Morning sickness explained

Morning sickness should not be confused with Mourning sickness.

Morning sickness
Field:Obstetrics
Synonyms:Nausea and vomiting of pregnancy, nausea gravidarum, emesis gravidarum, pregnancy sickness
Symptoms:Nausea, vomiting
Complications:Wernicke encephalopathy, esophageal rupture
Onset:4th week of pregnancy
Duration:Until 16th week of pregnancy
Causes:Unknown
Diagnosis:Based on symptoms after other causes have been ruled out
Differential:Hyperemesis gravidarum
Prevention:Prenatal vitamins
Treatment:Doxylamine and pyridoxine
Frequency:~75% of pregnancies

Morning sickness, also called nausea and vomiting of pregnancy (NVP), is a symptom of pregnancy that involves nausea or vomiting. Despite the name, nausea or vomiting can occur at any time during the day. Typically the symptoms occur between the 4th and 16th week of pregnancy. About 10% of women still have symptoms after the 20th week of pregnancy. A severe form of the condition is known as hyperemesis gravidarum and results in weight loss.[1] [2]

The cause of morning sickness is unknown but may relate to changing levels of the hormone human chorionic gonadotropin.[3] Some have proposed that morning sickness may be useful from an evolutionary point of view.[1] Diagnosis should only occur after other possible causes have been ruled out. Abdominal pain, fever, or headaches are typically not present in morning sickness.[1]

Taking prenatal vitamins before pregnancy may decrease the risk. Specific treatment other than a bland diet may not be required for mild cases.[3] [2] If treatment is used the combination of doxylamine and pyridoxine is recommended initially.[4] There is limited evidence that ginger may be useful. For severe cases that have not improved with other measures methylprednisolone may be tried. Tube feeding may be required in women who are losing weight.

Morning sickness affects about 70–80% of all pregnant women to some extent.[4] [5] About 60% of women experience vomiting.[3] Hyperemesis gravidarum occurs in about 1.6% of pregnancies.[1] Morning sickness can negatively affect quality of life, result in decreased ability to work while pregnant, and result in health-care expenses.[6] Generally, mild to moderate cases have no effect on the fetus, and most severe cases also have normal outcomes.[1] Some women choose to have an abortion due to the severity of symptoms.[1] Complications such as Wernicke encephalopathy or esophageal rupture may occur, but very rarely.[1]

Signs and symptoms

About 66% of women have both nausea and vomiting while 33% have just nausea.[1] Symptoms of both nausea and vomiting will normally climax around 10 and 16 weeks of pregnancy, subsiding around 20 weeks. However, after around 22 weeks, up to 10% of women continue to have lingering symptoms.[7]

Cause

The cause of morning sickness is unknown but may relate to changing levels of estrogen and the hormone human chorionic gonadotropin.[3] [8] Some have proposed that morning sickness may be useful from an evolutionary point of view, arguing that morning sickness may protect both the pregnant woman and the developing embryo just when the fetus is most vulnerable.[1] Diagnosis should only occur after other possible causes have been ruled out.[6] Abdominal pain, fever, or headaches are typically not present in morning sickness.[1]

Nausea and vomiting may also occur with molar pregnancy.[9]

Morning sickness is related to diets low in cereals and high in sugars, oilcrops, alcohol and meat.[10]

Pathophysiology

Hormone changes

Defense mechanism

Morning sickness may be an evolved trait that protects the fetus against toxins ingested by the mother. Independent Scholar-Biologist Margie Profet from Seattle was one of the first to investigate the morning sickness-mystery. She argued that nausea and food aversions during pregnancy evolved to impose dietary restrictions on the mother in the early weeks of pregnancy, when the mother and the embryo are most immunologically vulnerable, to minimize fetal exposure to toxins such as mutagens and teratogens.[14] A woman and her embryo are very vulnerable to toxins during pregnancy. By reducing exposure to such chemicals, morning sickness reduces impairments on normal embryonic development and increases the reproductive success of the mother and survival success of both the mother and her offspring. Evidence in support of this theory includes:[15]

Women who have no morning sickness are more likely to miscarry.[16] [17] This may be because such women are more likely to ingest substances that are harmful to the fetus.[18]

In addition to protecting the fetus, morning sickness may also protect the mother. A pregnant woman's immune system is suppressed during pregnancy, presumably to reduce the chances of rejecting tissues of her own offspring.[19] Because of this, animal products containing parasites and harmful bacteria can be especially dangerous to pregnant women. There is evidence that morning sickness is often triggered by animal products including meat and fish.[20]

If morning sickness is a defense mechanism against the ingestion of toxins, the prescribing of anti-nausea medication to pregnant women may have the undesired side effect of causing birth defects or miscarriages by encouraging harmful dietary choices.[15]

Also, morning sickness is a defense mechanism because when analyzing embryonic growth, several critical periods are identified in which there is mass proliferation and cell division resulting in the development of the heart and central nervous system that are very sensitive. In that period, the fetus is most at risk from damage to toxins and mutagens. These developments occur through week 6-18 which is in the same time frame in which the most nausea and vomiting of pregnancy (NVP) occurs. This relationship between the time at which the embryo is most susceptible to toxins lines up exactly with when the most severe NVP symptoms are seen, suggesting that this NVP is an evolutionary response developed in the mother, to indicate the sensitivity of the fetus hence making her wary to her health and in turn protecting the fetus.

Treatments

There is a lack of good evidence to support the use of any particular intervention for morning sickness.[21]

Medications

A number of antiemetics are effective and safe in pregnancy including: pyridoxine/doxylamine, antihistamines (such as diphenhydramine), metoclopramide, and phenothiazines (such as promethazine).[22] With respect to effectiveness it is unknown if one is superior to another.[22] In the United States and Canada, the doxylamine-pyridoxine combination (as Diclegis in US and Diclectin in Canada) is the only approved pregnancy category "A" prescription treatment for nausea and vomiting of pregnancy.[23]

Ondansetron may be beneficial, but there are some concerns regarding an association with cleft palate,[24] and there is little high quality data.[22] Metoclopramide is also used and relatively well tolerated.[25] Evidence for the use of corticosteroids is weak.[26]

Alternative medicine

A recent review of studies has found acupuncture to be safe and effective for NVP.[27] Acupressure applied at the acupuncture point PC6 with finger pressure or a nausea band has some evidence of effectiveness,[28] [29] as does auricular (ear acupuncture).

Some studies support the use of ginger, but overall the evidence is limited and inconsistent.[30] Safety concerns have been raised regarding its anticoagulant properties.[31] [32] [33]

History

Thalidomide

See main article: Thalidomide scandal. In the late 1950s and early 1960s, the use of thalidomide in 46 countries by women who were pregnant or who subsequently became pregnant resulted in the "biggest man‐made medical disaster ever," with more than 10,000 children born with a range of severe deformities, such as phocomelia, as well as thousands of miscarriages.[34] [35]

Thalidomide was introduced in 1953 as a tranquilizer, and was later marketed by the German pharmaceutical company Chemie Grünenthal under the trade name Contergan as a medication for anxiety, trouble sleeping, "tension", and morning sickness.[36] [37] It was introduced as a sedative and medication for morning sickness without having been tested on pregnant women.[38] While initially deemed to be safe in pregnancy, concerns regarding birth defects were noted in 1961, and the medication was removed from the market in Europe that year.[36] [39]

Notes and References

  1. Practice Bulletin No. 153: Nausea and Vomiting of Pregnancy . Obstetrics and Gynecology . 126 . 3 . e12–e24 . September 2015 . 26287788 . 10.1097/AOG.0000000000001048 . 19552518 .
  2. Web site: Pregnancy. Office on Women's Health. 5 December 2015. September 27, 2010. dead. https://web.archive.org/web/20151210060201/http://womenshealth.gov/pregnancy/you-are-pregnant/pregnancy-complications.html. 10 December 2015.
  3. Festin M . Nausea and vomiting in early pregnancy . BMJ Clinical Evidence . 2009 . June 2009 . 21726485 . 2907767 .
  4. Koren G . Treating morning sickness in the United States--changes in prescribing are needed . American Journal of Obstetrics and Gynecology . 211 . 6 . 602–606 . December 2014 . 25151184 . 10.1016/j.ajog.2014.08.017 . free .
  5. Einarson TR, Piwko C, Koren G . Prevalence of nausea and vomiting of pregnancy in the USA: a meta analysis . Journal of Population Therapeutics and Clinical Pharmacology . 20 . 2 . e163–e170 . 2013-01-01 . 23863545 .
  6. September 2015 . Practice Bulletin Summary No. 153: Nausea and Vomiting of Pregnancy . . Review . 126 . 3 . 687–688 . 10.1097/01.aog.0000471177.80067.19 . 26287781 . 39256123 . subscription.
  7. Lee NM, Saha S . Nausea and vomiting of pregnancy . Gastroenterology Clinics of North America . 40 . 2 . 309–34, vii . June 2011 . 21601782 . 3676933 . 10.1016/j.gtc.2011.03.009 .
  8. Viljoen E, Visser J, Koen N, Musekiwa A . March 2014 . A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting . . Systematic review; meta-analysis . 13 . 20 . 10.1186/1475-2891-13-20 . 3995184 . 24642205 . free.
  9. Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG . Hyperemesis gravidarum, a literature review . Human Reproduction Update . 11 . 5 . 527–539 . 2005 . 16006438 . 10.1093/humupd/dmi021 . free .
  10. Pepper GV, Craig Roberts S . Rates of nausea and vomiting in pregnancy and dietary characteristics across populations . Proceedings. Biological Sciences . 273 . 1601 . 2675–2679 . October 2006 . 17002954 . 1635459 . 10.1098/rspb.2006.3633 .
  11. Lagiou P, Tamimi R, Mucci LA, Trichopoulos D, Adami HO, Hsieh CC . Nausea and vomiting in pregnancy in relation to prolactin, estrogens, and progesterone: a prospective study . Obstetrics and Gynecology . 101 . 4 . 639–644 . April 2003 . 12681864 . 10.1016/s0029-7844(02)02730-8 . 13103469 .
  12. Web site: Morning Sickness: Coping With The Worst. NY Metro Parents Magazine. 2008-07-06. Bauchner E, Marquez W . dead. https://web.archive.org/web/20081204115500/http://www.nymetroparents.com/newarticle.cfm?colid=7114. 2008-12-04.
  13. Niebyl JR . Clinical practice. Nausea and vomiting in pregnancy . The New England Journal of Medicine . 363 . 16 . 1544–1550 . October 2010 . 20942670 . 10.1056/NEJMcp1003896 .
  14. Book: Why We Get Sick: The New Science of Darwinian Medicine. . Holt RD, Nesse RM, Williams GC . April 1996 . 978-0679746744 . 983. Knopf Doubleday Publishing .
  15. Book: Nesse RM, Williams GC . George C. Williams (biologist) . Why We Get Sick . 1996 . 1st . Vintage Books. New York . 290 .
  16. Chan RL, Olshan AF, Savitz DA, Herring AH, Daniels JL, Peterson HB, Martin SL . Severity and duration of nausea and vomiting symptoms in pregnancy and spontaneous abortion . Human Reproduction . 25 . 11 . 2907–2912 . November 2010 . 20861299 . 3140259 . 10.1093/humrep/deq260 . Amy H. Herring .
  17. Web site: Collins . Dr Francis . 2016-10-04 . Morning Sickness Associated with Lower Miscarriage Risk . 2023-06-25 . NIH Director's Blog . en-US.
  18. Sherman PW, Flaxman SM . Nausea and vomiting of pregnancy in an evolutionary perspective . American Journal of Obstetrics and Gynecology . 186 . 5 Suppl Understanding . S190–S197 . May 2002 . 12011885 . 10.1067/mob.2002.122593 . 10.1.1.611.7889 .
  19. Haig D . Genetic conflicts in human pregnancy . The Quarterly Review of Biology . 68 . 4 . 495–532 . December 1993 . 8115596 . 10.1086/418300 . 38641716 . David Haig (biologist) .
  20. Flaxman SM, Sherman PW . Morning sickness: a mechanism for protecting mother and embryo . The Quarterly Review of Biology . 75 . 2 . 113–148 . June 2000 . 10858967 . 10.1086/393377 . 28668687 .
  21. Matthews A, Haas DM, O'Mathúna DP, Dowswell T . September 2015 . Interventions for nausea and vomiting in early pregnancy . . Systematic review; meta-analysis . 2015 . 9 . CD007575 . 10.1002/14651858.CD007575.pub4 . 4004939 . 26348534 . free.
  22. Jarvis S, Nelson-Piercy C . June 2011 . Management of nausea and vomiting in pregnancy . . Review . 342 . d3606 . 10.1136/bmj.d3606 . 21685438 . 32242306 . subscription.
  23. Clark SM, Dutta E, Hankins GD . December 2014 . The outpatient management and special considerations of nausea and vomiting in pregnancy . . Review . 38 . 8 . 496–502 . 10.1053/j.semperi.2014.08.014 . 25267280 . subscription.
  24. . October 2012 . Is ondansetron safe for use during pregnancy? . Motherisk update . . 58 . 10 . 1092–1093 . . 3470505 . 23064917 .
  25. Tan PC, Omar SZ . April 2011 . Contemporary approaches to hyperemesis during pregnancy . Maternal-Fetal Medicine . . Review . 23 . 2 . 87–93 . 10.1097/GCO.0b013e328342d208 . 21297474 . 11743580 . subscription.
  26. Poon SL . October 2011 . BET 2: Steroid therapy in the treatment of intractable hyperemesis gravidarum . Best Evidence Topic reports . . Review . 28 . 10 . 898–900 . 10.1136/emermed-2011-200636 . 21918097 . 6667779 . subscription.
  27. Hu . Yao . Yang . Qian . Hu . Xianjin . 2024 . The efficacy and safety of acupuncture and moxibustion for the management of nausea and vomiting in pregnant women: A systematic review and meta-analysis . Heliyon . 10 . 2 . e24439 . 10.1016/j.heliyon.2024.e24439 . 2405-8440. 10828706 .
  28. 2018 . ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy . Obstetrics & Gynecology . en . 131 . 1 . e15–e30 . 10.1097/AOG.0000000000002456 . 0029-7844.
  29. Book: Management of nausea and vomiting in pregnancy: Antenatal care: Evidence review (NICE Guideline No. 201) . National Guideline Alliance (UK) . 2021 . 978-1-4731-4227-5 . London, UK.
  30. Thomson M, Corbin R, Leung L . 2014 . Effects of ginger for nausea and vomiting in early pregnancy: a meta-analysis . . Meta-analysis . 27 . 1 . 115–122 . 10.3122/jabfm.2014.01.130167 . 24390893 . free.
  31. Borrelli F, Capasso R, Aviello G, Pittler MH, Izzo AA . April 2005 . Effectiveness and safety of ginger in the treatment of pregnancy-induced nausea and vomiting . . 105 . 4 . 849–856 . 10.1097/01.AOG.0000154890.47642.23 . 15802416 . 1607109 . subscription.
  32. Tiran D . February 2012 . Ginger to reduce nausea and vomiting during pregnancy: evidence of effectiveness is not the same as proof of safety . . Review . 18 . 1 . 22–25 . 10.1016/j.ctcp.2011.08.007 . 22196569 . subscription.
  33. 6 . Hu Y, Amoah AN, Zhang H, Fu R, Qiu Y, Cao Y, Sun Y, Chen H, Liu Y, Lyu Q . January 2022 . Effect of ginger in the treatment of nausea and vomiting compared with vitamin B6 and placebo during pregnancy: a meta-analysis . . Meta-analysis . 35 . 1 . 187–196 . 10.1080/14767058.2020.1712714 . 31937153 . 210827751 . subscription.
  34. Vargesson, Neil. “Thalidomide-induced teratogenesis: history and mechanisms.” Birth defects research. Part C, Embryo today : reviews vol. 105,2 (2015): 140–56. doi:10.1002/bdrc.21096
  35. News: Bren L . Frances Oldham Kelsey: FDA Medical Reviewer Leaves Her Mark on History . FDA Consumer. . 28 February 2001 . 23 December 2009.
  36. Miller . Marylin T. . vanc . Thalidomide Embryopathy: A Model for the Study of Congenital Incomitant Horizontal Strabismus . Transactions of the American Ophthalmological Society . 1991 . 81 . 623–674 . 1808819 . 1298636 .
  37. Book: Loue . Sana . Sajatovic . Martha . vanc . Encyclopedia of Women's Health . 2004 . Springer Science & Business Media . 9780306480737 . 643–644 . en.
  38. Book: Sneader. Walter . vanc . Drug discovery: a history. limited. 2005. Wiley. Chichester. 978-0-471-89979-2. 367. Rev. and updated.
  39. Book: Cuthbert, Alan . The Oxford Companion to the Body . vanc . 2003 . Oxford University Press . 10.1093/acref/9780198524038.001.0001 . 9780198524038 . registration . 682 .

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Morning sickness".

Except where otherwise indicated, Everything.Explained.Today is © Copyright 2009-2024, A B Cryer, All Rights Reserved. Cookie policy.