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What Doctors Don't Tell You

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February 2019 (Vol. 3 Issue 12)

Morning sickness

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Q) I love being pregnant, but I'm suffering from terrible morning sickness

Q) I love being pregnant, but I'm suffering from terrible morning sickness. Can you recommend safe, effective treatments?-C.S., via e-mail

A) Nausea and vomiting of pregnancy (NVP), commonly known as 'morning sickness', is thought to affect up to 90 per cent of pregnant women (Health Qual Life Outcomes, 2008; 6: 32). These symptoms-which also include tiredness, dizziness and lethargy-usually disappear after the first few months, but can, in some cases, last throughout the pregnancy.

A small percentage of women suffer from severe NVP, known as 'hyperemesis gravidarum'. Unlike morning sickness, this condition may have serious implications for both maternal and fetal health, and requires close monitoring by a doctor (Am Fam Physician, 2003; 68: 121-8).

Most women with morning sickness, however, should be able to find relief from the following self-care methods.

- Try ginger. Recommended by both doctors and traditional healers, ginger (Zingiber officinale) appears to be a safe and effective remedy for morning sickness (Obstet Gynecol, 2005; 105: 849-56). In one trial, 77 per cent of women given a ginger syrup drink (1 tbsp of syrup in water, four times a day) experienced a significant improvement in nausea compared with only 20 per cent of those taking a placebo. What's more, 67 per cent of the ginger-taking women stopped vomiting within six days of starting treatment compared with 20 per cent with placebo (Altern Ther Health Med, 2002; 8: 89-91). Ginger capsules (up to 1 g/day in a divided dose), ginger tea and ginger biscuits may also help.

- Adjust your diet. One study conducted across 21 countries found that rates of NVP were correlated with high intakes of alcohol, sugar, oils and meat, and with low intakes of cereals and pulses (Proc Biol Sci, 2006; 273: 2675-9). Another study suggests that carbohydrate-rich snacks eaten at regular intervals may alleviate morning sickness (Prof Care Mother Child, 1994; 4: 13-5).

- Supplement with vitamin B6. An 11-month study of 342 women with morning sickness found that 30 mg/day of B6 (pyridoxine) reduced NVP episodes better than did a placebo (Am J Obstet Gynecol, 1995; 173: 881-4).

- Try acupressure. Acupressure wristbands that stimulate the P6 acupoint (about 4 cm up from the wrist creases) have significantly reduced NVP in placebo-controlled studies (Complement Ther Clin Pract, 2008; 14: 46-52; J Obstet Gynecol Neonatal Nurs, 2001; 30: 61-70). Moreover, a study of 60 pregnant women found that 10 minutes of self-applied manual acupressure on the P6 point improved symptoms of nausea (Obstet Gynecol, 1994; 84: 245-8).

- Keep well hydrated. Drinking at least six to eight glasses of water daily can help, but drink them between meals rather than while eating. Also, avoid diuretics such as coffee and alcohol.

- Identify nausea triggers. The taste and smell of some foods can cause NVP, so avoid them. Also, avoid brushing your teeth immediately after eating, as the strong flavours in toothpaste can trigger nausea in some.

You may also wish to try homeopathy, which can be helpful for both morning sickness and labour (Prof Care Mother Child, 1994; 4: 185-7). Hypnosis may also make for a more comfortable pregnancy and healthier fetal development, and might even prevent hyperemesis gravidarum (Birth, 1999; 26: 248-54).

Finally, herbs can help, but do consult a qualified herbalist. WDDTY columnist Dr Harald Gaier suggests taking up to three cups a day of a tea made from Harpago-phytum procumbens (devil's claw) to alleviate severe NVP as well as the low backache and dyspepsia that often accompanies it.

What causes morning sickness?

Although morning sickness has been documented for thousands of years, the exact cause remains unknown (Proc Nutr Soc, 2002; 61: 51-9). Still, a number of theories have been proposed, including:

- hormones. Studies in women with morning sickness have shown elevated levels of oestrogen and of human chorionic gonadotropin (hCG) (Am Fam Physician, 2003; 68: 121-8)

- evolutionary adaptation. Some scientists believe that NVP serves as an adaptive prophylactic function against ingestion of potentially harmful foodstuffs during pregancy (Proc Biol Sci, 2006; 273: 2675-9)

- gastrointestinal tract dysfunction, such as delayed gastric motility and abnormalities of gastric electrical rhythm (gastric dysrhythmias), has been suggested as a cause of NVP (Am Fam Physician, 2003; 68: 121-8)

- Helicobacter pylori. Chronic infection with these bacteria may play a role in hyperemesis gravidarum, as 62 per cent of pregnant women with hyperemesis were positive for H. pylori in saliva, compared with 28 per cent of pregnant women without hyperemesis (Am J Perinatol, 2000; 17: 243-7).

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