Definition

Morning sickness is nausea and vomiting that occurs during pregnancy. More than half of pregnant women experience nausea and vomiting, especially in the first trimester. Even though it is called morning sickness, this condition happens in the morning and at any time during the pregnancy. Nausea during pregnancy may happen due to hormonal changes in the pregnant woman's body. Even though it does not harm the mother and fetus, morning sickness may disturb daily activities.

Morning sickness symptoms may become more severe, known as hyperemesis gravidarum. Hyperemesis gravidarum is a condition of severe nausea and vomiting that can lead to dehydration and a weight loss of more than five per cent. In some cases, it can also cause malnutrition, which may require hospitalization for pregnant women.

Causes

The exact cause of morning sickness remains unknown, but hormonal changes are widely believed to play a significant role. In rare cases, medical conditions such as thyroid disorders or liver disease can lead to severe or persistent nausea and vomiting. Low blood sugar is another potential contributor to morning sickness. Additionally, several factors can exacerbate the symptoms, including:

• Twin pregnancy
• Excessive tiredness
• Emotional stress
• Frequent Travels

Risk factor

Morning sickness is a common pregnancy symptom but may occur more frequently in certain conditions.

• Nausea or vomiting due to motion sickness, migraines, sensitivity to certain smells, and exposure to estrogen (taking birth control pills before pregnancy)
• Have a history of morning sickness in a previous pregnancy
• Pregnancy with twins or more

You may experience hyperemesis gravidarum if you are pregnant with a baby girl, have a family history of hyperemesis gravidarum, or have a history of hyperemesis gravidarum in a previous pregnancy

Symptoms

There are several common symptoms of morning sickness:

• Nausea with or without vomiting during the first trimester, which can feel like motion sickness,
• Nausea happens in the morning, but it can appear at any time, even throughout the day
• Nausea gets worse if you smell certain aromas
• Nausea after eating, especially after eating spicy food
• Nausea or vomiting that occurs due to heat or excessive salivary production

Morning sickness most often occurs in the first trimester (around the 2nd and 3rd trimesters), but some pregnant women experience it in the first trimester. Usually, the symptoms of morning sickness begin to stop in the middle of the second trimester. However, some pregnant women still experience morning sickness until the end of the second trimester.

Diagnosis

Morning sickness will be diagnosed based on the symptoms and signs. The doctor will conduct several examinations to ensure you and your baby are healthy.

• Anamnesis (in-depth interview) regarding symptoms and history of previous pregnancies
• Urine test. A urine test to confirm that you are pregnant. This test can also help determine whether you are dehydrated.
• Blood examination. The doctor will take a blood sample to check your complete blood count and electrolytes. This examination must assess whether you have anemia or an electrolyte imbalance.
• Ultrasound (USG). An ultrasound examination is carried out to see the condition of the baby.

Management

The doctor will prescribe supplements or medicines to reduce nausea and prevent the body from dehydration, such as:

• Antihistamines reduce nausea and motion sickness.
• Phenothiazines help reduce severe nausea and vomiting.
• Metoclopramide helps reduce nausea and vomiting in gastrointestinal disorders.
• Antacids neutralize and prevent stomach acid reflux.

Do not take the above medicines without a doctor's instructions.

Moderate to severe nausea and vomiting can cause dehydration due to a lack of fluids and electrolyte imbalance, including sodium and potassium. This condition can be treated with intravenous fluids. If you suffer from hyperemesis gravidarum, you may require hospitalization and treatment with intravenous fluids and anti-vomiting medication.

Several ways to overcome morning sickness at home are:

• Get more rest (fatigue can make nausea worse)
• Avoid foods or aromas that can trigger nausea and vomiting
• Eating dry toast or plain biscuits.
• Eat small amounts often.
• Eat foods high in carbohydrates and low in fat, such as bread, rice, or pasta.
• Consuming cold foods such as ice cream or fruit
• Drink lots of water
• Eat foods or drinks that contain ginger
• Avoid caffeinated drinks
• Wear comfortable clothes
• Use air freshener, perfume, or clothes freshener with aromatherapy
• Try acupressure (a traditional healing technique from China that is similar to acupuncture). Several studies found that applying pressure to the wrist can relieve symptoms.

Complications

Nausea and vomiting can lead to appetite loss, a common concern among pregnant women. However, mild morning sickness is usually not harmful to the fetus and does not affect its growth and development. In some cases, severe vomiting can cause weight loss, which can lead to malnutrition and electrolyte imbalances, and if left untreated, it can harm the fetus.

Prevention

The following steps can help prevent morning sickness:

• Drink enough water
• Enough rest
• Improve the ventilation of your home or workspace to eliminate smells that make you nauseous.
• Avoid eating spicy food
• Eat small portions
• Avoid fatty foods
• Take vitamins at night
• Avoid cigarette smoke

When to see a doctor?

It is recommended to see a doctor when nausea and vomiting get worse. You need to see a doctor immediately in case you are experiencing conditions such as:

• Worsened nausea and vomiting
• Weight loss drastically
• Loss of appetite
• Infrequent urination in small amounts or dark-coloured urine
• Fever
• Palpitation
• Blood vomiting
• Frequent headache
• Stomach ache

Immediate treatment of morning sickness can improve the quality of life of pregnant women, as morning sickness can affect daily activities. Moreover, severe nausea and vomiting can cause several complications.