Nausea During Pregnancy (Does it get better?)

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Nausea During Pregnancy

Nausea during pregnancy occurs in 70% of women during the first trimester. Also known as morning sickness, first trimester nausea makes you feel sick to the stomach and is accompanied by vomiting in the first few pregnant months. It is referred to as morning sickness so people expect nausea in the morning, however, this feeling of nauseousness and vomiting can occur at any point of the day and can even last all day. 

When does pregnancy nausea start?  

The first questions that probably comes to your mind is When does morning sickness start? Morning sickness can be one of the early signs of pregnancy but symptoms cannot tell you when implantation happened. However, for most women, it tends to start in the 6th week of the pregnancy and becomes worse by the 9th week. Some women get relief in the second trimester but for some this can last throughout the pregnancy. If the symptoms are mild it does not harm the baby or you. However, if the nauseousness and vomiting symptoms become severe, you should reach out to your healthcare provider. When morning sickness becomes extreme the condition is called hyperemesis gravidarum and can be problematic.  

What is hyperemesis gravidarum? 

Hyperemesis gravidarum is severe pregnancy sickness that needs medical assessment and care. This condition arises when nausea and vomiting are excessive during the pregnancy. It leads to loss of water resulting in dehydration and causes loss of weight. This may start at an early stage and last throughout the pregnancy. If you do have Hyperemesis Gravidarum, you will require medical treatment to keep your baby and yourself safe.  

You could be at a higher risk for hyperemesis gravidarum if 

1. You are expecting twins or more. In that case, you are at an increased risk of severe morning sickness as your placenta is larger and the pregnancy hormones are higher than average pregnancy level hormones.  
2. There is a family history of severe morning sickness or if you have had a severe form of nausea in your past pregnancy 
3. You are overweight, suffer from migraines or motion sickness 
4. You are suffering from trophoblastic disease which is a condition leading to abnormal cell growth in the womb 

Seek medical advice promptly if nausea or vomiting makes eating or drinking difficult, affects daily life, or causes weight loss. Seek urgent care if you cannot keep fluids down or have signs of dehydration. Do not wait to reach a particular number of vomiting episodes. 

What are the causes of morning sickness?  

There is no sure-shot reason for the occurrence of morning sickness though it is believed to be caused by increased pregnancy hormones and low blood sugar. This condition can be worsened by stress, fatigue and certain foods. A few factors that could affect pregnancy nausea are:  

• Elevated levels of hCG which is a pregnancy hormone and peaks when morning sickness is at its worst 
• Digestion becomes less effective as the increased levels of progesterone and estrogen relax the muscles of the digestive tract 
• Many women experience metallic taste while pregnant increasing pregnancy nausea  
• Pregnant women tend to have more heartburn and Gastrointestinal reflux causing vomiting and nausea  

Every pregnant woman experiences morning sickness differently- infact some may not experience it at all. Some have only occasional nauseous moments and others feel the queasiness all day long. Some may just have the feeling but not actually vomit and some may vomit very frequently. 

Can you prevent or get help with pregnancy nausea? 

There are a few habits and techniques that help with pregnancy nausea.  

• Have an easy early morning routine. Do not rush as that tends to increase morning sickness. Keep some light snacks like crackers by your bedside and eat a few before you get out of bed to help your stomach settle.  
• Change your eating habits. Refrain from consuming fatty and spicy foods. Have light meals multiple times a day rather than 3 big meals. Try to choose food options that are easy to digest. Eat healthy snacks like in between meals to prevent your stomach from staying empty and causing nausea. Include plenty of fluids in your daily routine. Include ginger in your diet, it helps bring down nausea.  
• Try activities that reduce stress and help de-stress. Prenatal Yoga, meditation and visualization are techniques that help minimize queasiness. Try and sleep long hours.  
• Steer clear of offensive smells that increase pregnancy nausea. Some scents that you once loved may start making you sick to the stomach, avoid such smells. Keep the house ventilated so the odour does not stagnate in your house.  
• Try alternative therapies like Acupressure and acustimulation wristbands. The technique involves pressure on certain body points, with uncertain benefit for nausea.  
• Acupuncture is another suggested option. Check complementary therapies with your healthcare professional; they should not delay medical treatment. This treatment involves the insertion of thin needles into your skin. Your healthcare provider maybe able to recommend a trained acupuncturist who specializes with pregnant women. 

Is there a medical treatment for morning sickness relief?  

You can ask your healthcare professional for help at any stage. You do not have to try every home remedy before discussing treatment. Severe vomiting and nausea can be treated using medication.  

Vitamin B6 and doxylamine 

Vitamin B6 and doxylamine are among the treatments a healthcare professional may consider. Ask your doctor or pharmacist which medicine and dose are appropriate for you, and check any supplements you already take. Do not change prescribed iron or other vitamins without advice.

Antiemetic drugs 

These drugs prevent vomiting and may be prescribed for you if Doxylamine and Vitamin B6 for morning sickness are not creating an impact and bringing the nauseousness down. Not all antiemetic drugs are safe to consume during pregnancy so it best to let the doctor prescribe the best one for you.  

Never consume any drugs without a prior discussion with your doctor even if they are OTC drugs or are widely being consumed for morning sickness relief.  

SECOND AND THIRD TRIMESTER NAUSEA 

Nausea often eases as pregnancy progresses, but some people have symptoms for longer and may need ongoing treatment. Some women may have a longer period of morning sickness which may extend till the beginning of the second trimester, in that case they should continue following the first trimester relief tactics.  

Some women get lucky and only experience first trimester nausea. But for others third trimester morning sickness is unfortunately a real phenomenon. Now you may wonder why are you experiencing this when you are so close to your date of delivery.  

There are multiple reasons for this. Your baby has grown and the room in your stomach is limited for this grown baby. This puts pressure on the digestive system causing constipation, heartburn and nausea.  

Your prenatal vitamin which contains high amounts of iron becomes difficult to digest without GI distress. If you have been experiencing nausea all throughout the pregnancy or have recently changed your prenatal vitamin brand – this could be a cause for the rising nauseousness.  

Even though the hormones are said to level out after the first three months, they are very unpredictable. The hormonal ups and downs may be a cause for the third trimester morning sickness.  

You may crave spicy, oily, and other food that could be high in acid-content. Since there is less room in your stomach, a few cravings could be the cause of nauseousness.

Ongoing nausea deserves review if it affects eating, drinking or daily life. New or worsening vomiting later in pregnancy should be assessed by your maternity team rather than assumed to be morning sickness.  

Contact your maternity service urgently if vomiting comes with a severe headache, vision changes, pain under your ribs or sudden swelling. Avoid nausea triggering foods and odour, sip on ginger tea, take a B6 supplement after discussing with your doctor, try and sleep as much as you can, have lemon and peppermint candies and the likes. 

If your nausea worsens and you feel it is causing dehydration, it is best to get it checked out. If nausea is making pregnancy difficult, you deserve support and treatment. 

For Australian information, read NSW Health guidance on severe pregnancy sickness and the Emergency Care Institute fact sheet.

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