Morning sickness: what's the deal?

Morning sickness can feel all-consuming. Fertility dietitian Claudia Vavasour from Fertility Nutrition explains what's really going on and how to help. 

I will never forget being pregnant with my daughter and feeling nauseated day and night until around 18 weeks. It was so debilitating, even as a dietitian, my food choices were nothing short of lacklustre. Let’s face it – pregnancy can be more about survival!
 

WHAT IS MORNING SICKNESS AND WHO DOES IT AFFECT?

Nausea and vomiting in pregnancy (NVP), more commonly referred to as 'morning sickness', is an unpleasant condition that affects approximately 70-80% of pregnant women. It usually occurs within the first trimester (first 12 weeks of pregnancy), and symptoms include nausea, vomiting, reflux, dry retching, and sensitivity to food taste, sight or smell. But don’t be fooled by the term 'morning sickness', it can strike at any time of the day, last the whole day, and linger long after the first trimester. Those who’ve experienced NVP in the past are also more likely to experience it again.
 

WHY IS MORNING SICKNESS SUCH A COMMON SYMPTOM IN PREGNANCY?

Although the cause of NVP is complex, it's widely accepted to be multifactorial with genetic, endocrine and gastrointestinal factors involved. Symptoms are thought to be triggered by changes to hormone levels, specifically the hCG hormone. This pregnancy hormone is produced by the cells (which later become the placenta) that surround the human embryo. Levels of hCG in the body steadily rise shortly after a woman falls pregnant and NVP symptoms typically begin at 4-6 weeks, peaking at 8-12 weeks. However, up to 15% of women find that NVP continues beyond 16 weeks and extends up to the delivery date. Increasing severity of NVP has been linked with poor quality diet – particularly a low consumption of fruit (especially citrus), vegetables, and cereals and high consumption of white breads and soft drinks.

WHY DO SOME GET MORNING SICKNESS AND OTHERS DON'T?

As mentioned earlier, 70-80% of women experience NVP, but what about the other 20-30%, why don’t they experience symptoms? This is very difficult to answer as the exact cause for NVP is unknown. If you manage to avoid this pregnancy symptom, it might be due to your body being able to better tolerate the rise in hormone levels. However, if you are one of the lucky ones, have peace of mind, because not experiencing NVP does not signify that something is wrong with your pregnancy.
 

WHAT CAN WE DO TO TREAT MORNING SICKNESS?

Be sure to discuss with your LMC, GP or obstetrician if anti-nausea medication is appropriate for you. For many, you'll likely want to exhaust all your options before taking medications, especially as anti-emetic medications will not be appropriate for some women during pregnancy. As a first line of defence I recommend giving these natural remedies and strategies a try as they might just be enough to alleviate the burden of NVP and help you to get through your pregnancy more comfortably. I know they certainly helped me.

What’s the difference between pregnancy nausea and vomiting and Hyperemesis Gravidarum? Hyperemesis Gravidarum (HG) is a severe form of NVP that affects approximately 1% of pregnant women. The key characteristics of HG include persistent vomiting resulting in weight loss, dehydration, and electrolyte imbalances which often result in hospitalisation. If you think you fit the description, a trip to your GP and a thorough clinical assessment is needed to exclude other conditions and diagnose HG. First line treatment is rehydration to replace fluid and electrolytes lost through vomiting as well as thiamine (vitamin B1) replacement. Women who experience ongoing vomiting may also be prescribed a form of medication called anti-emetics, which are a group of drugs that prevent or reduce nausea and vomiting. It's important to seek treatment if you have unmanageable NVP as HG can cause serious complications for both the mother and baby, including foetal growth restriction and even death.

FOODS THAT HELP WITH GENERAL NAUSEA AND MORNING SICKNESS

Ginger Tea

The phytochemicals in ginger seem to work in harmony to reduce nausea – they improve gastric emptying so that food is digested more efficiently as well as boosting our happy hormone serotonin. A 2009 study by Ozgoli and colleagues, found that a group of mothers with active NVP who were given 1000mg ginger root powder a day for 4 days, had an 84% improvement in nausea intensity compared to 56% of women in the control group. The evidence to date, however, shows that whilst ginger might reduce nausea, it doesn’t reduce episodes of vomiting. 

Important note: Before you start adding ginger to all your meals, it’s important to know that ginger acts as an anticoagulant which is a particular concern for pregnant mothers who:

+  Have a history of bleeding or clotting disorders

+  Are close to labour

+  Take anticoagulant medication 

However, it’s generally considered that 1000mg of ginger a day is safe in pregnancy. How much is 1000mg of ginger you ask? 5g of fresh grated ginger or 4 cups of pre-packaged ginger tea. Some prenatal vitamins also contain ginger, so be sure to check that back label of your supplement too.

Consider a Vitamin B6 (Pyridoxine) Supplement

This B vitamin first made waves for its anti-nausea effects in 1991, after a double blind placebo controlled trial was published in the Journal of Obstetrics and Gynaecology. They showed that B6 supplementation taken every 8 hours over 3 days significantly improved nausea in women with severe nausea, with results from a recent RCT echoing these findings. The exact dose is yet to be determined, but it’s generally considered safe in levels less than 500mg.

Top tip: My advice is to check to see if your prenatal vitamin contains vitamin B6 and aim for a supplement of approximately 25mg 3 times a day, keeping your total intake less than 500mg/day. The other great thing is that it can be used in conjunction with other natural anti-emetics such as ginger.

Prioritise Protein

Protein requirements increase in pregnancy from 0.8g/kg/day to 1.1g/kg/day, and while we usually get more than enough protein in our diets, when we’re feeling nauseated our intake can become compromised. A 1999 study in pregnant women published in the American Journal of Physiology found that protein-rich meals significantly reduced nausea in the first trimester. Try to prioritise the protein part of your meal first and include protein-rich snack foods such as nuts, cheese and yoghurt. Think nausea popsicles – made with yoghurt, citrus, pineapple and ginger. But avoid protein powders as they often contain ingredients not disclosed on the label which can be detrimental to a developing baby.

Keep Hydrated

Water is the body's largest element equating to 55-60% of a female's body. As blood volume increases in pregnancy, so too do our fluid needs. Dehydration not only makes nausea and vomiting worse, but if left untreated can result in an electrolyte imbalance and in severe cases, hospitalisation. Our fluid requirements increase to at least 9 cups of water a day in pregnancy, yet sufficient fluid can be one of the most difficult things to achieve in early pregnancy. Some of my top tips:

+  Sip little and often

+  Flavour your water with fresh lemon, mint and ginger

+  Try sparkling water

+  Enjoy safe herbal teas

+  Utilise other fluids such as milk or freshly squeezed orange juice

FOODS TO AVOID

Often food aversion plays a huge role in the worsening of NVP symptoms and these will vary from person to person and pregnancy to pregnancy. I’ve compiled a list of some evidence-based tricks that are tried and tested to help you cope with NVP:

+  Avoid foods with strong odours and eliminate your personal triggers

+  Avoid spicy foods

+  Take your multivitamin at night

+  Eat small and frequent meals

+  Keep your home and office well ventilated to eliminate scents that make your nausea worse

+  Rest – fatigue can exacerbate symptoms so rest as much as you can

+  Call on your village to help prepare meals, snacks, and stock your fridge and freezer for you

+  Be kind to yourself – your mental health can take a hit when suffering from nausea and vomiting. Take every minute as it comes and don’t put unnecessary pressure on yourself during this time. Find someone you can talk with to manage the ups and downs and remember for most women, it will pass by 16 weeks.

RED FLAGS

Keep an eye out for any of these signs and be sure to seek medical help for a thorough assessment and treatment if required:

+  Weight loss

+  Dehydration – signs include a dry sticky mouth, sleepiness, feeling thirsty, decreased need to urinate, headache, constipation, dizziness

+  Growth restriction on scans

+  Feelings of low mood, tearfulness, thoughts of harming yourself

+  Nutrient deficiencies – mainly iron, zinc and folate deficiencies

NVP can be really challenging. If you’re struggling with it or are concerned you have HG, don’t delay in seeking medical care to ensure you don't have an electrolyte imbalance or dehydration. If left untreated, NVP can lead to serious maternal and foetal complications. Luckily, there are some natural strategies that you can try to help combat it, and be sure to reach out to your healthcare professional for support.

Claudia Vavasour is a NZ registered dietitian and leading expert in fertility and pregnancy nutrition. Her practice, Fertility Nutrition, has a team of specialised registered dietitians who are dedicated to helping women and couples improve their fertility, have healthy pregnancies and give their babies the best start in life through evidence-based nutrition. Find her at fertilitynutrition.co.nz and on social media – Facebook @fertilitynutritionnz and Instagram @fertility_nutrition_dietitians.