Often called “Morning Sickness” this is one of the most common symptoms of the first trimester. I’ve noticed through the years that every pregnancy truly is different. You may have morning sickness one pregnancy but not the next. It varies in intensity without rhyme or reason, and it can be there one day and gone the next. It’s comforting to tell a patient who is afflicted with a severe case that it is a sign of a healthy pregnancy, but not having it at all is likely totally normal as well. I can only wonder what God’s intention is for this, but I’m certain the symptoms or the path taken to correct the symptoms are part of a bigger plan that modern medicine does not yet understand.
Morning sickness is thought to correlate with the human chorionic gonadotropin (HCG) concentration in the blood of the mother. HCG is secreted by the placenta and is the molecule that triggers a positive pregnancy test. These levels start low and double roughly every other day in the first several weeks of pregnancy before hitting a peak mid-first trimester and then coming back down.
Common symptoms include general loss of appetite or development of aversion to certain foods and smells, feeling queasy, increased saliva production, gagging and spitting up and even vomiting. These can lead to mild weight loss, fatigue and tiredness, constipation and mild dehydration in normal cases to severe weight loss and dehydration in more concerning situations. Just knowing that mild symptoms are normal is important. “Less often is more” in the first trimester especially and so, if tolerable, it’s often best to avoid medications. We’ll discuss use of meds later for severe cases (also called Hyperemesis Gravidarum).
There are several things a patient can do to help manage the symptoms outlined below from the American College of Obstetrics and Gynecology algorithm on treatment of Nausea and Vomiting of Pregnancy:
Sometimes the symptoms cannot be controlled or tolerated with a more conservative option and a prescription is needed. The two most commonly used medications are Zofran® and PhenerganTM. Though I’ve not seen it, apparently there are some lawyer ads on TV phishing for patients who have taken these medications and had any kind of birth defects. The data* simply doesn’t support this being a major concern especially if we practice the “less is more” approach. If a patient just can’t function or is losing too much weight or has become severely dehydrated due to morning sickness, it becomes a risk benefit situation where we’ve clearly got to do something. We often use Phenergan as a gel, oral tablet or suppository, and Zofran as an oral pill or quick dissolve pill. Common side effects are sedation for the Phenergan and constipation for Zofran. These are two of the most commonly prescribed medications for more severe morning sickness though there are several other more complex options available to help manage and control the symptoms of Hyperemesis Gravidarum that are beyond the scope of this article.
In conclusion, I’d suggest that, once established, patients feel free to try some of the conservative non-prescription options outlined above first and then contact us if they are unable to keep anything down for more than 24 hours, lose more than 2% of their body weight, feel like they may be dehydrated, or are simply wanting to check in to see if more can be done to help. On a better note, it typically totally resolves by the end of the 1st trimester.
Kyle P. McMorries, MD, FACOG
Ondansetron in pregnancy and risk of adverse fetal outcomes. Pasternak B, Svanström H, Hviid A. N Engl J Med. 2013 Feb;368(9):814-23.
Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Anderka M, Mitchell AA, Louik C, Werler MM, Hernández-Diaz S, Rasmussen SA, National Birth Defects Prevention Study. Birth Defects Res A Clin Mol Teratol. 2012 Jan;94(1):22-30. Epub 2011 Nov 19.