What is it?
Nausea and vomiting during pregnancy—also known as “morning sickness”— are most common during the first trimester. This is caused by rising hormone levels in early pregnancy, primarily human chorionic gonadotropin (hCG) and progesterone.
Despite the name, many people experience morning sickness throughout the day and night. One study showed that 80% of people experiencing morning sickness felt sick all day.
There are things you can do to relieve morning sickness, but if your nausea and vomiting are severe your healthcare provider may prescribe medication or recommend other treatments to control your symptoms
How common is it?
Severe nausea and vomiting, known as Hyperemesis Gravidarum (HG), affects 1.2% of pregnancies and should be managed closely with a healthcare provider. If you are throwing up more than three times a day, you should discuss treatment options with your healthcare provider.
How long does it last?
The hormone hCG, along with nausea and vomiting, typically peaks toward the end of the first trimester (weeks 8-12) and resolves by weeks 10-12 for most. For others it can last longer, but usually resolves by week 20 of pregnancy. If you’re pregnant with twins or multiples, you may have higher hCG levels and experience more nausea and vomiting.
What can I do about it?
Morning sickness can significantly impact your daily life. It can increase stress levels, reduce social functioning, and decrease your ability to perform daily activities. Several treatment options are available to reduce nausea and vomiting. Discuss them with your healthcare provider so you can find the best option for your specific symptoms.
Dietary changes to reduce nausea and vomiting
- Try eating smaller meals and snacks throughout the day, rather than large meals.
- Try to keep some food in your stomach, as an empty stomach can enhance the feeling of nausea.
- Consider keeping a snack by your bed, and eat it when you wake up in the morning or if you happen to wake up in the middle of the night. Blood sugar levels tend to drop during the night, and waking up with low blood sugar levels may contribute to nausea.
- When it comes to specific foods to eat or avoid, one study suggests that people who experience nausea and vomiting tend to consume more carbohydrates and added sugar, primarily from sugar-containing soft drinks. But whether higher intakes of carbohydrates are a result of symptoms—people choosing foods that they think won’t exacerbate nausea and vomiting—or are causing the condition is unknown.
- You may want to avoid lying down after eating, which can slow digestion.
- If your prenatal vitamin makes you nauseated, you can take it with a meal, a snack, or at night.
- Avoid smells and scents that can trigger nausea for you.
Tips to stay hydrated
Drinking fluids, especially water, is important throughout pregnancy and postpartum. Staying hydrated is particularly important to avoid dehydration, especially if you are vomiting.
- Drink consistently throughout the day, but take small sips so that sudden changes in fluid volume don’t trigger vomiting.
- Try sparkling water, as the bubbles may help settle your stomach, and avoid sugary soft drinks when possible.
- Some find that drinking out of a straw increases water consumption.
- Cold liquids may be easier to consume than room-temperature beverages.
- Adding electrolyte tablets to your water can also ensure you get essential minerals to maintain your hydration levels.
- Consuming foods with a high water content (like watermelon, cucumbers, and fruit-based popsicles) may also help with hydration.
Herbal and vitamin supplements
Ginger is commonly used to relieve nausea through non-pharmaceutical means. A comprehensive review of current research found ginger to be particularly helpful for alleviating nausea, but not necessarily vomiting. One study found that ginger capsules decreased nausea and vomiting within one week compared to placebo tablets. Overall, the research is limited, but anecdotally many find ginger to be soothing.
Like ginger, Vitamin B6 has been shown to decrease nausea but does not have much effect on vomiting. Discuss the dose and frequency with your healthcare provider if you want to explore this option. Read more under “pharmacological treatments” (below) for information on prescription and over-the-counter ways to use Vitamin B6.
Acupressure, a method developed in traditional Chinese medicine which puts continuous pressure on specific body areas without needles, has been shown to alleviate nausea and vomiting, but research on these strategies is limited and inconsistent. Since this is a low-cost and low-intervention option without side effects that studies suggest works for some people, it’s worth trying. However, as always, consult with your care provider before using any treatment.
- Motion sickness bands that apply pressure to the P6 pressure point on your wrists have been found to reduce the severity of nausea and the frequency of vomiting in pregnancy.
- Auricular pressure (including use of ear seeds) involves applying pressure to key points in the ear, which were shown in a randomized double-blind study to provide significant relief for nausea, although it did not provide relief for vomiting.
Acupuncture and acupressure have been shown to reduce nausea and the use of anti-nausea medications, but the research is limited. A very small study of 12 participants found that the use of acupuncture during the first trimester of pregnancy brought rapid relief of nausea and vomiting within 4 weeks of therapy, but there was insufficient evidence to make any recommendations for use as an effective therapy. Acupuncture does provide an opportunity for rest and relaxation, which is beneficial.
Avoid marijuana and CBD
Marijana and CBD are often used to treat nausea and vomiting in cancer patients, but their use in pregnancy is currently not recommended. Current research on their safety and effectiveness is limited and inconclusive.
- Some research shows that cannabis use in pregnancy has been associated with developmental and mental health disorders in infants and children.
- Another study found that cannabis use was associated with a significantly increased risk of preterm birth.
- There is even more limited research on using CBD (cannabidiol) in pregnancy, and it should be avoided until further research can validate safety and efficacy.
Pharmacological treatment can help you manage symptoms enough that you can experience greater quality of life, and are able to eat and drink sufficiently and avoid dehydration.
Doxylamine succinate–pyridoxine hydrochloride (brand name: Diclegis, Bonjesta)
These FDA-approved medications are a combination of vitamin B6 with an antihistamine. They are widely prescribed for safety and ease of use, and have been shown to improve nausea and vomiting symptoms over a 15-day period. The antihistamine component of the medication can cause fatigue, so it’s important to discuss the dose and timing with your healthcare provider if daytime sleepiness is interfering with your life. The prescription formulations of doxylamine succinate-pyridoxine hydrochloride are not always covered by insurance and can be expensive. But you can also purchase over-the-counter (OTC) options to make your own combination, which may be more economical and just as effective. To do so, combine OTC doxylamine succinate (generic or brand name: Unisom) in tablet form with OTC Vitamin B6. Discuss the dosage and formations with your healthcare provider before starting this.
Ondansetron (brand name: Zofran, Zuplenz)
For more severe nausea and vomiting, ondansetron can provide more immediate relief. Most studies found no association between maternal ondansetron use in early pregnancy and congenital anomalies, but there is inconsistent evidence for a small increase in congenital heart disease associated with ondansetron. It’s important to discuss risks and benefits with your healthcare provider.
Intravenous (IV) Rehydration
If you have frequent or severe vomiting, it may be recommended that you rehydrate with IV fluids in your healthcare provider's office or hospital. The IV fluids are typically normal saline with additional potassium chloride to replace and balance your electrolytes.
Other prescription medications for severe vomiting
A few other medications are approved for managing nausea and vomiting in pregnancy. Metoclopramide is commonly prescribed when Vitamin B6 and an antihistamine have failed to work. In severe cases, like Hyperemesis gravidarum, steroids may be prescribed by your healthcare provider to manage acute vomiting.
When should I be worried?
If your morning sickness is severe and interfering with your daily life, or if you have trouble keeping fluids down or any other troublesome symptoms, discuss treatment options with your healthcare provider. Severe nausea and frequent vomiting could be a sign of hyperemesis gravidarum, which requires close management from a healthcare provider.