A Royal Pain: Morning Sickness in Pregnancy
The news of Duchess Kate Middleton’s third pregnancy—and accompanying morning sickness—again sheds light on this unfortunate side of pregnancy. Morning sickness can be a royal pain for many expectant moms. But when it escalates to the point of extreme nausea, dehydration and weight-loss, it can be downright miserable.
UR Medicine obstetrician Dr. Loralei Thornburg, who sees a lot of patients with hyperemesis gravidarum—severe morning sickness—answers some commonly asked questions about the condition.
Health Matters: How do you know morning sickness is extreme? And is it common?
Thornburg: It’s not uncommon for pregnant women to experience some nausea and vomiting in the first few weeks. Sometimes it’s the first sign of a pregnancy. But when it doesn’t subside, no matter what you do, and you’re unable to keep any food down, losing weight and feeling debilitated, that’s extreme. Obstetricians look for both weight loss and signs of dehydration before diagnosing hyperemesis, separating this condition from more common mild nausea and vomiting during pregnancy.
Some 50,000 women with extreme morning sickness require hospitalization each year and they lose just over 200 hours of time at work during a pregnancy. And that doesn’t count the emotional toll of feeling horrible during what is supposed to be one of the happiest times of their lives.
Health Matters: How do you treat hyperemesis?
Thornburg: We can ease the symptoms with anti-nausea medications like Zofran, Phenergan and Reglan, as well as Vitamin B6 and over-the-counter Unisom. Tums or other antacids can also be helpful for reflux. Ginger has soothing properties that can quell the nausea too, and is available as a variety of candy, drinks and foods. This is why hospitals serve ginger ale to patients who’ve had surgery. (URMC scientists have studied the use of ginger to ease nausea from chemotherapy that offers some clues to the healing power of this amazing root.)
If those medications don’t work and a woman becomes dehydrated or malnourished, intravenous fluids and a feeding tube could be required, but these carry risks and should be avoided whenever possible. If a woman has underlying medical conditions such as diabetes, then the treatments can be more complicated.
Health Matters: What can a pregnant woman do to manage less severe forms of nausea and vomiting?
Thornburg: Here are a few tips that help many women:
- Consider taking your prenatal vitamin at night, finding one without iron in it for a few weeks, or trying other forms of prenatal vitamin such as a chewable or gummy vitamin (you still only need one).
- Stay hydrated and get plenty of rest. Frozen juice bars/popsicles can be helpful and provide water, sugar and electrolytes. Use small, frequent sips of fluids to avoid overwhelming a sensitive tummy.
- Eat smaller meals five to six times a day. Eat carbohydrate-rich foods, like bread or saltines, before getting out of bed in the morning. Avoid spicy or acidic foods that can worsen heartburn and increase nausea.
- Try ginger; some evidence shows that ginger may help to subdue symptoms.
- Consider the use of pressure point wrist bands (sea bands) to provide relief.
- B6 is available over-the-counter and, when taken routinely, may help reduce nausea symptoms. It is not effective for acute nausea symptoms.
- Sour and salty flavors are often well-tolerated in nausea, but eat what appeals to you. Typically a low-residue diet (pasta, potatoes, bread, and other simple foods) are better tolerated than foods that have heavy sauces or strong flavors.
Loralei L. Thornburg, M.D., is associate professor of Obstetrics and Gynecology, specializing in high-risk pregnancies. An active researcher, she focuses on maternal obesity, ultrasound and premature birth.