Morning sickness

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Morning sickness
Other namesNausea and vomiting of pregnancy, nausea gravidarum, emesis gravidarum, pregnancy sickness
Specialty Obstetrics
Symptoms Nausea, vomiting [1]
Complications Wernicke encephalopathy, esophageal rupture [1]
Usual onset4th week of pregnancy [2]
DurationUntil 16th week of pregnancy [2]
CausesUnknown [2]
Diagnostic method Based on symptoms after other causes have been ruled out [3]
Differential diagnosis Hyperemesis gravidarum [1]
Prevention Prenatal vitamins [3]
Treatment Doxylamine and pyridoxine [3] [4]
Frequency~75% of pregnancies [4] [5]

Morning sickness, also called nausea and vomiting of pregnancy (NVP), is a symptom of pregnancy that involves nausea or vomiting. [1] Despite the name, nausea or vomiting can occur at any time during the day. [2] Typically the symptoms occur between the 4th and 16th week of pregnancy. [2] About 10% of women still have symptoms after the 20th week of pregnancy. [2] A severe form of the condition is known as hyperemesis gravidarum and results in weight loss. [1] [6]

Contents

The cause of morning sickness is unknown but may relate to changing levels of the hormone human chorionic gonadotropin. [2] 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. [3] Abdominal pain, fever, or headaches are typically not present in morning sickness. [1]

Taking prenatal vitamins before pregnancy may decrease the risk. [3] Specific treatment other than a bland diet may not be required for mild cases. [2] [6] [3] If treatment is used the combination of doxylamine and pyridoxine is recommended initially. [3] [4] There is limited evidence that ginger may be useful. [3] [7] For severe cases that have not improved with other measures methylprednisolone may be tried. [3] Tube feeding may be required in women who are losing weight. [3]

Morning sickness affects about 70–80% of all pregnant women to some extent. [4] [5] About 60% of women experience vomiting. [2] 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. [3] 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. [8] However, after around 22 weeks, up to 10% of women continue to have lingering symptoms. [8]

Cause

The cause of morning sickness is unknown but may relate to changing levels of estrogen and the hormone human chorionic gonadotropin. [2] [9] 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. [3] Abdominal pain, fever, or headaches are typically not present in morning sickness. [1]

Nausea and vomiting may also occur with molar pregnancy. [10]

Morning sickness is related to diets low in cereals and high in sugars, oilcrops, alcohol and meat. [11]

Pathophysiology

Hormone changes

Pathophysiology of vomiting in pregnancy Morning sickness.svg
Pathophysiology of vomiting in pregnancy

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. [15] 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: [16] [11]

Women who have no morning sickness are more likely to miscarry. [17] [18] This may be because such women are more likely to ingest substances that are harmful to the fetus. [19]

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. [20] 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. [21]

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. [16]

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. [21]

Treatments

There is a lack of good evidence to support the use of any particular intervention for morning sickness. [7]

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] [23] 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

Some studies support the use of ginger, but overall the evidence is limited and inconsistent. [3] [7] [9] [27] Safety concerns have been raised regarding its anticoagulant properties. [9] [28] [29] [30]

History

Thalidomide

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. [31] [32]

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. [33] [34] It was introduced as a sedative and medication for morning sickness without having been tested on pregnant women. [35] 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. [33] [36]

Related Research Articles

Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field.

<span class="mw-page-title-main">Miscarriage</span> Natural death and expulsion of an embryo or fetus before its independent survival

Miscarriage, also known in medical terms as a spontaneous abortion, is the death and expulsion of an embryo or fetus before it can survive independently. The term miscarriage is sometimes used to refer to all forms of pregnancy loss and pregnancy with abortive outcomes before 20 weeks of gestation.

An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics, and chemotherapy directed against cancer. They may be used for severe cases of gastroenteritis, especially if the patient is dehydrated.

<span class="mw-page-title-main">Dysmenorrhea</span> Pain during and sometimes before menstruation

Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in the pelvis or lower abdomen. Other symptoms may include back pain, diarrhea or nausea.

<span class="mw-page-title-main">Obstetric ultrasonography</span> Use of medical ultrasonography in pregnancy

Obstetric ultrasonography, or prenatal ultrasound, is the use of medical ultrasonography in pregnancy, in which sound waves are used to create real-time visual images of the developing embryo or fetus in the uterus (womb). The procedure is a standard part of prenatal care in many countries, as it can provide a variety of information about the health of the mother, the timing and progress of the pregnancy, and the health and development of the embryo or fetus.

Electroacupuncture is a form of acupuncture where a small electric current is passed between pairs of acupuncture needles.

<span class="mw-page-title-main">Placental abruption</span> Medical condition

Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure. Complications for the mother can include disseminated intravascular coagulopathy and kidney failure. Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.

<span class="mw-page-title-main">Stretch marks</span> Form of scarring

Stretch marks, also known as striae or striae distensae, are a form of scarring on the skin with an off-color hue. Over time they may diminish, but will not disappear completely. Striae are caused by tearing of the dermis during periods of rapid growth of the body, such as during puberty or pregnancy, in which they usually form during the last trimester. Usually on the belly, these striae also commonly occur on the breasts, thighs, hips, lower back, and buttocks. Pregnancy-related striae are known as striae gravidarum. Striae may also be influenced by the hormonal changes associated with puberty, pregnancy, bodybuilding, or hormone replacement therapy. There is no evidence that creams used during pregnancy prevent stretch marks. Once they have formed there is no clearly effective treatment, though various methods have been attempted and studied.

<span class="mw-page-title-main">Pregnancy</span> Time of offspring development in mothers body

Pregnancy is the time during which one or more offspring develops (gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.

Hyperemesis gravidarum (HG) is a pregnancy complication that is characterized by severe nausea, vomiting, weight loss, and possibly dehydration. Feeling faint may also occur. It is considered more severe than morning sickness. Symptoms often get better after the 20th week of pregnancy but may last the entire pregnancy duration.

<span class="mw-page-title-main">Complications of pregnancy</span> Medical condition

Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.

Pyridoxine/doxylamine, sold under the brand name Diclectin among others, is a combination of pyridoxine hydrochloride (vitamin B6) and doxylamine succinate. It is generally used for nausea and vomiting of pregnancy (morning sickness); even though its efficacy has not been proven and subsequent research has led to the removal of recommendations in medical journals.

<span class="mw-page-title-main">Nausea</span> Medical symptom or condition

Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat.

<span class="mw-page-title-main">Maternal physiological changes in pregnancy</span>

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Marlena Schoenberg Fejzo is an American medical scientist and professor of research on hyperemesis gravidarum and ovarian cancer.

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<span class="mw-page-title-main">Cannabis in pregnancy</span> Effects of cannabis consumption during pregnancy

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Signs and symptoms of pregnancy are common, benign conditions that result from the changes to the body that occur during pregnancy. Signs and symptoms of pregnancy typically change as pregnancy progresses, although several symptoms may be present throughout. Depending on severity, common symptoms in pregnancy can develop into complications. Pregnancy symptoms may be categorized based on trimester as well as region of the body affected.

<span class="mw-page-title-main">Pregnancy Sickness Support</span>

Pregnancy Sickness Support is a UK charity supporting women experiencing nausea and vomiting in pregnancy and Hyperemesis gravidarum.

Jennifer R. Niebyl (1942) is a Canadian obstetrics and gynecology researcher and professor. She has made significant contributions to the understanding of drugs in pregnancy and lactation.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 "Practice Bulletin No. 153: Nausea and Vomiting of Pregnancy". Obstetrics and Gynecology. 126 (3): e12–e24. September 2015. doi:10.1097/AOG.0000000000001048. PMID   26287788. S2CID   19552518.
  2. 1 2 3 4 5 6 7 8 9 10 Festin M (June 2009). "Nausea and vomiting in early pregnancy". BMJ Clinical Evidence. 2009. PMC   2907767 . PMID   21726485.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 "Practice Bulletin Summary No. 153: Nausea and Vomiting of Pregnancy" . Obstetrics and Gynecology (Review). 126 (3): 687–688. September 2015. doi:10.1097/01.aog.0000471177.80067.19. PMID   26287781. S2CID   39256123.
  4. 1 2 3 4 Koren G (December 2014). "Treating morning sickness in the United States--changes in prescribing are needed". American Journal of Obstetrics and Gynecology. 211 (6): 602–606. doi: 10.1016/j.ajog.2014.08.017 . PMID   25151184.
  5. 1 2 Einarson TR, Piwko C, Koren G (2013-01-01). "Prevalence of nausea and vomiting of pregnancy in the USA: a meta analysis". Journal of Population Therapeutics and Clinical Pharmacology. 20 (2): e163–e170. PMID   23863545.
  6. 1 2 "Pregnancy". Office on Women's Health. September 27, 2010. Archived from the original on 10 December 2015. Retrieved 5 December 2015.
  7. 1 2 3 Matthews A, Haas DM, O'Mathúna DP, Dowswell T (September 2015). "Interventions for nausea and vomiting in early pregnancy". The Cochrane Database of Systematic Reviews (Systematic review; meta-analysis). 2015 (9): CD007575. doi: 10.1002/14651858.CD007575.pub4 . PMC   4004939 . PMID   26348534.
  8. 1 2 Lee NM, Saha S (June 2011). "Nausea and vomiting of pregnancy". Gastroenterology Clinics of North America. 40 (2): 309–34, vii. doi:10.1016/j.gtc.2011.03.009. PMC   3676933 . PMID   21601782.
  9. 1 2 3 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". Nutrition Journal (Systematic review; meta-analysis). 13: 20. doi: 10.1186/1475-2891-13-20 . PMC   3995184 . PMID   24642205.
  10. ↑ Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG (2005). "Hyperemesis gravidarum, a literature review". Human Reproduction Update. 11 (5): 527–539. doi: 10.1093/humupd/dmi021 . PMID   16006438.
  11. 1 2 Pepper GV, Craig Roberts S (October 2006). "Rates of nausea and vomiting in pregnancy and dietary characteristics across populations". Proceedings. Biological Sciences. 273 (1601): 2675–2679. doi:10.1098/rspb.2006.3633. PMC   1635459 . PMID   17002954.
  12. ↑ Lagiou P, Tamimi R, Mucci LA, Trichopoulos D, Adami HO, Hsieh CC (April 2003). "Nausea and vomiting in pregnancy in relation to prolactin, estrogens, and progesterone: a prospective study". Obstetrics and Gynecology. 101 (4): 639–644. doi:10.1016/s0029-7844(02)02730-8. PMID   12681864. S2CID   13103469.
  13. ↑ Bauchner E, Marquez W. "Morning Sickness: Coping With The Worst". NY Metro Parents Magazine. Archived from the original on 2008-12-04. Retrieved 2008-07-06.
  14. ↑ Niebyl JR (October 2010). "Clinical practice. Nausea and vomiting in pregnancy". The New England Journal of Medicine. 363 (16): 1544–1550. doi:10.1056/NEJMcp1003896. PMID   20942670.
  15. ↑ Holt RD, Nesse RM, Williams GC (April 1996). Why We Get Sick: The New Science of Darwinian Medicine. Knopf Doubleday Publishing. p. 983. ISBN   978-0679746744.
  16. 1 2 Nesse RM, Williams GC (1996). Why We Get Sick (1st ed.). New York: Vintage Books. p. 290.
  17. ↑ Chan RL, Olshan AF, Savitz DA, Herring AH, Daniels JL, Peterson HB, Martin SL (November 2010). "Severity and duration of nausea and vomiting symptoms in pregnancy and spontaneous abortion". Human Reproduction. 25 (11): 2907–2912. doi:10.1093/humrep/deq260. PMC   3140259 . PMID   20861299.
  18. ↑ Collins, Dr Francis (2016-10-04). "Morning Sickness Associated with Lower Miscarriage Risk". NIH Director's Blog. Retrieved 2023-06-25.
  19. ↑ Sherman PW, Flaxman SM (May 2002). "Nausea and vomiting of pregnancy in an evolutionary perspective". American Journal of Obstetrics and Gynecology. 186 (5 Suppl Understanding): S190–S197. CiteSeerX   10.1.1.611.7889 . doi:10.1067/mob.2002.122593. PMID   12011885.
  20. ↑ Haig D (December 1993). "Genetic conflicts in human pregnancy". The Quarterly Review of Biology. 68 (4): 495–532. doi:10.1086/418300. PMID   8115596. S2CID   38641716.
  21. 1 2 Flaxman SM, Sherman PW (June 2000). "Morning sickness: a mechanism for protecting mother and embryo". The Quarterly Review of Biology. 75 (2): 113–148. doi:10.1086/393377. PMID   10858967. S2CID   28668687.
  22. 1 2 3 Jarvis S, Nelson-Piercy C (June 2011). "Management of nausea and vomiting in pregnancy" . The BMJ (Review). 342: d3606. doi:10.1136/bmj.d3606. PMID   21685438. S2CID   32242306.
  23. 1 2 Clark SM, Dutta E, Hankins GD (December 2014). "The outpatient management and special considerations of nausea and vomiting in pregnancy" . Seminars in Perinatology (Review). 38 (8): 496–502. doi:10.1053/j.semperi.2014.08.014. PMID   25267280.
  24. ↑ Koren G (October 2012). "Is ondansetron safe for use during pregnancy?". Motherisk update. Canadian Family Physician . 58 (10): 1092–1093. PMC   3470505 . PMID   23064917.
  25. ↑ Tan PC, Omar SZ (April 2011). "Contemporary approaches to hyperemesis during pregnancy" . Maternal-Fetal Medicine. Current Opinion in Obstetrics & Gynecology (Review). 23 (2): 87–93. doi:10.1097/GCO.0b013e328342d208. PMID   21297474. S2CID   11743580.
  26. ↑ Poon SL (October 2011). "BET 2: Steroid therapy in the treatment of intractable hyperemesis gravidarum" . Best Evidence Topic reports. Emergency Medicine Journal (Review). 28 (10): 898–900. doi:10.1136/emermed-2011-200636. PMID   21918097. S2CID   6667779.
  27. ↑ Thomson M, Corbin R, Leung L (2014). "Effects of ginger for nausea and vomiting in early pregnancy: a meta-analysis". Journal of the American Board of Family Medicine (Meta-analysis). 27 (1): 115–122. doi: 10.3122/jabfm.2014.01.130167 . PMID   24390893.
  28. ↑ 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" . Obstetrics and Gynecology . 105 (4): 849–856. doi:10.1097/01.AOG.0000154890.47642.23. PMID   15802416. S2CID   1607109.
  29. ↑ Tiran D (February 2012). "Ginger to reduce nausea and vomiting during pregnancy: evidence of effectiveness is not the same as proof of safety" . Complementary Therapies in Clinical Practice (Review). 18 (1): 22–25. doi:10.1016/j.ctcp.2011.08.007. PMID   22196569.
  30. ↑ Hu Y, Amoah AN, Zhang H, Fu R, Qiu Y, Cao Y, et al. (January 2022). "Effect of ginger in the treatment of nausea and vomiting compared with vitamin B6 and placebo during pregnancy: a meta-analysis" . The Journal of Maternal-Fetal & Neonatal Medicine (Meta-analysis). 35 (1): 187–196. doi:10.1080/14767058.2020.1712714. PMID   31937153. S2CID   210827751.
  31. ↑ 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
  32. ↑ Bren L (28 February 2001). "Frances Oldham Kelsey: FDA Medical Reviewer Leaves Her Mark on History". FDA Consumer. U.S. Food and Drug Administration . Retrieved 23 December 2009.
  33. 1 2 Miller MT (1991). "Thalidomide Embryopathy: A Model for the Study of Congenital Incomitant Horizontal Strabismus". Transactions of the American Ophthalmological Society. 81: 623–674. PMC   1298636 . PMID   1808819.
  34. ↑ Loue S, Sajatovic M (2004). Encyclopedia of Women's Health. Springer Science & Business Media. pp. 643–644. ISBN   9780306480737.
  35. ↑ Sneader W (2005). Drug discovery: a history (Rev. and updated ed.). Chichester: Wiley. p.  367. ISBN   978-0-471-89979-2.
  36. ↑ Cuthbert A (2003). The Oxford Companion to the Body . Oxford University Press. p.  682. doi:10.1093/acref/9780198524038.001.0001. ISBN   9780198524038.
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