Does everyone get morning sickness in pregnancy?

Nausea and Vomiting During Pregnancy

Morning Sickness in pregnancy

Pregnancy is often depicted as a glowing, joyful time in a woman’s life, but the reality for many expectant mothers includes a less glamorous side effect: nausea and vomiting, commonly referred to as morning sickness. While these symptoms are usually temporary and subside as pregnancy progresses, they can significantly impact a woman’s quality of life.  In fact, only 25% of pregnancies are unaffected by nausea with or without vomiting.  Approximately 35% of all pregnant women are absent from work on at least one occasion through nausea and vomiting. Among affected woman, recurrence in subsequent pregnancies varies. Although the symptoms are often most pronounced in the first trimester, they are by no means confined to it. Despite the usage of the term “morning sickness” in only a minority of cases are symptoms confined to the morning. In this article, we’ll explore the causes of nausea and vomiting in pregnancy, its potential complications, and strategies for managing these symptoms.

What Causes Morning Sickness During Pregnancy?

Nausea and vomiting during pregnancy are believed to result from a combination of hormonal changes, particularly increased levels of human chorionic gonadotropin (hCG) and Estrogen, as well as alterations in gastrointestinal motility. These hormonal fluctuations can affect the sensitivity of the stomach and trigger the symptoms of nausea and vomiting.

Morning sickness typically begins around the sixth week of pregnancy, peaking around weeks eight to twelve, and gradually subsiding by the end of the first trimester for most women. However, for some, it may persist into the second trimester or, in rare cases, throughout the entire pregnancy.

Other factors that may contribute to morning sickness include:

  • Sensitivity to Odours: Pregnant women often experience heightened sensitivity to certain smells, which can trigger nausea.
  • Gastric Emptying: Slowed gastric emptying during pregnancy may result in food staying in the stomach longer, increasing the likelihood of nausea and vomiting.
  • Emotional and Psychological Factors: Stress, anxiety, and emotional upheaval can exacerbate symptoms of morning sickness.
  • Gastrointestinal Disorders: Women with preexisting gastrointestinal conditions may be more prone to experiencing severe nausea and vomiting during pregnancy.

Complications:

For many women, morning sickness is an inconvenience rather than a serious medical concern. However, for some, severe and persistent symptoms can lead to complications such as dehydration, weight loss, and nutritional deficiencies. Hyperemesis gravidarum, a severe form of nausea and vomiting, affects approximately 0.3% to 2% of pregnancies and requires medical intervention to prevent complications.

How to Manage Morning sickness.

Managing morning sickness in pregnancy often involves a combination of lifestyle modifications, dietary changes, and, in severe cases, medical interventions. Treatment of nausea and vomiting depends on the perception of severity. Here are some strategies that may help alleviate symptoms:

  • Dietary Modifications: Eating small, frequent meals throughout the day can help prevent feelings of nausea. Opting for bland, easily digestible foods such as crackers, toast, and rice may also be helpful, and lemon-flavored products are often recommended for their antiemetic properties. Avoiding spicy, greasy, or overly rich foods can help reduce symptoms.
  • Hydration Staying hydrated is crucial, even if drinking fluids triggers nausea. Sipping on water, clear broths, or electrolyte-rich beverages can help prevent dehydration.
  • Lifestyle Changes: Getting plenty of rest, practicing relaxation techniques such as deep breathing or prenatal yoga, and avoiding triggers such as strong odours can help minimize symptoms.
  • Ginger: Ginger has long been used as a natural remedy for nausea. Consuming ginger tea, ginger ale, or ginger supplements may provide relief for some women.
  • Acupressure: Some women find relief from nausea and vomiting through acupressure wristbands or acupuncture sessions.
  • Medications: In cases of severe morning sickness, healthcare providers may prescribe antiemetic medications to provide relief while minimizing risks to the foetus.
  • Alternative Therapies: Acupuncture, hypnosis, and aromatherapy are among the alternative therapies that some women find beneficial in managing nausea and vomiting during pregnancy.

What is Hyperemesis Gravidarum?

For some women, pregnancy brings the challenge of hyperemesis gravidarum, a severe form of morning sickness affecting 0.3 to 3% of pregnancies. Those who experience hyperemesis in their first pregnancy face a heightened risk of recurrence, though intriguingly, changing paternity has been linked to a reduced risk. Conversely, women with no prior history of hyperemesis may find that a longer interval between births slightly raises the likelihood of encountering it in subsequent pregnancies. This underscores the complex interplay of factors influencing the onset and severity of hyperemesis gravidarum, highlighting the importance of tailored support and proactive measures for expectant mothers.

Conclusion

Nausea and vomiting during pregnancy, while often dismissed as a common and benign inconvenience, can have a significant impact on a woman’s physical, emotional, and psychological well-being. Understanding the underlying causes, implementing appropriate management strategies, and seeking medical attention when necessary are crucial steps in navigating this challenging aspect of the maternal journey. By providing support, empathy, and effective care, healthcare providers can help expectant mothers cope with morning sickness.

References:

  1. Gadsby, R., Barnie-Adshead, A. M., & Jagger, C. (1993). A prospective study of nausea and vomiting during pregnancy. *British Journal of General Practice, 43*(371), 245–248.
  2. Smith, J. A., Fox, K. A., Clark, S., & Kahn, S. R. (2004). Nausea and vomiting of pregnancy: treatment preferences and outcomes. *Obstetrics & Gynecology, 103*(4), 771–778.
  3. American College of Obstetricians and Gynecologists. (2015). ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy. *Obstetrics & Gynecology, 126*(3), e12–e24.
  4. Fejzo, M. S., & MacGibbon, K. W. (2020). Hyperemesis gravidarum: Strategies for a successful pregnancy and recovery. *American Journal of Perinatology Reports, 10*(3), e227–e236.
  5. Smith, James A., et al. “Management of nausea and vomiting in pregnancy: a survey of obstetrician practice.” Journal of maternal-fetal & neonatal medicine 31.14 (2018): 1845-1852.
  6. Koren, Gideon, et al. “Risk factors for hyperemesis gravidarum.” Journal of the American Board of Family Medicine 21.5 (2008): 449-455.
  7. Matthews, Anne, et al. “Interventions for nausea and vomiting in early pregnancy.” Cochrane Database of Systematic Reviews 2010.9 (2010): CD007575.
  8. Heitmann, Kristine, et al. “The natural course of hyperemesis gravidarum and morning sickness: a longitudinal population-based study.” BJOG: 118.13 (2011): 1649-1657.
  9. Trogstad LI, Stoltenberg C, Magnus P, Skjaerven R, Irtens LM. Recurrence risk in hyperemesis gravidarum. BJOG 2005;112:1641-5

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