Morning Sickness

Nearly two-thirds of pregnant women experience some degree of morning sickness.

The term "morning sickness" is actually a misnomer, says Iffath Hoskins, M.D., an obstetrician-gynecologist in Brooklyn. That's because the nausea and vomiting of pregnancy can occur at any time of the day or night.

The condition is now usually referred to as "NVP," for "nausea and vomiting during pregnancy." NVP may last longer than the first trimester—women can suffer from symptoms for the entire nine months. A small percentage of women also suffer such severe symptoms that they become dehydrated and malnourished, and are hospitalized for treatment. This condition is call hypermesis gravidarum.

"Nobody really knows the exact reason why pregnant women suffer from morning sickness," says Dr. Hoskins. "The most commonly thought reason is the natural increase in hormones, especially human chorionic gonadotropin, or HCG." Women who are having twins or multiples have much higher levels of HCG than women who carry one baby, she explains, and they are more prone to nausea and vomiting.

Positive spin

In recent years, researchers have begun searching for clues to the cause of morning sickness, and some now believe that the condition may have a positive benefit. Researchers in Ithaca, N.Y., for instance, have found that typical food dislikes during pregnancy may actually protect mothers and fetuses from foodborne illness and defend the baby from chemicals that can deform fetal organs during the most crucial time in development.

Among women who experience morning sickness, symptoms peak precisely when organ development is most susceptible to chemical disruption, between weeks six and 18 of pregnancy.

The most common food aversions are to meats, fish, poultry, and eggs. These foods are more likely to carry harmful microorganisms and parasites. Women also may develop an aversion to strong-tasting vegetables, as well as alcoholic and caffeinated beverages.

Dr. Hoskins believes that this makes sense, and that the beneficial angle helps her patients deal with the condition more positively. "The more I can convince a woman that her morning sickness—or any other discomforting symptom—is good for her baby, she will accept it better. No matter how terrible she feels at the time," she says. "And as long as the pregnancy is healthy and progressing well, that is the most important thing to me."

Hormones as culprits

Bruce Bagley, M.D., medical director of quality improvement at the American Academy of Family Physicians, favors a hormonal theory supporting the condition. This theory suggests that in addition to HCG, other female hormones such as estrogen and progesterone are at their highest levels during the first trimester of pregnancy and may cause nausea and vomiting, as well.

Dr. Bagley says the medical community only has theories to explain the phenomena, but he has seen a consistent pattern among women who experience morning sickness during every pregnancy. "We know that it is most likely that a woman who experiences some form of sickness usually will suffer again in subsequent pregnancies, yet perhaps at a different level of severity," he says.

That knowledge, says Dr. Hoskins, is helpful for doctors because they can treat a woman more efficiently if they know that a previous pregnancy included NVP. "If we know there was sickness the first time around, the second time we will be more attuned to it and treat the patient more quickly, perhaps with medications or over-the-counter (OTC) drugs, if necessary," she says.

Women who suffer from morning sickness should discuss it with their doctor before taking any OTC medications. "You may think [morning sickness] is going to kill you, but you need to discuss it with your doctor and let the medical professionals decide when there is a real concern," says Dr. Hoskins. If a woman has gone one-half to a full day without keeping any food or fluid down, or is losing weight, she should contact her doctor immediately.

Most important, eat what you can get down, no matter what its nutritional value. "I tell my patients that if they are suffering from morning sickness, it is not a time to hold themselves up to an unreasonable standard of eating," says Dr. Hoskins, who sees women worrying about not getting the exact number of calories or eating the "right" foods. "Getting any nutrition at this time is critical, and you can't be picky when your body is limiting you. "You need to eat what you want, when you feel like it."

Tips to ease morning sickness

Here are a few ways to ease nausea in pregnancy, as recommended by the American College of Obstetricians and Gynecologists:

• Avoid smells that bother you. Pregnancy hormones tend to enhance a woman's sense of smell and cause you to be sickened by certain potent odors.

• Slow down. Get up slowly in the morning and sit on the side of the bed for a few minutes.

• Eat five or six small meals each day. Try not to let your stomach get too empty or too full, and sit upright after meals.

• Drink fluids often during the day. Herbal teas and cold drinks that are bubbly and sweet may help.

• Freeze it! If keeping fluids down is a problem, try freezing fluids such as milk, juice, or water. The cold numbs the back of your mouth and takes away the bad taste and sensation that brings on nausea.

• Get plenty of fresh air. Take a short walk or try sleeping with the window open.

• Eat foods that are low fat and easy to digest. The BRATT diet (bananas, rice, applesauce, toast, and tea) may help. This diet is easy to keep down, provides calories, liquids, and electrolytes.

• Consider your vitamins. Prenatal vitamins and iron may also cause nausea. A children's chewable vitamin with folic acid taken may help.