Morning Sickness Management

Morning sickness, which involves symptoms of nausea and vomiting in pregnancy, is very common for women in the first and second trimester of their pregnancy.

Although it doesn’t cause any harm to the baby and usually improves at 16 to 20 weeks of the pregnancy, the symptoms can be distressing for affected women. For this reason, symptomatic management of morning sickness may be required. However, care must be taken to ensure the safety of both the mother and baby during pregnancy.

Diet and Lifestyle

Initially, diet and lifestyle changes should be recommended to reduce the symptoms of morning sickness. This can often help reduce the severity of symptoms significantly, and is not associated with an increased risk of adverse effects for the mother and baby.

For women who feel sick in the morning, getting up slowly can be helpful. Having something to eat, such as a piece of dry toast or a plain biscuit, before you get up can also reduce symptoms.

Other changes may include:

• Keep hydrated by sipping water frequently
• Eating small and frequent meals
• Opt for meals with high carbohydrate and protein content
• Reduce intake of meals with high salt or fat content
• Avoid very sweet or spicy foods that may trigger symptoms
• Eat cold meals, which tend to be less aromatic than hot meals
• Wear loose clothing to reduce pressure on the abdomen
• Avoid smoking or areas where other people smoke
• Getting enough rest (fatigue can worsen symptoms)

If there are certain foods that are known to trigger symptoms of morning sickness for a woman, these foods should be avoided.

Supplements

Some research has supported the use of ginger to reduce nausea and vomiting associated with morning sickness. This is often a preferred choice of treatment because there are few side effects associated with ginger supplements. However, as ginger supplements are unlicensed and available as an alternative medicine, it is important that supplements come from a reliable source.

Additionally, vitamin B6 supplements may also offer a benefit to reduce symptoms. However, only doses less than 200 mg per day should be used, as beyond this there is a greater potential for harm.

Acupressure

There is some evidence that acupressure on the wrist can help to reduce symptoms of morning sickness. This technique involves a band or bracelet that is worn on the forearm of the affected woman, which is thought to apply pressure to certain points that lead to the release of neurotransmitters in the brain to reduce nausea and vomiting.

The women who have tried acupressure during pregnancy have reported mild adverse effects, such as numbness and swelling of the hands, but severe effects have not been reported.

Medications

If diet and lifestyle changes and other treatments do not provide sufficient relief for symptoms of morning sickness, antiemetic medications that are safe to be used during pregnancy may be recommended.

Examples of antiemetic medications that have been used for several years by pregnant women and are thought to be safe in pregnancy include promethazine and cyclizine. Other medications that are sometimes recommended include metoclopramide, prochlorperazine, and ondansetron.

Some antihistamine medications, which are usually used in the treatment of hay fever, may also help to reduce nausea associated with morning sickness.

Severe Cases

For women with severe morning sickness, further medical treatment may be required. Pregnant women should be advised to see a doctor if they can’t keep food and drinks down due to the frequent vomiting. This is important to avoid dehydration and malnourishment, which could affect the baby.

Hyperemesis gravidarm (HG) is a severe form of nausea and vomiting with potentially serious outcomes, and affects approximately 1 in 1000 pregnant women. Women with suspected HG should be referred to a specialist for management advice.

References

• https://www.health.qld.gov.au/nutrition/resources/antenatal_mrnsick.pdf
• http://www.nhs.uk/conditions/pregnancy-and-baby/pages/morning-sickness-nausea.aspx
• https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-morning-sickness
• https://medlineplus.gov/ency/patientinstructions/000604.htm
• http://patient.info/health/morning-sickness-in-pregnancy