Morning Sickness in Pregnancy
Written by Dr.M.D.Mazumdar, MD
Vomiting, with nausea, is one of the earliest symptoms of pregnancy. In earlier days when diagnostic tests for pregnancy were not available, any women complaining of loss of menstrual periods with vomiting or nausea were assumed to be pregnant.
Typically, nausea and vomiting starts soon after the first missed periods and continues in different degrees of severity till about the fourth month.
It is more common and more severe in the first pregnancy than in later pregnancies.
Most pregnant women feel sick as soon as they get up from bed in the morning. Hence the name, 'morning sickness'. Many others however, feel nauseous the whole day.
The smell of certain food, especially raw fish and meat at any time of the day can bring on the gush of saliva in the mouth and the queasy feeling in the stomach that so many pregnant women dread.
More than the vomiting, many women complain that it is the nausea that is so distressing.
Thankfully, morning sickness is rarely severe enough to cause any deterioration in the health of the pregnant woman. But occasionally constant and continuous vomiting can cause dehydration and starvation. In a condition called 'Hyperemesis Gravidarum', the vomiting may be severe enough to cause the woman to be hospitalized and receive supportive treatment.
Causes of Morning Sickness
- Rise in the level of the HCG hormone: The HCG (Human Chorionic Gonadotrophin) hormone is secreted by the ovaries to support the growing embryo in the first three months of pregnancy before the placenta is fully formed. The placenta becomes fully functional only from the fourth month and secretes progesterone to support the embryo. At this time the levels of HCG also decreases to a certain extent and there is also a decrease in the intensity of morning sickness.
- Gastritis and Acidity: The normal gastric emptying time (time taken to empty food from the stomach), is 3-4 hours. But in pregnancy, this emptying time is increased and food can stagnate in the stomach leading to indigestion . This also causes pooling of highly acidic gastric juices in the stomach.
The acidity thus produced can cause nausea and vomiting by itself. Or it can lead to inflammation of the stomach wall ('gastritis'), increasing the nausea and vomiting of morning sickness.
- Acid Reflux: The sphincter between the stomach and the oesophagus (food pipe leading from the mouth to the stomach) becomes somewhat loose during pregnancy helping food and gastric acid to be regurgitated back into the oesophagus. Contact of the acidic food from the stomach with the tissues of the oesopahagus lead to heartburn and nausea.
How to Control Morning Sickness
The nausea and vomiting of morning sickness cannot be completely eliminated. But the symptoms can be decreased to a certain extent.
- Do not eat solid and liquid food together. The solids will float, causing indigestion and adding to the bloating sensation. Drink liquids at least half an hour after you have eaten your solid food.
- Since the nausea occurs more commonly on an empty stomach, eat a dry cracker as soon as you wake up in the morning, while you are still in bed. Lie in bed for another few minutes and get up slowly. Nibble at another cracker sitting on the side of your bed and then stand up slowly. The dry cracker will absorb some of the gastric fluid secreted overnight.
- Try to eat five small meals instead of three larger ones.
- Avoid spicy and hot foods, especially those containing pepper, chillies or garlic.
- Avoid fried or greasy food. These will increase your nausea.
- Avoid any odours that make you uneasy.
- Nibble at a dry cracker, toast or a peeled apple whenever you feel nauseous.
- Sip ice-cold water from time to time to control the heartburn. You can also eat ice-creams or custards, but do remember to calculate the calories that go with it.
- Avoid tea, coffee or alcohol as they often contribute to acidity.
- Drink soups as they provide plenty of fluids, vitamins and minerals. However, lukewarm soup is better than very hot soup.
- Many women feel better if they smell at pieces of ginger or lime whenever they feel sick.
- Ask your doctor for antacids to control your acidity.
- Your doctor may also prescribe tablets containing perchloperazine or trimethylperazine as they can control the vomiting to a great extent. They are also safe in pregnancy.
- Contact your doctor if your vomiting is very severe and you feel dizzy at any time. It is possible that you may need treatment in a hospital.
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