Debunking the myths and finding solutions to morning sickness

For many women, the thrilling ride of pregnancy can come to a sudden halt if they start experiencing vomiting and nausea. What should you do if your new baby bump brings tummy troubles that can interrupt life both day and night? We caught up with Zena Kharsa, MD, who recently joined the Stanford Medicine Women’s Health practice in Palo Alto and asked her to shed light on the topic of morning sickness.

Q: How common is nausea and/or vomiting for pregnant women?

Dr. Kharsa: Nausea and vomiting of pregnancy affects about half of all pregnant women, while another 25% have nausea alone, and 25% are unaffected.

Q: What can I do to reduce nausea?

Dr. Kharsa: The standard recommendation is to take prenatal vitamins for three months before conception in preparation for pregnancy and early fetal development. Studies have shown that this practice may also reduce the incidence and severity of nausea and vomiting.

Q: Are there particular foods that are better than others?

Dr. Kharsa: In general, it’s best to avoid a full or empty stomach, which can aggravate nausea. Try to eat small, frequent meals every few hours and include high-protein snacks and bland or dry foods that may be better tolerated than spicy, acidic, fatty or carbohydrate-heavy meals. Examples of snacks that may be easier to tolerate include nuts, pretzels, crackers, cereal or toast. In addition, ginger lozenges, capsules, or ginger-containing foods may help reduce nausea.

Q: Is there medication I can take to help?

Dr. Kharsa: If dietary and lifestyle changes are not successful in managing nausea, first line therapy in pregnancy is Vitamin B6 or a combination of Vitamin B6 and doxylamine, an antihistamine. These can be prescribed by your doctor and taken separately or in one tablet in combination. Numerous research studies have demonstrated that this combination is both safe and effective to take in pregnancy. There are other medications that can be taken for nausea if first line therapy is not helpful.

Q: When should I be concerned about nausea and vomiting?

Dr. Kharsa: You should contact your doctor if you have severe nausea and vomiting that is not responsive to first line measures, if you are having difficulty keeping down anything you eat or drink (especially liquids), if you feel dizzy or light-headed, or are urinating very little or have very dark urine (signs of dehydration). In rare cases, severe nausea and vomiting of pregnancy can be classified as hyperemesis gravidarum (5% or more weight loss from pre-pregnancy weight, signs of malnutrition, possible electrolyte abnormalities), which affects less than 3% of all pregnancies. In some cases, patients may require intravenous hydration and hospitalization. Early treatment of nausea and vomiting is recommended to prevent progression to hyperemesis.

Q: Why is it called “morning sickness” if I feel sick throughout the day?

While traditionally called “morning sickness”, nausea or vomiting can occur at any time during the day.

Q: If I don’t have nausea am I more likely to have a miscarriage?

While studies have shown that the presence of nausea and vomiting of pregnancy is associated with a lower risk of miscarriage, about 20-30% of women with completely normal pregnancies do not experience nausea and vomiting.

Q: When is morning sickness most likely to occur?

Nausea and vomiting of pregnancy typically has an onset at 5 to 6 weeks of gestation, peaking around 9 weeks, and usually subsides by around 16-18 weeks gestation for most women.