II. Definitions
- Morning Sickness
-
Hyperemesis Gravidarum (Windsor Definition)
- Severe, intractable Nausea and/or Vomiting onset in pregnancy starting before 16 weeks gestation
- May be associated with Starvation Ketosis and weight loss >5% under pre-pregnancy weight
- Inability to eat or drink normally, strongly affecting daily activities
III. Epidemiology
- Prevalence: Nausea and/or Vomiting in first trimester (esp. <9 weeks): 70 to 80%
IV. Pathophysiology
- See Hyperemesis
V. Symptoms
- Gastrointestinal upset
- Timing
- Often in morning hours (but not limited to this time)
- Onset in pregnancy at 4-10 weeks gestation (typically 4-7 weeks)
- Usually improves by 13 weeks gestation (by 20 weeks gestation in 90% of women)
- Severity
- Unlike hyperemesis, patients can still perform daily activities
VI. Differential Diagnosis
VII. Management: Dietary recommendations
- Bedrest 15 minutes after awakening
- Crackers before arising from bed
- Clear liquids and advance as tolerated
- Small, frequent meals (6 meals/day)
- Suck on Hard Candy
- Avoid greasy or spicy foods, or those with intense flavors or smells
- Minimize fluid with meals (maximize fluid other times)
- Avoid foods that slow gastric emptying
- Avoid high Protein foods
- Avoid fatty foods
- Better tolerated foods
- Carbohydrate (breads, crackers, cereals) and fiber rich meals (fruits, vegetables)
- Eat low-fat, bland foods
- Salty foods (e.g. potato chips)
- Sour liquids (e.g. lemonade)
- Consider salty and tart foods together
- Example: potato chips with Lemonade
VIII. Management: Other options
- See Hyperemesis Gravidarum for evaluation, managment and medications for more severe cases
-
Pyridoxine (Vitamin B6) 25 mg every 8 hours
- May also be used in combination with Doxylamine (Unisom) and considered safe in first trimester
-
Ginger extract
- Dosing: 125-250 mg every 6-8 hours (e.g. 250 mg three times daily)
- Effective and safe at standard doses in first trimester (but safety unclear at higher dose)
- Limit to no more than 1500 mg/day
- Ding (2013) Women Birth 26(1):e26-30 [PubMed]
- Avoid after first trimester
- Risk of Vaginal Bleeding, premature birth, decreased Fetal Head Circumference
- Munoz (2019) Obstet Gynecol 133(5): 920-32 [PubMed]
- Acupressure, Acupuncture or Acustimulation
- Acupressure applied at Pericardium 6 (P6, Neiguan point)
- Located 3 finger breadths proximal to the wrist crease at midline volar Forearm
- Examples
- Sea-Band elastic band worn on wrists
- Electrical nerve stimulation (Acustimulation)
- Efficacy
- Variable with some studies demonstrating no improvement better than Placebo for acupressure or Acupuncture
- Rosen (2003) 102:129-35 [PubMed]
- References
- Fugh-Bergman (1999) Altern Ther Womens Health, 1:9
- Larimore (2000) Prim Care 27(1): 35-53 [PubMed]
IX. Prevention: Dental Erosion from recurrent Stomache acid exposure
- Rinse mouth with a teaspoon of Baking Soda in one cup of water after Vomiting
- Use a soft Tooth Brush only
- Avoid toothbrusing immediately after Vomiting
- Use fluoride rinse (e.g. ACT) nightly
- Silk (2008) Am Fam Physician 77:1139-44 [PubMed]