a day

Persistent nausea and vomiting that lasts beyond your first trimester

An inability to work or complete daily tasks

Dark urine that smells stronger than usual

Feeling weak, dizzy or lightheaded

Weight loss, especially if it’s 5 percent or more of your original body weight

HG can be treated with the same medications used to treat more mild nausea and vomiting, but sometimes requires hospitalization in order to replenish fluids and to ensure adequate nutrition. In the most severe cases, some patients require IV infusion pumps of anti-nausea medications and home health care.

Fortunately, HG is rarely harmful to a growing baby as long as the mother gets adequate medical care and stays hydrated and well nourished. Over time, symptoms normally do improve and resolve with delivery of the baby.

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