Morning Sickness

Morning sickness is the common but poorly understood nausea that frequently accompanies early pregnancy. It is generally not serious, although it can be quite unpleasant. Hyperemesis gravidarum is uncontrollable nausea and vomiting during pregnancy that results in severe dehydration and pH imbalances in the blood. It is distinct from morning sickness with nausea and vomiting. This condition requires treatment by a healthcare professional and, sometimes, hospitalization. Hyperemesis gravidarum can sometimes result from hyperthyroidism,¹ liver disease, kidney infection, pancreatitis, intestinal obstruction, or other causes—conditions that will not respond to any of the natural substances discussed in this article.

Checklist for Morning Sickness

Rating	Nutritional Supplements	Herbs
	Vitamin B6
		Ginger
	Adrenal extracts Vitamin C Vitamin K
See also: Homeopathic Remedies for Morning Sickness
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

How is it treated? Doctors typically recommend that women with morning sickness drink plenty of fluids and try to eat whatever they can, regardless of its nutritional value. No drugs are FDA-approved for the treatment of morning sickness. However, conventional treatment includes medications such as dimenhydrinate (Dramamine®, TripTone®), diphenhydramine (Benadryl®), prochlorperazine (Compazine®), ondansetron (Zofran®), meclizine (Antivert®, Marezine®), promethazine (Phenergan®, Anergan®), droperidol (Inapsine®), and metoclopramide (Reglan®).

Dietary changes that may be helpful: Some doctors recommend that women with morning sickness eat dry crackers upon waking. Drinking liquids and eating solid foods at separate times may be helpful as well.

In a Harvard University study, women with a high intake of saturated fat (found mainly in meat and dairy) during the year prior to pregnancy had a much higher risk of severe morning sickness than did women eating less saturated fat. An increase in saturated fat intake of 15 grams per day (the equivalent of a four-ounce cheeseburger or three cups of whole milk) was associated with a greater than threefold increase in the risk of developing morning sickness.²

Nutritional supplements that may be helpful: In two double-blind trials, supplementation with vitamin B6 (10 or 25 mg three times per day) significantly reduced the severity of morning sickness.³ ⁴

Vitamin K and vitamin C, taken together, may provide relief of symptoms for some women. In one study, 91% of women who took 5 mg of vitamin K and 25 mg of vitamin C per day reported the complete disappearance of morning sickness within three days.⁵ However, most doctors use higher amounts of vitamin C (500 to 1,000 mg per day).

In a preliminary study done in the 1930s, eight women suffering from nausea and vomiting during the first trimester (13 weeks) of pregnancy received large amounts of oral adrenal cortex extract. In most cases, vomiting stopped after three to four days.⁶ In a follow-up study, women with nausea and vomiting of pregnancy received adrenal cortex extract, usually by injection at first, followed by oral administration. More than 85% of the women were completely relieved of the problem or showed definite improvement.⁷ Since no safety data exist for use during pregnancy, adrenal extract should not be used in these situations unless supervised by a doctor.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Ginger is well-known for alleviating nausea and improving digestion. One gram of encapsulated ginger powder was used in one study to reduce the severe nausea and vomiting associated with hyperemesis gravidarum.⁸ This condition is potentially life-threatening and should only be treated by a qualified healthcare professional.

Because ginger contains some compounds that cause chromosomal mutation in the test tube, some doctors are concerned about the safety of using ginger during pregnancy. However, the available clinical research, combined with the fact that ginger is widely used in the diets of many cultures, suggests that prudent use of ginger for morning sickness is probably safe in amounts up to 1 gram per day.⁹

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that might be helpful: A controlled trial found that acupuncture significantly reduced symptoms in women with hyperemesis gravidarum, a severe form of nausea and vomiting of pregnancy that usually requires hospitalization.¹⁰ Treatment consisted of acupuncture at a single point on the forearm three times daily for two consecutive days. Acupressure (in which pressure, rather than needles, is used to stimulate acupuncture points) has also been found in several preliminary trials to be mildly effective in the treatment of nausea and vomiting of pregnancy.¹¹ ¹² ¹³

References:

1. Chan NN. Thyroid function in hyperemesis gravidarum. Lancet 1999;353:2243 [letter].

2. Signorello LB, Harlow BL, Wang SP, Erick MA. Saturated fat intake and the risk of severe hyperemesis gravidarum. Am J Epidemiol 1996;143 (11 Suppl):S25 [abstract # 97].

3. Sahakian V, Rouse D, Sipes S, et al. Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study. Obstet Gynecol 1991;78:33–6.

4. Vutyavanich T, Wongtra-ngan S, Ruangsri R. Pyridoxine for nausea and vomiting of pregnancy: a randomized, double blind, placebo-controlled trial. Am J Obstet Gynecol 1995;173:881–4.

5. Merkel RL. The use of menadione bisulfite and ascorbic acid in the treatment of nausea and vomiting of pregnancy. Am J Obstet Gynecol 1952;64:416–8.

6. Kemp WN. Hyperemesis gravidarum treated as a temporary adrenal cortex deficiency. Can Med Assoc J 1933;28:389–91.

7. Kemp WN. The vomiting of pregnancy treated as a temporary relative insufficiency of maternal corticoadrenal function. Med Rec 1934;140:239–41.

8. Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping U. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 1990;38:19–24.

9. Fulder S, Tenne M. Ginger as an anti-nausea remedy in pregnancy and the issue of safety. HerbalGram 1996;38:47–50.

10. Carlsson CPO, Axemo P, Bodin A, et al. Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study. J Pain Symptom Manage 2000;20:273–9.

11. Stainton MC, Neff EJ. The efficacy of SeaBands for the control of nausea and vomiting in pregnancy. Health Care Women Int 1994;15:563–75.

12. Belluomini J, Litt RC, Lee KA, Katz M. Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Obstet Gynecol 1994;84:245–8.

13. Hyde E. Acupressure therapy for morning sickness. A controlled clinical trial. J Nurse Midwifery 1989;34:171–8.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2003.