Join me for a free webinar on Tuesday, April 10. I'll be showing you the key piece of the puzzle for finally putting diets behind you, for good!
Morning sickness… the very act of reading that phrase can make a woman’s stomach turn. But if you’re currently dealing with it, I bet you’re scouring the internet trying to find two things: 1) camaraderie with women who’ve been there and know what you’re feeling, and 2) what the heck you can do to feel better! So today, I’m going to try to give you both of those things.
A while back, I put a survey out to my lovely Facebook followers so I could hear about their experiences with their pregnancies. I was very lucky to have an uncomplicated pregnancy with no morning sickness, no real cravings, and very little physical pain (please don’t hate me!). But I am well aware that this isn’t a typical experience! So I wanted to hear from others. Pregnancy is an experience quite unlike anything else. Each woman, and each individual pregnancy, is different. While the end result of a cute little bundle of joy is the same, the journey to delivery day is an incredibly individual experience!
So today, let’s shine some light on those experiences so that no matter what you’re facing as you navigate pregnancy, you’ll find some sympathy here. My evidence-searching self wanted to gather up the research that’s out there too, so you can have something other than just sympathy to take away from this post!
Experiences with morning sickness certainly run the gamut. Some are lucky enough to never have it, some have it with some pregnancies but not others, and some get horrible all-day sickness that lasts much longer than the experts say it’s supposed to!
Of the ladies who were brave enough to share their experiences with me, we had a great spread of all different types of experiences:
Let’s dive into these experiences a bit more!
Let’s get the worst ones out of the way first. Here are some of their experiences in their own words, so if you’re currently feeling like no one understands the complete HELL you’re going through, you’ll find some camaraderie here I think!
“Yes. I had hyperemisis gravidum. First 4 months. I lived off of sprite and Cheetos/crackers. I was miserable and constantly vomiting. Lost weight and had to be given fluids a few times. But at the 3.5-4mo mark it disappeared.”
“Yes. Up until about 18 weeks it affected day to day life. Vomited a few times after that, but coped okay. I would make myself vomit in the morning so I could eat breakfast and get down an anti-emetic (can’t remember which, the basic ones). I felt nauseous for most of the day and would vomit occasionally during the day (not every day), but the medication definitely helped.”
“I had horrible, horrible ALL DAY sickness and vomiting until I was about 20 weeks or so. Unfortunately, I didn’t find any relief with the unisom and B6 combination until a few months after taking it. I started taking it early in first trimester, but it didn’t help with anything but sleeping until about 16 weeks. I couldn’t keep much down until middle of my pregnancy, but some snacks helped mellow my belly. I did well with potato chips and lemonade, coke and vanilla milkshakes were my best friends. I also did alright with most fruit. Smell aversions were horrific until about 16 weeks, as well. Garlic, chicken and any strong smelling vegetables set me off!”
Wow. I can’t even imagine how tough of a time these ladies had during their pregnancies! To deal with that for weeks on end while trying to grow a little human inside you is such a testament to a mother’s love and resilience. I bow to every single one of you who have dealt with this. I’d put you all up on pedestals if I could!
Now that we’ve gotten the worst cases out of the way, here are some that should give you hope that pregnancy isn’t necessarily destined to leave you feeling awful the whole time. At least there is a light at the end of the nausea-tunnel for most of us!
“Yup! Mostly done by week 13, but basically I felt like any uncomfortable feeling was experienced as nausea. Hungry? Nausea. Tired? Nausea. Cold ? Hot? Nausea, always. 🙂 Throughout the day too, definitely not limited to the morning!”
“11 weeks…all day, everyday”
“Constant nausea not isolated to the morning. I felt like I was going to throw up all the time but I only did so twice.”
“Yes, during first trimester. It was ok as long as I slowly snacked on saltines basically all day long.”
“The first time I had it mild for one week, the second time worse but only for about a month. Only nausea, no throwing up.”
I am hoping this isn’t the category I eventually fall into, but you never know! These ladies didn’t have morning sickness with their first pregnancy, but they did have it during subsequent ones. Goes to show how not just every woman, but every pregnancy is different!
“Yes, only while I was pregnant with the girls. It wasn’t too bad.”
“None with my first. Horrible all day nausea with my second for the whole first trimester. Food just never sounded good, and even my first love (coffee) repulsed me!”
“Basically none with first, lots of nausea this time around from ~5 weeks through 11 weeks” L
“Basically none with first, lots of nausea this time around from ~5 weeks through 11 weeks”
“Certain smells would make me nauseous, and I had this more with my second pregnancy, but I didn’t throw up even once.”
The good news is this made up 27% of our (admittedly very small sample size) group. And I did didn’t include myself in that number either. There’s not much to put here in the way of quotes when the answer to a question is “no” though!
I wish we could get together and tell everyone else our “secrets” to getting through the pregnancy without feeling queasy, but I doubt any of us could say what helped us avoid this particular pregnancy issue! I just hope that our group of lucky ladies can help to reassure you that it IS possible to have a pregnancy without feeling sick!
Since I like to delve into some of the science behind these things, I did some research on this to see if there was a consensus about causes, treatments, risk factors, and other things related to morning sickness (or NVP – nausea and vomiting of pregnancy – as it’s called in research).
I wish I could tell you that we’ve found answers to what causes it and how you can prevent it, but sadly, that’s not yet the case. Like many other areas, it’s been studied a lot, but we don’t have a lot of concrete answers.
Pregnancy is tough to study. Most women won’t sign up for a controlled trial of various interventions (can you blame them?), so a lot of data is observational, and subject to lots of potentially interfering variables. There is also a big reliance on questionnaires for a lot of this research, which isn’t really the most reliable thing either, even when the questionnaires have been validated for use in research.
Here are the things I did manage to find.
Incredibly common! The majority of women experience it to some extent. Numbers vary, but it seems roughly 80% of pregnant women deal with morning sickness.(1) Thankfully, not all of those experience the actual vomiting part. In one large study that differentiated between nausea and nausea+vomiting, 72% had nausea, but only 33% also had vomiting.(1)
Symptoms tend to start early in the first trimester, peak around the 9th week, and subside by week 16 for about 60% of cases and by 20 weeks for 87%.(2) So although it’s very common to feel nausea, the actual progression to vomiting isn’t as common, and there is most often a light at the end of the tunnel, with the nausea subsiding by about the half-way point, if not earlier. Thank goodness, right?!
And hey, for a little bit of good news… “In pregnancies with uncomplicated nausea and vomiting, there is a decreased risk of miscarriage, as well as lower rates of preterm delivery, fetal death, and growth restriction.”(2) So those old wives tales you’ve heard about morning sickness actually meaning a healthy baby may have a small basis in truth.
In the worst cases, which thankfully aren’t too common (up to about 1% of women), the sickness is bad enough to progress to hyperemesis gravidarum (HG), which means prolonged and severe nausea and vomiting (more than 3 times per day), dehydration, electrolyte imbalances, and weight loss of more than 5%.(3) Yikes!
We still don’t know what causes morning sickness. Research continues, and there are a few theories, but the base answer is still, unfortunately, “we don’t know yet.”
In addition to the hormonal factors that seems to contribute to NVP (which I’ll discuss below), there are a few demographical things that tend to be correlated to higher likelihoods of experiencing it. But remember that correlation does NOT equal causation. So if the below factors apply to you, don’t think it means you will automatically get morning sickness when pregnant.
Women who are older, black, less educated, have lower incomes, have multiple gestations (pregnant with twins or more), women who’ve had multiple pregnancies (including any miscarriages), and women with a history of migraines, motion sickness, or nausea when using estrogen-containing birth control pills tend to have a higher risk of NVP.(2)
Interestingly, marriage seems to be associated with NVP more so than being single or cohabitating with a partner. “A link between marriage and NVP has been reported previously, whereby stress related to poor communication between partners was associated with the severity of NVP.”(1)
I can see how the stress of a bad relationship could increase NVP, but I’d assume that being single while pregnant would also mean dealing with quite a bit of stress! It’s an interesting, and kind of strange observation.
The most commonly considered cause of NVP is the rise in human chorionic gonadotrophin (hCG) concentration that happens early in pregnancy, and is related to the size and activity of the placenta. Many studies have shown a correlation between higher levels of hCG and higher severity of NVP. “Women with higher hCG levels, such as those with multiple gestations, hydatidiform moles [pregnancies in which no fetus is actually present], or fetuses with Down syndrome, are at increased risk of nausea and vomiting.”(2)
However, it’s interesting that there are also several studies where this correlation hasn’t been found. It’s possible that there are different types or isoforms of hCG and that this contributes to the difference seen in the various studies.(4) So there is lots of variability, and again, we come back to: we don’t really know yet.
Other hormones, like estrogen and progesterone could also be involved. And there have been proposed associations with other hormones too, like thyroid hormones, serotonin, and leptin, as well as effects on changes in gastrointestinal motility. So far, none have shown consistent association to causing NVP.(4)
Another potential contributing factor is the dilution of our blood that happens early in pregnancy. Our blood volume has to increase quite a bit when we’re pregnant, and the plasma increases disproportionally to the other content of our bloodstream. This makes things more dilute than usual, which changes the osmolality of our blood and can lead to hyponatremia.(1)
Relaxin, a hormone produced in pregnancy, has been associated with the resetting of the receptors that detect osmolality and work to correct it. Therefore, a delayed response from those receptors, and a difficulty adjusting to the osmolality changes, could potentially contribute to NV symptoms.(1)
As you can probably see from the above experiences, dealing with nausea and vomiting tends to mean we change how we eat in order to cope! Everyone has to do what works for them, what feels right, and what helps. This is a NO JUDGEMENT zone! Do what you need to do to feel better so you can make it through your day. Your baby will be fine!
Now, let’s discuss what’s been seen in some of the research:
In one study, being more nauseous meant that the women reduced their consumption of veggies, tea/coffee, rice, cereal, pasta, fruit juices, and a few other things, while increasing their intake of white bread and soft drinks. These changes were short-lived though, and there was no observed change in diet quality from before pregnancy to late in pregnancy. Basically, once they were past the nausea issues, they ate pretty similarly to how they ate before they were pregnant.(5)
Another study showed that nausea caused the majority of the women to eat less (59% of them), with more of them being women who actually experienced vomiting (68%) than those with “just” nausea (51%).(1)
Just like in the first study, the women in this one also increased their intake of carbohydrates and sugar (usually in the form of soft drinks). “Whether higher intakes of carbohydrates are a response aimed to alleviate symptoms, or are actually provoking the condition, is not known.”(1)
I don’t know about you, but when I’m nauseous, crackers and ginger ale do sound pretty good! My bet is that it’s an attempt to feel better.
What’s interesting though, is that an earlier study “found high-carb meals to exasperate gastric dysrhythmias, which can lead to nauseous effects in pregnancy.”(1) So while the added carbs may feel better in the moment, it’s possible they’re not actually helping in the long run.
It seems that protein intake can actually be helpful, or maybe preventative, or maybe both. Nausea has been shown to be reduced when women eat higher protein meals, and interviews with women who suffered from NVP suggest that higher protein meals were effective in decreasing their symptoms.(1)
As you’d expect, the first line of defense tends to be changes to the diet. Most women do this instinctively… we go with what feels good and seems like it helps, right?! If the smell or sight of something turns our stomach, it’s not likely we’re going to keep eating it. So if you personally notice foods that make nausea worse, or that make it better, let those observations guide you!
As I wrote above, the natural inclination is to go for higher carbohydrate foods. However, that may not be the best approach since it can make certain gastric motility issues (and subsequent nausea symptoms) worse. On the other hand, protein-rich meals seem to be helpful in decreasing nausea symptoms, so that can be a dietary change to try.
But what about other recommendations?
The following is taken from WebMD, which comes up on the first page of a Google search for “morning sickness” (which is how most nauseous pregnant women are probably finding advice), and is actually a reputable source:
“The following are safe, proved treatments for morning sickness. Still, few women gain complete relief from morning sickness treatment.
After looking into some papers myself, it seems like these are pretty good recommendations, based on the current evidence:
Hyperemesis (HG) is a whole other can of worms, and usually needs more help than regular morning sickness (like actual hospitalization).
Notice how there are very few, if any, definitive answers? That’s how this research stuff works, unfortunately. Just because one study finds that a certain treatment works, doesn’t mean it works across the board, in different populations or under different conditions. That’s why things need to be studies several times in several different ways before a recommendation can be made. I know it’s frustrating not to have “answers” to this age-old question yet. But it’s being worked on.
In the meantime, do what you need to in order to deal with the symptoms. Take comfort in the knowledge that the discomfort is temporary. Try the above recommendations (with your doctor’s input!) and see if any of them work for YOU.
Wishing comfortable pregnancies for all!