Morning sickness

■ 1st trimester

Morning sickness is one of the classic signs of early pregnancy. The majority of expectant mothers — up to 70 percent — experience nausea and vomiting.

Although these signs and symptoms are commonly known as morning sickness, the name is misleading because nausea and vomiting can occur at any time of the day. The signs and symptoms typically first start at four to eight weeks of gestation and subside by 13 to 14 weeks. But some women have nausea and vomiting beyond the first trimester. Morning sickness may be more severe in a first pregnancy, in young women and in women carrying multiple fetuses.

The cause of morning sickness isn't completely understood, although the relaxation of the stomach muscle probably plays a part. The stomach empties somewhat more slowly under the influence of pregnancy hormones. Another possible cause is the rapidly rising levels of estrogen produced by the placenta and fetus. Emotional stress, fatigue, traveling and some types of food may aggravate the problem.

Although morning sickness can be quite distressing, it seldom leads to more serious problems such as dehydration or significant weight loss. Morning sickness doesn't affect your baby or mean that your baby is sick. In fact, nausea is generally a sign the pregnancy is progressing well.

Prevention and self-care for morning sickness

Dietary measures. You may be able to alleviate nausea by keeping some food in your stomach — by avoiding having a stomach that's completely empty or completely full. Here are some other dietary suggestions for preventing or relieving nausea:

• Eat smaller meals or snacks frequently throughout the day.

• Before getting out of bed in the morning, eat a couple of soda crackers or a piece of dry toast. Rise slowly, allowing some time for digestion to occur before you get up.

• Have a small snack at bedtime and when you get up to go to the bathroom at night.

• Avoid foods and smells that trigger nausea.

• Drink fewer fluids with your meals.

• Eat more carbohydrates, such as white rice, dry toast or a plain baked potato.

• Try eating low-fat, bland foods or high-protein foods such as peanut butter on apple slices, nuts, cheese and crackers, milk and yogurt. Other good choices are gelatin desserts (Jell-O), popsicles and chicken broth. Some women find it helpful to eat salty and tart foods in combination, such as pretzels and lemonade.

• Avoid foods that are high in fat and salt and low in nutrition. Avoid greasy, rich and spicy foods.

• If you're in the habit of drinking ginger ale when you're feeling nauseated, you may have science on your side. Several studies have found a benefit from ginger in reducing nausea and vomiting, with no apparent risks. Some ways to consume the spice include ginger soda or tea, ginger snaps or ginger in capsule form. You can also buy whole ginger root. Cut a slice or grate it and boil it. Let it steep for about five minutes, then sweeten it with honey if you like.

Lifestyle and alternative measures. Some other simple steps that you might find helpful are as follows:

• Keep rooms well ventilated and free of cooking odors and cigarette smoke, which can aggravate nausea.

• Get plenty of fresh air. Take a walk or try sleeping with a window open.

• Rest. The fatigue that's common in early pregnancy can contribute to nausea. Lying down may help.

• Some studies have shown a benefit from acupressure and acupuncture. Acupressure involves stimulating points in the body without use of needles or electricity. Elastic bands worn on the wrists may help counter morning sickness. These bracelets exert a steady pressure over an acupressure point on the inside of the wrist. Because these bands are also used for seasickness, you can usually find them at boating stores or travel agencies.

• The iron in prenatal vitamins may cause nausea. Switching to a children's chewable vitamin with folic acid may help. Talk to your health care provider before changing your vitamins.

• Ask your health care provider about taking a vitamin B-6 supplement. Studies have found that this vitamin reduces nausea and vomiting during pregnancy. The recommended dosage is 25 milligrams three times a day.

■ When to seek medical help for morning sickness

In rare instances, nausea and vomiting may be so severe that you can't maintain proper nutrition and fluids and gain enough weight. Severe or persistent nausea and vomiting may also be caused by other rare but serious diseases, such as liver disease or thyroid disease.

Call your health care provider if:

• Morning sickness doesn't improve, despite trying self-care remedies

• You're vomiting blood or material that looks like coffee grounds

• You lose more than 2 pounds

• You have prolonged, severe vomiting

Severe cases of nausea and vomiting may require treatment with medications, including antiemetics, which control nausea. Some women find relief with over-the-counter antacids or with motion sickness drugs or antihistamines. Your health care provider will discuss your options with you. (See also Nausea throughout the day.)

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