What to know about morning sickness

Morning sickness, or nausea and vomiting that occurs due to pregnancy, is one of the most common symptoms that pregnant people may experience, especially in the first trimester (the first three months of pregnancy). In fact, nausea and vomiting affects nearly 3 in 4 pregnancies. (And it can happen any time of day, not just in the morning.)

Despite how common it is, the cause is still not completely understood. Hormonal changes are at least partially responsible. The hormones most likely involved are high levels of estrogen and the pregnancy hormone human chorionic gonadotropin (hCG), says Lisa Beard, MD, an OBGYN with the Woman’s Hospital of Texas in Houston.

Morning sickness symptoms usually get better by the second (middle three months of pregnancy) or third trimester (last three months of pregnancy). Talk with your healthcare provider (HCP) if you experience any symptoms of morning sickness during your pregnancy. Let your HCP know, too, if symptoms worsen or interfere with daily activities or if you are losing weight or having trouble gaining weight as expected during pregnancy.

Read on to learn more about morning sickness, what it says about the health of you and your pregnancy, and how to cope.

Although morning sickness is very common, nausea and vomiting during pregnancy is sometimes caused by a separate medical issue. Potential causes include:

• Thyroid disease, which can cause either high or low levels of thyroid hormone 
• Gallbladder disease, which affects the sac that stores bile (which helps with digestion) and is found near the liver
• Stomach ulcers, sores in the lining of the stomach 
• Foodborne illnesses, infections caused by certain germs in food

Normally, morning sickness symptoms start around the sixth week of pregnancy. Most of the time, symptoms improve during the middle three months of pregnancy (weeks 13 to 27). Every pregnancy is different, however, and symptoms might last just a few days or for the entire length of the pregnancy.

Talk to an HCP to help ensure the right diagnosis.

Hyperemesis gravidarum is a medical term that means severe morning sickness. Just about 3 percent of pregnant people will experience hyperemesis gravidarum. Signs and symptoms include:

• You vomit more than three to four times a day.
• You lose more than 5 percent of your pre-pregnancy body weight. (Some experts advise seeking medical attention if you lose more than 5 pounds.)
• You feel dizzy and light-headed.
• You get dehydrated.

Factors that may increase your risk for hyperemesis gravidarum include:

• Morning sickness during a previous pregnancy
• More than one fetus
• A parent or sibling with a history of morning sickness
• Female fetus
• Prior history of motion sickness or migraines

“Hyperemesis gravidarum can impact daily function, impair one's ability to work, cause anxiety and, if left untreated, cause rare complications like fetal growth restriction, malnutrition, and esophageal tears [damage to the pipe that carries food from your mouth to your stomach], among other things,” Dr. Beard says. 

If an HCP suspects hyperemesis, you may need lab testing to screen for causes of vomiting unrelated to pregnancy or to assess for complications of severe vomiting. In some cases, an ultrasound imaging test is suggested to check for more than one fetus.

Usually, morning sickness shouldn’t affect your health or the health of your fetus. But if you have trouble eating or drinking fluids, that can affect your weight and the birth weight of your newborn. In addition, elevated hormone levels associated with morning sickness or hyperemesis gravidarum can cause issues that affect your thyroid, liver, or balance of fluids in your body. Very rarely, injury to the esophagus can happen.

Get medical attention quickly if:  

• You’re unable to keep fluids down.
• You feel dizzy or lightheaded.
• There is blood or a brown color in your vomit.
• You have abdominal pain.
• You’ve lost over five pounds.
• You’re making little or no urine.
• Your heart rate is fast.
• You feel very tired or confused.

Nausea and vomiting during pregnancy can be treated in a number of ways. Avoiding things that may make you feel bad—such as fatty or spicy foods, smells, bright lights, and car rides—can reduce symptoms. Get plenty of fresh air and stay hydrated. It’s recommended that pregnant people drink 8 to 12 cups of water per day, although your HCP may have another suggestion.

Eating small, frequent meals and bland foods like broth, gelatin, rice, crackers, potatoes, or toast might help prevent nausea, too. You can also try bananas, rice, applesauce, or toast (the “BRAT” diet). Ginger, including ginger tea or ginger supplements, candies, or sodas (watch the sugar) may help. Don’t use cannabis, which is not proven to be safe for the baby and may also harm the health of the pregnant person.

Over-the-counter (OTC) treatments might also help. Before trying any OTC treatments, though, check with an OBGYN.

If these options are not effective, prescription medications called antiemetics may reduce vomiting. Hyperemesis gravidarum may require a hospital stay so HCP can evaluate your liver; monitor weight loss or malnutrition; give IV fluids (fluid through a vein in your arm), medications, and/or nutrition; and/or treat any imbalances in salts in your blood.