Managing Morning Sickness and Nausea

If you’re feeling sick during pregnancy, know that you are not alone: 70% to 80% of pregnant people experience nausea and vomiting.

Despite nausea being a normal part of pregnancy, it doesn’t make it any less unpleasant or sometimes scary to deal with. People often choose to suffer in silence rather than seek out help for their symptoms. Hopefully, some data can help ease worries or frustrations.

Take me to the bottom line

What is morning sickness?

“Morning sickness” refers to the general feeling of nausea during pregnancy. It’s a bit of a misnomer; although many people do feel nauseous in the morning, studies show that most people report feeling sick all day, not just in the morning.

Pregnancy-related nausea usually starts around six weeks, peaks between eight and nine weeks, and then fades away gradually in the second trimester, between 13 and 14 weeks (timing depends on the person). Symptoms can also include vomiting, being sensitive to smells, avoiding foods, loss of appetite, and even weird cravings.

Of the up to 80% of pregnant people who deal with some form of nausea, more than half also experience vomiting. For most people, vomiting is not constant; actual vomiting is reported on an average of only six days during pregnancy.

If you are experiencing nausea — especially bad nausea — you may wonder, Why me? Unfortunately, we don’t fully understand why some people get nauseous, and others don’t. The answer very likely lies in your hormones, but the endocrine system is notoriously challenging to understand.

This lack of understanding extends to hyperemesis gravidarum, a rare condition in pregnancy that involves persistent severe vomiting, dehydration, and inability to gain weight. This condition affects an estimated 1% of pregnancies. Why some people get it, and some do not, is not fully known. One study points the finger at a particular hormone called GDF15, which is present at higher levels in women with severe nausea and vomiting. This is also linked to nausea at any level; more research is needed to be confident in the importance of this link, however, and to consider whether there are actionable ways to use that understanding.

Is there a relationship between nausea and miscarriage?

If you have read this and discovered you’re above average in terms of nausea and are now cursing your body for failing you, hold off a minute. As unpleasant as it is, nausea is a sign of a healthy pregnancy. Miscarriage rates are lower for women who are nauseated than for those who are not. For example, one study showed that the overall risk of first-trimester miscarriage was 30% for women without nausea, versus just 8% for those who were nauseated.

So there is some reassurance in that nausea, although it is also very important to note that the majority of women without nausea do not miscarry.

How do you treat nausea in pregnancy?

While not preventable, there are numerous ways to treat morning sickness and nausea. Most of the baseline advice is similar to what you’d hear anytime you have a stomach bug, for any reason. Staying hydrated is key, as well as eating more frequent, smaller meals to avoid an empty stomach.

Some other things you can try on your own:

Keep away from potential triggers, like unpleasant smells
Try ginger mints, tea, or gum (there are some small studies showing a benefit, though they are of limited quality)
Vitamin B6 supplements (randomized trials suggest a reduction in nausea from relatively high doses) and/or Unisom — both available over the counter
Take your prenatal vitamin with food

Not all of these tips have studies that support them. Some, like the advice to eat crackers, are simple common sense that apply to non-pregnancy nausea as well. On the flip side, there is no support in the data for acupressure or acupuncture to treat nausea, although there is also no harm in trying them, if you wish to.

Some pregnant people have used marijuana to help with nausea. Generally, I urge caution with recreational marijuana use in pregnancy, as we don’t have enough good data on the effects. For extreme nausea, this is a conversation you might have with your doctor, especially if you are struggling to stay sufficiently hydrated and nourished.

When to talk to your doctor

The short answer is, you should talk to your doctor if you feel it would be helpful. In the case of nausea during pregnancy, there are many things that can be done to help you feel better; you do not need to suffer in silence.

Your doctor or midwife may prescribe a medication like Zofran or promethazine, both of which can improve symptoms. Although some pregnant people are reluctant to take these medications, the safety profile of both is good, and they can prevent more serious outcomes like dehydration.

There are some symptoms that should prompt a more immediate call to your doctor. These include:

Weight loss
Feeling dizzy
Vomit with blood
Fever or body aches
Faster-than-normal heartbeat

If you are experiencing these symptoms, your doctor or nurse will likely check your weight and ask you a series of questions to help determine the best treatment plan. If your nausea and vomiting are severe, to the point where you are unable to eat or drink sufficiently, you may be diagnosed with hyperemesis gravidarum. This can lead to dehydration and a need for IV fluids, and it’s very important to get treatment.

The bottom line

Some nausea during pregnancy, including vomiting, is completely normal and points to a healthy pregnancy.
There are several safe options to treat nausea at home or with prescription medications like Zofran.
Vomiting several times daily is not the normal experience, and extra care is likely needed.