Is morning sickness the first sign of pregnancy?

Morning sickness, nausea, and vomiting can be among the first early pregnancy symptoms and signs. It typically begins around 4 weeks to 6 weeks into the pregnancy or around the time you miss your period and is one of the most common (and most irritating) parts of early pregnancy.  Although women may feel as though it will last forever, nausea and vomiting usually go away after the first trimester.

It often presents as a set of symptoms that characterize early pregnancy, including tender breasts, back pain, constipation, and an increased sense of smell. Unfortunately, constipation and increased sense of smell may make the condition worse.

Nausea and vomiting may last up until the 16th week of pregnancy in most cases, but this is not a number set in stone. There are some women who suffer from nausea for the duration of the pregnancy.

Morning sickness most likely occurs at the following times:

• Between 4 weeks and 8 weeks after conception and fertilization
• Implantation
• Around the time you miss your first period

What causes morning sickness?

Hormones, specifically estrogen, are thought to be a primary cause of morning sickness. Estrogen levels suddenly increase and fluctuate during the first month or so of pregnancy. As this hormone fluctuates, women often see changes in their sense of smell, which may be linked to nausea. Other causes of morning sickness may include hCG, relaxing digestive muscles, and skipping meals due to fear of vomiting.

How do you treat morning sickness? 

If you allow yourself plenty of time to get out of bed, (about an hour or so before you actually need to get up) and start slow then you should experience less morning sickness. Another tip is to drink fluids either before or after your meal (about half an hour) but not with your meals. If the smells of food cooking bother you, open a window while you cook/or have someone cook for you.

Slow and steady wins the race and the same goes for nausea and morning sickness. Eating meals slowly can greatly reduce nausea associated with pregnancy. Crackers and water are perfect in the morning when nausea tends to be strongest. If morning sickness happens later in the day, eat only light meals when nausea is the strongest. Eating before bed may also help prevent sickness upon waking, as the stomach tends to feel nauseous when empty.

Most recently, the FDA approved a safe and effective drug for nausea and vomiting in pregnancy called "Diclegis" which contains 10 mg doxylamine and 10 mg pyridoxine in a delayed release formulation. Diclegis is usually started at 2 tablets at night, and if symptoms persist 1 tablet is added in the morning on day 3, and if that does not work, 1 tablet is added in the afternoon.

How common are nausea and vomiting in pregnancy?

Nausea and vomiting during pregnancy are common and usually occur early in pregnancy in up to one out of every 2-3 women, usually before 9 weeks of the pregnancy. Between 50-80% of pregnant women have morning sickness. About 50% of pregnant women will have nausea plus vomiting, 25% will have nausea only, and 25% of women will have neither nausea nor vomiting. 

Does morning sickness happen only in the morning?

Though the name suggests it only occurs in the morning, nausea and vomiting can occur anytime throughout the day. Although women experiencing morning sickness may feel as though it will last forever, nausea and vomiting usually go away after the first trimester. It usually happens prior to 9 weeks of the pregnancy. If it happens later in pregnancy then other conditions should be evaluated in the differential diagnosis.

How bad can nausea and vomiting get?

Symptoms can range from mild to severe, with no known definitive cause as to why some pregnant women suffer from mild symptoms as opposed to severe symptoms. If you have nausea and vomiting in the 2nd and third trimester, especially if it's associated with diarrhea, you may have something besides typical morning sickness and should see your doctor. Nausea and vomiting are separate from the much more severe form of hyperemesis gravidarum which often requires medical treatment.

Take this quiz and find out with 3 questions how severe your nausea and vomiting is. 

How can I prevent morning sickness?

Small, Frequent Meals: Keep snacks such as dry toast, cereal, and crackers near you at all times. Get up slowly in the morning and have a snack such as Shredded Wheat bite-sized biscuits kept near your bedside to avoid moving around on an empty stomach. Then make sure your stomach is not empty throughout the rest of the day by eating five or six small meals including easy-to-digest foods such as bananas, rice, applesauce, and tea. Try to eat at least every two hours.

Drink Fluids: Your body needs more water during the first few months of pregnancy so it’s important to stay hydrated. Have beverages, soup, and fruit juices mixed with carbonated beverages to settle your stomach between meals. You may want to try avoiding drinking beverages with your meals as the fluid will fill up your stomach making less room for food and worsening feelings of nausea. Strive to consume 6-8 eight-ounce servings of fluids per day. 

Control Your Environment: By avoiding smells that do not appeal to you (some of which may have never bothered you before) you can prevent nausea. Have someone else cook for you so you do not become nauseated by a certain ingredient used in the cooking process. Also, try to create a restful environment since reducing stress has been shown to reduce nausea and vomiting. Try listening to relaxing music, practicing yoga or meditation, or breathing exercises. These techniques may also help you get a better night’s sleep which has also been associated with decreased nausea.

Anti-Nausea Foods: Fresh ginger has been shown to help alleviate nausea. Try flat ginger ale, ginger tea, gingersnaps, gingerbread, shredded fresh ginger, and ginger candies. Peppermint is another food known to soothe nausea. Citrus fruits also tend to be helpful- just smelling a lemon when you feel queasy may alleviate nausea.

Vitamin B6: Vitamin B6 may help women with severe and persistent nausea and vomiting. Even for women without these symptoms, vitamin B6 is an important vitamin that is required in greater amounts especially during later stages of pregnancy when the fetus is increasing the most in size. Consult with your physician before taking B6 since large doses taken for long periods of time may affect the growing baby’s nutritional status. 

Dos and don'ts of morning sickness

Do:

• Eat small meals often
• Drink fluids 1/2 hour before or after a meal, but not with meals
• Drink small amounts of fluids during the day to avoid dehydration
• Eat soda crackers 15 minutes before getting up in the morning
• Avoid foods and smells that increase nausea
• Ask someone else to cook for you and open the windows or turn on fans if the odor bothers you
• Get plenty of rest and nap during the day
• Avoid warm places (feeling hot adds to nausea)
• Sniff lemons or ginger, drink lemonade or eat watermelon to relieve nausea
• Eat salty potato chips (they have been found to settle stomachs enough to eat a meal)

Don't:

• Do not lie down after eating
• Do not skip meals
• Do not cook or eat spicy food