Morning sickness

Symptoms Of Morning Sickness 

Morning sickness is one of the most common early signs of pregnancy. It usually begins in the 4th–9th week, peaks between weeks 7–12, and resolves by week 16 for most women. Associated symptoms include:

• Nausea
• Vomiting
• All-day nausea (reported by 80% of affected women, rather than only morning bouts)
• Fatigue or Tiredness
• Gastroesophageal reflux disease (acid reflux)
• Motion sickness.
• Feeling of something stuck in the throat
• Hunger pangs

Causes Of Morning Sickness

Morning sickness occurs due to several changes in the body during early pregnancy. These include: 

• Hormonal surge: Pregnancy hormones like hCG and estrogen spike early on and can irritate the parts of your brain that control nausea.

• Slowed digestion: Progesterone relaxes your stomach muscles, slowing digestion and causing that queasy, full feeling.

• Brain-gut communication: Some signals from your growing placenta (like GDF15) can trigger the brain's vomiting center.

• Protective instinct: Some experts think this is nature’s way of helping you avoid potentially harmful foods early in pregnancy.

Could morning sickness be due to something other than pregnancy?

• Not all nausea in pregnancy is just morning sickness
• Conditions like gastroesophageal reflux disease (acid reflux) or indigestion can cause similar symptoms, especially in the first trimester
• In some cases, infections like Helicobacter pylori may be involved. 
• If symptoms are severe, your doctor may suggest testing and treatment during pregnancy.

Risk Factors For Morning Sickness

Morning sickness, especially nausea and vomiting, affects many women during early pregnancy. Certain factors can increase the risk. These include:

• First pregnancy: Women pregnant for the first time are more likely to experience morning sickness.

• Younger age: Pregnant individuals under 30 may have a higher risk of nausea and vomiting.

• Carrying twins or multiples: A higher hormone load can intensify morning sickness symptoms.

• History of motion sickness or migraine: Women with these sensitivities are linked to increased nausea during pregnancy.

• Family history: If your mother or sister had severe morning sickness, you might too.

• High hCG or GDF15 levels: Elevated pregnancy hormones are strongly associated with nausea.

• Female fetus: Some studies show that carrying a girl is more often linked to morning sickness.

• Obesity: Excess weight or a higher BMI (Body Mass Index) can raise the risk and severity of symptoms.

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Diagnosis Of Morning Sickness

Morning sickness is usually diagnosed based on your symptoms, especially if you're in early pregnancy and experiencing nausea and vomiting. It consists of:

History and physical exam

Your doctor will:

• Ask about your symptoms: How often you're vomiting, how much you're eating and drinking, and if it's affecting your daily life.

• Check for dehydration or weight loss: This is important, especially in severe cases like hyperemesis gravidarum.

Blood Tests

• Pregnancy test: Confirms if nausea and vomiting are due to early pregnancy

• Urine test: Checks for dehydration or ketones, which can indicate severe morning sickness

• Serum electrolyte: Assesses fluid and salt imbalances from excessive vomiting

• Thyroid profile: Rules out thyroid disorders that can mimic or worsen nausea in pregnancy.

Imaging tests

Most cases of morning sickness don’t require advanced testing. However, if symptoms are severe or atypical, doctors may suggest a few specific tests to rule out other causes. These include:

• Ultrasound: Helps confirm the pregnancy and check if you're carrying twins/more, or if there's an abnormal pregnancy growth.

• Upper endoscopy: Performed if symptoms suggest a gastrointestinal issue like gastritis or peptic ulcers.

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Specialist To Visit

An obstetrician-gynecologist (OB-GYN) who is your primary doctor during pregnancy can manage nausea, vomiting, and overall prenatal care. However, if morning sickness becomes hard to manage, they can refer you to the following:

• Gastroenterologist
• Nutritionist or Dietitian

You may be referred to a gastroenterologist if digestive issues or other stomach-related concerns are suspected.

A dietitian can guide you on managing symptoms through diet.

Note: A general physician is the first point of contact for initial evaluation if you haven't yet confirmed your pregnancy.

When to see a doctor?

See a doctor if:

• Nausea or vomiting is severe and persistent
• You are unable to keep food or fluids down for over 24 hours
• You notice signs of dehydration, like dry mouth (xerostomia) or dark urine
• You experience dizziness, weight loss, or fatigue
• Vomiting starts after the first trimester
• Over-the-counter remedies aren’t helping.

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Prevention Of Morning Sickness

Morning sickness is one of the most common symptoms of pregnancy. Try these simple, practical tweaks to reduce your chances of morning sickness: 

1. Snack before you rise

Keep dry crackers or toast by your bedside and eat a small bite before getting up

2. Go small and frequent

Eat light meals every 2–3 hours instead of large portions; an empty or overloaded stomach can worsen nausea

3. Stay cool and hydrated

Sip cold water or suck on ice chips to ease queasiness and prevent dehydration

4. Avoid strong smells

Stay away from cooking smells, perfumes, or anything that triggers your nausea

5. Choose cold over hot meals

Cold foods generally have milder odors and are less likely to upset your stomach.

6. Rest and relax

Get plenty of sleep and take breaks; fatigue can make nausea worse.

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Treatment Of Morning Sickness

Most cases of morning sickness can be managed with simple lifestyle changes. But when symptoms persist, medications may be needed to ease discomfort and prevent complications. Always consult your doctor before taking any medicine during pregnancy to ensure it’s safe for you and your baby. Treatment includes:

Pharmacological treatments 

• Doxylamine + Vitamin B6 (Pyridoxine): This combination is widely recommended as the first-line treatment for persistent nausea and vomiting in pregnancy. 

• Antiemetics: When first-line options are ineffective, these may be prescribed. Commonly used drugs are:

  • Metoclopramide
  • Promethazine
  • Diphenhydramine
  • Ondansetron 

• Corticosteroids: Reserved for severe cases unresponsive to other treatments. Usually considered after the first trimester due to potential risks. Examples include:

  • Methylprednisolone
  • Prednisolone

For severe cases (hyperemesis gravidarum)

• Hospitalization to administer IV fluids, electrolytes is suggested. Sometimes, feeding tubes or nutrients directly through a vein are recommended for severe dehydration or malnutrition.

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Home-care For Morning Sickness

Home remedies can offer relief in mild cases of morning sickness, but if symptoms are severe or persistent, it's important to consult a doctor. Always consult your doctor before trying out anything new. Remedies that can help include:

Lemon (Nimbu): The citrus scent of lemon can ease nausea and reduce vomiting.

How to use it?

Sniff freshly cut lemon, sip lemon water, or suck on lemon candy to ease morning sickness.

Mint (Pudina): It has a calming, anti-nausea effect and can help relax stomach muscles.

How to use it?

Drink peppermint tea, or add mint to buttermilk or chutney. You can also chew fresh mint leaves to alleviate nausea.

Cumin and Ajwain (Zeera and Ajwain): These improve digestion, reduce bloating, and nausea.

How to use it?

Boil 1/2 tsp each of cumin and ajwain in 1 cup of water, strain, and sip warm. You can take it 1–2 times a day after meals.

Fennel seeds (Saunf): They can relieve bloating and mild nausea by aiding digestion.

How to use it?

Chew 1/2 tsp saunf after meals or make fennel tea by boiling 1 tsp saunf in water.

Ginger (Adrak): It has been shown to reduce nausea safely during pregnancy.

How to use it?

Sip ginger tea, chew a small piece of fresh ginger, or take ginger supplements (after consulting your doctor) to help reduce nausea.

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Diet plays a key role in managing morning sickness. Adding or avoiding certain foods can help with morning sickness.

What to eat

• Plain crackers or toast, especially before getting out of bed
• Small, frequent meals rich in carbs like rice, oats, and bananas
• Ginger tea or ginger candies
• Cold or room-temperature foods 
• Lemon-infused water or lemonade

What to avoid

• Spicy, greasy, or fried foods
• Strong-smelling dishes
• Caffeine and carbonated drinks
• Skipping meals or eating large portions at once.

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Complications Of Morning Sickness

Most pregnant women experience mild to moderate morning sickness without complications. But when symptoms are severe or prolonged, they can lead to the following:

• Severe dehydration & weight loss: Persistent vomiting can lead to significant fluid loss and a drop of up to 5% in pre-pregnancy weight.

• Electrolyte imbalances & nutritional deficiencies: Vomiting disrupts essential minerals like sodium and potassium, and can cause vitamin B1 deficiency.

• Digestive tract damage: Repeated vomiting may lead to esophageal tears (Mallory-Weiss), inflammation, or even bleeding.

• Organ stress & metabolic issues: Conditions such as kidney dysfunction, low blood sugar, altered blood acidity (alkalosis), and imbalanced metabolic function may occur.

• Impact on mental health: Severe morning sickness is linked to higher rates of anxiety and depression.

• Risks to fetal health: In extreme cases, the baby may be born with low birth weight or prematurely, especially in regions with limited access to care.

Alternative Therapies For Morning Sickness

While some alternative therapies may help relieve morning sickness symptoms, they lack strong clinical evidence. Always consult your doctor before trying them, especially during pregnancy:

1. Acupressure (P6 or Nei‑Guan point)

This technique may shorten the duration of nausea. Wristbands like Sea-Bands or applying pressure to the inner wrist can be used several times a day.

2. Acupuncture

Though some women report relief, evidence on its effectiveness for morning sickness is mixed. It should only be done by a certified practitioner and under medical supervision.