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{{short description|Nausea due to pregnancy}}
{{short description|Nausea due to pregnancy}}
{{distinguish|mourning sickness}}
{{distinguish|Mourning sickness}}
{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = Morning sickness
| name = Morning sickness
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| symptoms = [[Nausea]], [[vomiting]]<ref name=ACOG2015Full/>
| symptoms = [[Nausea]], [[vomiting]]<ref name=ACOG2015Full/>
| complications = [[Wernicke encephalopathy]], [[esophageal rupture]]<ref name=ACOG2015Full/>
| complications = [[Wernicke encephalopathy]], [[esophageal rupture]]<ref name=ACOG2015Full/>
| onset = 4th [[gestational age|week of pregnancy]]<ref name=Fes2009/>
| onset = 4th [[Gestational age (obstetrics)|week of pregnancy]]<ref name=Fes2009/>
| duration = Until 16th week of pregnancy<ref name=Fes2009/>
| duration = Until 16th week of pregnancy<ref name=Fes2009/>
| types =
| types =
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}}
}}
<!-- Definition and symptoms -->
<!-- Definition and symptoms -->
'''Morning sickness''', also called '''nausea and vomiting of pregnancy''' ('''NVP'''), is a [[Symptoms and discomforts of pregnancy |symptom of pregnancy]] that involves [[nausea]] or [[vomiting]].<ref name=ACOG2015Full/> Despite the name, nausea or vomiting can occur at any time during the day.<ref name=Fes2009/> Typically the symptoms occur between the 4th and 16th [[gestational age|week of pregnancy]].<ref name=Fes2009/> About 10% of women still have symptoms after the 20th week of pregnancy.<ref name=Fes2009/> A severe form of the condition is known as [[hyperemesis gravidarum]] and results in weight loss.<ref name=ACOG2015Full>{{cite journal|title= Practice Bulletin No. 153: Nausea and Vomiting of Pregnancy|journal= Obstetrics and Gynecology|date= September 2015|volume= 126|issue= 3|pages= e12–24|pmid= 26287788|doi= 10.1097/AOG.0000000000001048}}</ref><ref name=Women2010>{{cite web|title= Pregnancy|url= http://www.womenshealth.gov/pregnancy/you-are-pregnant/pregnancy-complications.html|website= Office on Women's Health|access-date= 5 December 2015|date= September 27, 2010|url-status= dead|archive-url= https://web.archive.org/web/20151210060201/http://womenshealth.gov/pregnancy/you-are-pregnant/pregnancy-complications.html|archive-date= 10 December 2015}}</ref>
'''Morning sickness''', also called '''nausea and vomiting of pregnancy''' ('''NVP'''), is a [[Symptoms and discomforts of pregnancy|symptom of pregnancy]] that involves [[nausea]] or [[vomiting]].<ref name=ACOG2015Full/> Despite the name, nausea or vomiting can occur at any time during the day.<ref name=Fes2009/> Typically the symptoms occur between the 4th and 16th [[Gestational age (obstetrics)|week of pregnancy]].<ref name=Fes2009/> About 10% of women still have symptoms after the 20th week of pregnancy.<ref name=Fes2009/> A severe form of the condition is known as [[hyperemesis gravidarum]] and results in weight loss.<ref name=ACOG2015Full>{{cite journal | vauthors = | title = Practice Bulletin No. 153: Nausea and Vomiting of Pregnancy | journal = Obstetrics and Gynecology | volume = 126 | issue = 3 | pages = e12–e24 | date = September 2015 | pmid = 26287788 | doi = 10.1097/AOG.0000000000001048 | s2cid = 19552518 }}</ref><ref name=Women2010>{{cite web|title= Pregnancy|url= http://www.womenshealth.gov/pregnancy/you-are-pregnant/pregnancy-complications.html|website= Office on Women's Health|access-date= 5 December 2015|date= September 27, 2010|url-status= dead|archive-url= https://web.archive.org/web/20151210060201/http://womenshealth.gov/pregnancy/you-are-pregnant/pregnancy-complications.html|archive-date= 10 December 2015}}</ref>


<!-- Cause and diagnosis -->
<!-- Cause and diagnosis -->
The cause of morning sickness is unknown but may relate to changing levels of the [[hormone]] [[human chorionic gonadotropin]].<ref name=Fes2009>{{cite journal|last1= Festin|first1= M|title= Nausea and vomiting in early pregnancy|journal= BMJ Clinical Evidence|date= 3 June 2009|volume= 2009|pmid= 21726485|pmc= 2907767}}</ref> Some have proposed that morning sickness may be useful from an [[evolutionary]] point of view.<ref name=ACOG2015Full/> Diagnosis should only occur after other possible causes have been ruled out.<ref name=ACOG2015/> [[Abdominal pain]], fever, or [[headache]]s are typically not present in morning sickness.<ref name=ACOG2015Full/>
The cause of morning sickness is unknown but may relate to changing levels of the hormone [[human chorionic gonadotropin]].<ref name=Fes2009>{{cite journal | vauthors = Festin M | title = Nausea and vomiting in early pregnancy | journal = BMJ Clinical Evidence | volume = 2009 | date = June 2009 | pmid = 21726485 | pmc = 2907767 }}</ref> Some have proposed that morning sickness may be useful from an [[evolutionary]] point of view.<ref name=ACOG2015Full/> Diagnosis should only occur after other possible causes have been ruled out.<ref name=ACOG2015/> [[Abdominal pain]], fever, or [[headache]]s are typically not present in morning sickness.<ref name=ACOG2015Full/>


<!-- Prevention and treatment -->
<!-- Prevention and treatment -->
Taking [[prenatal vitamins]] before pregnancy may decrease the risk.<ref name=ACOG2015/> Specific treatment other than a bland diet may not be required for mild cases.<ref name=Fes2009/><ref name=Women2010/><ref name=ACOG2015/> If treatment is used the combination of [[Pyridoxine/doxylamine|doxylamine and pyridoxine]] is recommended initially.<ref name=ACOG2015/><ref name=Kor2014>{{cite journal|last1= Koren|first1= G|title= Treating morning sickness in the United States--changes in prescribing are needed|journal= American Journal of Obstetrics and Gynecology|date= December 2014|volume= 211|issue= 6|pages= 602–6|pmid= 25151184|doi= 10.1016/j.ajog.2014.08.017|doi-access= free}}</ref> There is limited evidence that [[ginger]] may be useful.<ref name=ACOG2015/><ref name="ReferenceA">{{cite journal|last1= Matthews|first1= A|last2= Haas|first2= DM|last3= O'Mathúna|first3= DP|last4= Dowswell|first4= T|title= Interventions for nausea and vomiting in early pregnancy|journal= The Cochrane Database of Systematic Reviews|date= 8 September 2015|issue= 9|pages= CD007575|pmid= 26348534|doi= 10.1002/14651858.CD007575.pub4|pmc= 4004939}}{{open access}}</ref> For severe cases that have not improved with other measures [[methylprednisolone]] may be tried.<ref name=ACOG2015/> [[Tube feeding]] may be required in women who are losing weight.<ref name=ACOG2015/>
Taking [[prenatal vitamins]] before pregnancy may decrease the risk.<ref name=ACOG2015/> Specific treatment other than a bland diet may not be required for mild cases.<ref name=Fes2009/><ref name=Women2010/><ref name=ACOG2015/> If treatment is used the combination of [[Pyridoxine/doxylamine|doxylamine and pyridoxine]] is recommended initially.<ref name=ACOG2015/><ref name=Kor2014>{{cite journal | vauthors = Koren G | title = Treating morning sickness in the United States--changes in prescribing are needed | journal = American Journal of Obstetrics and Gynecology | volume = 211 | issue = 6 | pages = 602–606 | date = December 2014 | pmid = 25151184 | doi = 10.1016/j.ajog.2014.08.017 | doi-access = free }}</ref> There is limited evidence that [[ginger]] may be useful.<ref name=ACOG2015/><ref name="ReferenceB" /> For severe cases that have not improved with other measures [[methylprednisolone]] may be tried.<ref name=ACOG2015/> [[Tube feeding]] may be required in women who are losing weight.<ref name=ACOG2015/>


<!-- Prognosis, history, epidemiology, and culture -->
<!-- Prognosis, history, epidemiology, and culture -->
Morning sickness affects about 70–80% of all pregnant women to some extent.<ref name=Kor2014/><ref name=Ei2013>{{Cite journal|last1= Einarson|first1= Thomas R.|last2= Piwko|first2= Charles|last3= Koren|first3= Gideon|date= 2013-01-01|title= Prevalence of nausea and vomiting of pregnancy in the USA: a meta analysis|journal= Journal of Population Therapeutics and Clinical Pharmacology |volume= 20|issue= 2|pages= e163–170|issn= 1710-6222|pmid= 23863545}}</ref> About 60% of women experience vomiting.<ref name=Fes2009/> Hyperemesis gravidarum occurs in about 1.6% of pregnancies.<ref name=ACOG2015Full/> Morning sickness can negatively affect [[quality of life]], result in decreased ability to work while pregnant, and result in health-care expenses.<ref name=ACOG2015>{{cite journal|title= Practice Bulletin Summary No. 153: Nausea and Vomiting of Pregnancy|journal= Obstetrics and Gynecology|date= September 2015|volume= 126|issue= 3|pages= 687–8|pmid= 26287781|doi= 10.1097/01.aog.0000471177.80067.19}}</ref> Generally, mild to moderate cases have no effect on the fetus, and most severe cases also have normal outcomes.<ref name=ACOG2015Full/> Some women choose to have an [[abortion]] due to the severity of symptoms.<ref name=ACOG2015Full/> Complications such as [[Wernicke encephalopathy]] or [[esophageal rupture]] may occur, but very rarely.<ref name=ACOG2015Full/>
Morning sickness affects about 70–80% of all pregnant women to some extent.<ref name=Kor2014/><ref name=Ei2013>{{cite journal | vauthors = Einarson TR, Piwko C, Koren G | title = Prevalence of nausea and vomiting of pregnancy in the USA: a meta analysis | journal = Journal of Population Therapeutics and Clinical Pharmacology | volume = 20 | issue = 2 | pages = e163–e170 | date = 2013-01-01 | pmid = 23863545 }}</ref> About 60% of women experience vomiting.<ref name=Fes2009/> Hyperemesis gravidarum occurs in about 1.6% of pregnancies.<ref name=ACOG2015Full/> Morning sickness can negatively affect [[quality of life]], result in decreased ability to work while pregnant, and result in health-care expenses.<ref name="ACOG2015">{{cite journal |vauthors= |date=September 2015 |title=Practice Bulletin Summary No. 153: Nausea and Vomiting of Pregnancy |url=https://journals.lww.com/greenjournal/citation/2015/09000/practice_bulletin_summary_no__153__nausea_and.42.aspx |journal=[[Obstetrics & Gynecology (journal)|Obstetrics and Gynecology]] |type=Review <!-- from pubmed --> |volume=126 |issue=3 |pages=687–688 |doi=10.1097/01.aog.0000471177.80067.19 |pmid=26287781 |s2cid=39256123 |url-access=subscription}}</ref> Generally, mild to moderate cases have no effect on the fetus, and most severe cases also have normal outcomes.<ref name=ACOG2015Full/> Some women choose to have an [[abortion]] due to the severity of symptoms.<ref name=ACOG2015Full/> Complications such as [[Wernicke encephalopathy]] or [[esophageal rupture]] may occur, but very rarely.<ref name=ACOG2015Full/>


==Signs and symptoms==
==Signs and symptoms==
About 66% of women have both nausea and vomiting while 33% have just nausea.<ref name=ACOG2015Full/> Symptoms of both nausea and vomiting will normally climax around 10 and 16 weeks of pregnancy, subsiding around 20 weeks.<ref name=":1" /> However, after around 22 weeks, up to 10% of women continue to have lingering symptoms.<ref name=":1">{{cite journal | vauthors = Lee NM, Saha S | title = Nausea and vomiting of pregnancy | journal = Gastroenterology Clinics of North America | volume = 40 | issue = 2 | pages = 309–34, vii | date = June 2011 | pmid = 21601782 | pmc = 3676933 | doi = 10.1016/j.gtc.2011.03.009 }}</ref>
About 66% of women have both nausea and vomiting while 33% have just nausea.<ref name=ACOG2015Full/>


==Cause==
==Cause==


The cause of morning sickness is unknown but may relate to changing levels of estrogen and the [[hormone]] [[human chorionic gonadotropin]].<ref name=Fes2009/><ref name=":0">{{Cite journal|last1=Viljoen|first1=Estelle|last2=Visser|first2=Janicke|last3=Koen|first3=Nelene|last4=Musekiwa|first4=Alfred|date=2014-03-19|title=A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting|journal=Nutrition Journal|volume=13|pages=20|doi=10.1186/1475-2891-13-20|issn=1475-2891|pmc=3995184|pmid=24642205}}</ref> 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.<ref name=ACOG2015Full/> Diagnosis should only occur after other possible causes have been ruled out.<ref name=ACOG2015/> [[Abdominal pain]], fever, or [[headache]]s are typically not present in morning sickness.<ref name=ACOG2015Full/>
The cause of morning sickness is unknown but may relate to changing levels of estrogen and the hormone [[human chorionic gonadotropin]].<ref name=Fes2009/><ref name=":0">{{cite journal |vauthors=Viljoen E, Visser J, Koen N, Musekiwa A |date=March 2014 |title=A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting |journal=[[Nutrition Journal]] |type=Systematic review; meta-analysis<!-- from title and pubmed --> |volume=13 |pages=20 |doi=10.1186/1475-2891-13-20 |pmc=3995184 |pmid=24642205 |doi-access=free}}</ref> 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.<ref name=ACOG2015Full/> Diagnosis should only occur after other possible causes have been ruled out.<ref name=ACOG2015/> [[Abdominal pain]], fever, or [[headache]]s are typically not present in morning sickness.<ref name=ACOG2015Full/>


Nausea and vomiting may also occur with [[molar pregnancy]].<ref>{{cite journal|last1=Verberg|first1=MF|last2=Gillott|first2=DJ|last3=Al-Fardan|first3=N|last4=Grudzinskas|first4=JG|title=Hyperemesis gravidarum, a literature review|journal=Human Reproduction Update|date=2005|volume=11|issue=5|pages=527–39|pmid=16006438|doi=10.1093/humupd/dmi021|doi-access=free}}</ref>
Nausea and vomiting may also occur with [[molar pregnancy]].<ref>{{cite journal | vauthors = Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG | title = Hyperemesis gravidarum, a literature review | journal = Human Reproduction Update | volume = 11 | issue = 5 | pages = 527–539 | date = 2005 | pmid = 16006438 | doi = 10.1093/humupd/dmi021 | doi-access = free }}</ref>


Morning sickness is related to diets low in cereals and high in sugars, oilcrops, alcohol and meat.<ref>{{cite journal|last1=Pepper|first1=GV|last2=Craig Roberts|first2=S|title=Rates of nausea and vomiting in pregnancy and dietary characteristics across populations|journal=Proceedings of the Royal Society B|date=2006|volume=273|issue=1601|pages=2675–2679|pmid=17002954|pmc=1635459|doi=10.1098/rspb.2006.3633}}</ref>
Morning sickness is related to diets low in cereals and high in sugars, oilcrops, alcohol and meat.<ref name = "Pepper_2006">{{cite journal | vauthors = Pepper GV, Craig Roberts S | title = Rates of nausea and vomiting in pregnancy and dietary characteristics across populations | journal = Proceedings. Biological Sciences | volume = 273 | issue = 1601 | pages = 2675–2679 | date = October 2006 | pmid = 17002954 | pmc = 1635459 | doi = 10.1098/rspb.2006.3633 }}</ref>


==Pathophysiology==
==Pathophysiology==
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===Hormone changes===
===Hormone changes===
[[File:Morning sickness.svg|thumb|300px|Pathophysiology of vomiting in pregnancy]]
[[File:Morning sickness.svg|thumb|300px|Pathophysiology of vomiting in pregnancy]]
* An increase in the circulating level of the [[hormone]] [[estrogen]].<ref>{{cite journal |last1=Lagiou |first1=P |author2=Tamimi, R |author3=Mucci, LA |author4=Trichopoulos, D |author5=Adami, HO |author6=Hsieh, CC|title=Nausea and vomiting in pregnancy in relation to prolactin, estrogens, and progesterone: a prospective study |journal=Obstetrics and Gynecology|date=April 2003|volume=101|issue=4|pages=639–44|pmid=12681864 |doi=10.1016/s0029-7844(02)02730-8|s2cid=13103469 }}</ref> However, there is no consistent evidence of differences in estrogen levels and levels of [[bilirubin]] between women that experience sickness and those that do not.<ref>{{cite web|url=http://www.nymetroparents.com/newarticle.cfm?colid=7114|title=Morning Sickness: Coping With The Worst|publisher=NY Metro Parents Magazine|access-date=2008-07-06|author=Elizabeth Bauchner|author2=Wendy Marquez|url-status=dead|archive-url=https://web.archive.org/web/20081204115500/http://www.nymetroparents.com/newarticle.cfm?colid=7114|archive-date=2008-12-04}}</ref> Related to increased [[estrogen]] levels, a similar form of nausea is also seen in some women who use [[hormonal contraception]] or [[Hormone replacement therapy (menopause)|hormone replacement therapy]].
* An increase in the circulating level of the hormone [[estrogen]].<ref>{{cite journal | vauthors = Lagiou P, Tamimi R, Mucci LA, Trichopoulos D, Adami HO, Hsieh CC | title = Nausea and vomiting in pregnancy in relation to prolactin, estrogens, and progesterone: a prospective study | journal = Obstetrics and Gynecology | volume = 101 | issue = 4 | pages = 639–644 | date = April 2003 | pmid = 12681864 | doi = 10.1016/s0029-7844(02)02730-8 | s2cid = 13103469 }}</ref> However, there is no consistent evidence of differences in estrogen levels and levels of [[bilirubin]] between women that experience sickness and those that do not.<ref>{{cite web|url=http://www.nymetroparents.com/newarticle.cfm?colid=7114|title=Morning Sickness: Coping With The Worst|publisher=NY Metro Parents Magazine|access-date=2008-07-06| vauthors = Bauchner E, Marquez W |url-status=dead|archive-url=https://web.archive.org/web/20081204115500/http://www.nymetroparents.com/newarticle.cfm?colid=7114|archive-date=2008-12-04}}</ref> Related to increased [[estrogen]] levels, a similar form of nausea is also seen in some women who use [[hormonal contraception]] or [[Hormone replacement therapy (menopause)|hormone replacement therapy]], but does not predict future reactions to pregnancy.
* An increase in [[progesterone]] relaxes the [[muscle]]s in the [[uterus]], which prevents early [[childbirth]], but may also relax the [[stomach]] and [[intestine]]s, leading to excess [[stomach acid]]s and [[gastroesophageal reflux disease|gastroesophageal reflux disease (GERD)]].
* An increase in [[progesterone]] relaxes the [[muscle]]s in the [[uterus]], which prevents early [[childbirth]], but may also relax the [[stomach]] and [[intestine]]s, leading to excess [[stomach acid]]s and [[gastroesophageal reflux disease|gastroesophageal reflux disease (GERD)]].
* An increase in [[human chorionic gonadotropin]]. It is probably not the HCG itself that causes the nausea. More likely, it is the HCG stimulating the maternal ovaries to secrete estrogen, which in turn causes the nausea.<ref>{{cite journal | doi = 10.1056/NEJMcp1003896 | last1 = Niebyl | first1 = Jennifer R. | year = 2010| title = Nausea and Vomiting in Pregnancy | journal = New England Journal of Medicine | volume = 363 | issue = 16| pages = 1544–1550 | pmid = 20942670 }}</ref>
* An increase in [[human chorionic gonadotropin]]. It is probably not the HCG itself that causes the nausea. More likely, it is the HCG stimulating the maternal ovaries to secrete estrogen, which in turn causes the nausea.<ref>{{cite journal | vauthors = Niebyl JR | title = Clinical practice. Nausea and vomiting in pregnancy | journal = The New England Journal of Medicine | volume = 363 | issue = 16 | pages = 1544–1550 | date = October 2010 | pmid = 20942670 | doi = 10.1056/NEJMcp1003896 }}</ref>


===Defense mechanism===
===Defense mechanism===
Morning sickness may be an [[natural selection|evolved trait]] that protects the fetus against [[toxin]]s 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.<ref>{{Cite book |title=Why We Get Sick: The New Science of Darwinian Medicine. |vauthors=Holt RD, Nesse RM, Williams GC |date=April 1996 |isbn=978-0679746744 |pages=983|publisher=Knopf Doubleday Publishing }}</ref> 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:<ref name="Nesse">{{cite book | vauthors = Nesse RM, Williams GC |author-link2=George C. Williams (biologist) |title= Why We Get Sick |year=1996 |edition=1st |publisher= Vintage Books|location= New York |pages=290 }}</ref><ref name = "Pepper_2006" />
Morning sickness may be an [[natural selection|evolved trait]] that protects the fetus against [[toxin]]s ingested by the mother. Evidence in support of this theory includes:<ref name="Nesse">{{cite book |last1=Nesse |first1= Randolphe M|author-link=George C. Williams (biologist) |last2=Williams |first2=George C |title= Why We Get Sick |year=1996 |edition=1st |publisher= Vintage Books|location= New York |pages=290 }}</ref><ref name="Pepper">{{cite journal|vauthors=Pepper GV, Craig Roberts S | title = Rates of nausea and vomiting in pregnancy and dietary characteristics across populations | journal = Proceedings of the Royal Society B | volume = 273 | issue = 1601 | pages = 2675–2679 |date=October 2006 | pmid = 17002954 | pmc = 1635459 | doi = 10.1098/rspb.2006.3633}}</ref>
* Morning sickness is very common among pregnant women, which argues in favor of its being a functional adaptation and against the idea that it is a [[pathology]].
* Morning sickness is very common among pregnant women, which argues in favor of its being a functional adaptation and against the idea that it is a [[pathology]].
* Fetal vulnerability to toxins peaks at around 3 months, which is also the time of peak susceptibility to morning sickness.
* Fetal vulnerability to toxins peaks at around 3 months, which is also the time of peak susceptibility to morning sickness.
* There is a good correlation between toxin concentrations in foods, and the tastes and odors that cause revulsion.
* There is a good correlation between toxin concentrations in foods, and the tastes and odors that cause revulsion.


Women who have ''no'' morning sickness are more likely to [[miscarriage|miscarry]].<ref>{{cite journal | last1 = Chan | first1 = Ronna L. | last2 = Olshan | first2 = A. F. | last3 = Savitz | first3 = D. A. | last4 = Herring | first4 = A. H. |author4-link=Amy H. Herring| last5 = Daniels | first5 = J. L. | last6 = Peterson | first6 = H. B. | last7 = Martin | first7 = S. L. | title = Severity and duration of nausea and vomiting symptoms in pregnancy and spontaneous abortion | journal = Human Reproduction | volume = 25 | pages = 2907–12 | date = Sep 22, 2010 | pmid = 20861299 | issue = 11 | doi = 10.1093/humrep/deq260 | pmc = 3140259 | display-authors = etal }}</ref> This may be because such women are more likely to ingest substances that are harmful to the fetus.<ref>{{cite journal | last1 = Sherman | first1 = Paul W. | last2=Flaxman | first2 = Samuel M. | title = Nausea and vomiting of pregnancy in an evolutionary perspective | journal = Am J Obstet Gynecol |volume = 186 | pages = S190–S197 | year = 2002| pmid = 12011885| issue = 5 | doi = 10.1067/mob.2002.122593| citeseerx = 10.1.1.611.7889 }}</ref>
Women who have ''no'' morning sickness are more likely to [[miscarriage|miscarry]].<ref>{{cite journal | vauthors = Chan RL, Olshan AF, Savitz DA, Herring AH, Daniels JL, Peterson HB, Martin SL | title = Severity and duration of nausea and vomiting symptoms in pregnancy and spontaneous abortion | journal = Human Reproduction | volume = 25 | issue = 11 | pages = 2907–2912 | date = November 2010 | pmid = 20861299 | pmc = 3140259 | doi = 10.1093/humrep/deq260 | author4-link = Amy H. Herring }}</ref><ref>{{Cite web |last=Collins |first=Dr Francis |date=2016-10-04 |title=Morning Sickness Associated with Lower Miscarriage Risk |url=https://directorsblog.nih.gov/2016/10/04/nausea-in-pregnancy-is-associated-with-lower-miscarriage-risk/ |access-date=2023-06-25 |website=NIH Director's Blog |language=en-US}}</ref> This may be because such women are more likely to ingest substances that are harmful to the fetus.<ref>{{cite journal | vauthors = Sherman PW, Flaxman SM | title = Nausea and vomiting of pregnancy in an evolutionary perspective | journal = American Journal of Obstetrics and Gynecology | volume = 186 | issue = 5 Suppl Understanding | pages = S190–S197 | date = May 2002 | pmid = 12011885 | doi = 10.1067/mob.2002.122593 | citeseerx = 10.1.1.611.7889 }}</ref>


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 [[transplant rejection|rejecting]] tissues of her own offspring.<ref>{{cite journal| last = Haig | first = David | author-link = David Haig (biologist) | title = Genetic conflicts in human pregnancy | journal = Quarterly Review of Biology | volume = 68 | pages = 495–532 | date = October 1993 | pmid = 8115596 | issue = 4| doi=10.1086/418300| s2cid = 38641716 | url = http://nrs.harvard.edu/urn-3:HUL.InstRepos:3153297 }}</ref> Because of this, animal products containing [[parasite]]s 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.<ref>{{cite journal | first1 = Samuel M. | last1 = Flaxman | first2 = Paul W. | last2 = Sherman | title = Morning sickness: a mechanism for protecting mother and embryo | journal = Quarterly Review of Biology | volume = 75 | pages = 113–148 | date = June 2000 | pmid = 10858967 | issue = 2| doi=10.1086/393377| s2cid = 28668687 }}</ref>
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 [[transplant rejection|rejecting]] tissues of her own offspring.<ref>{{cite journal | vauthors = Haig D | title = Genetic conflicts in human pregnancy | journal = The Quarterly Review of Biology | volume = 68 | issue = 4 | pages = 495–532 | date = December 1993 | pmid = 8115596 | doi = 10.1086/418300 | s2cid = 38641716 | url = http://nrs.harvard.edu/urn-3:HUL.InstRepos:3153297 | author-link = David Haig (biologist) }}</ref> Because of this, animal products containing [[parasite]]s 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.<ref name = "Flaxman_2000">{{cite journal | vauthors = Flaxman SM, Sherman PW | title = Morning sickness: a mechanism for protecting mother and embryo | journal = The Quarterly Review of Biology | volume = 75 | issue = 2 | pages = 113–148 | date = June 2000 | pmid = 10858967 | doi = 10.1086/393377 | s2cid = 28668687 }}</ref>


If morning sickness is a defense mechanism against the ingestion of toxins, the prescribing of [[anti-nausea drugs|anti-nausea medication]] to pregnant women may have the undesired [[side effect]] of causing birth defects or miscarriages by encouraging harmful dietary choices.<ref name="Nesse"/>
If morning sickness is a defense mechanism against the ingestion of toxins, the prescribing of [[anti-nausea drugs|anti-nausea medication]] to pregnant women may have the undesired [[side effect]] of causing birth defects or miscarriages by encouraging harmful dietary choices.<ref name="Nesse"/>


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.<ref>{{cite journal|last1=Flaxman|first1=Samuel|last2=Sherman|first2=Paul|date=June 2000|title=Morning sickness: a mechanism for protecting mother and embryo|url=https://pubmed.ncbi.nlm.nih.gov/10858967/|journal=Quarterly Review of Biology|publisher=University of Chicago Press|volume=75|issue=2|pages=113–46|doi=10.1086/393377|pmid=10858967|s2cid=28668687}}</ref>
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.<ref name = "Flaxman_2000" />


==Treatments==
==Treatments==
There is a lack of good evidence to support the use of any particular intervention for morning sickness.<ref name="ReferenceB">{{cite journal|last1=Matthews|first1=A|last2=Haas|first2=DM|last3=O'Mathúna|first3=DP|last4=Dowswell|first4=T|title=Interventions for nausea and vomiting in early pregnancy|journal=The Cochrane Database of Systematic Reviews|date=8 September 2015|issue=9|pages=CD007575|pmid=26348534|doi=10.1002/14651858.CD007575.pub4|pmc=4004939}}</ref>
There is a lack of good evidence to support the use of any particular intervention for morning sickness.<ref name="ReferenceB">{{cite journal |vauthors=Matthews A, Haas DM, [[Donal O'Mathuna|O'Mathúna DP]], Dowswell T |date=September 2015 |title=Interventions for nausea and vomiting in early pregnancy |journal=[[Cochrane Library|The Cochrane Database of Systematic Reviews]] |type=Systematic review; meta-analysis <!-- from Pubmed --> |volume=2015 |issue=9 |pages=CD007575 |doi=10.1002/14651858.CD007575.pub4 |pmc=4004939 |pmid=26348534 |doi-access=free}}</ref>


===Medications===
===Medications===
A number of [[antiemetic]]s are effective and safe in pregnancy including: [[pyridoxine/doxylamine]], [[antihistamines]] (such as [[diphenhydramine]]), [[metoclopramide]], and [[phenothiazines]] (such as [[promethazine]]).<ref name=BMJ2011>{{cite journal|last1=Jarvis|first1=S|author2=Nelson-Piercy, C|title=Management of nausea and vomiting in pregnancy|journal=BMJ (Clinical Research Ed.)|date=Jun 17, 2011|volume=342|pages=d3606|pmid=21685438|doi=10.1136/bmj.d3606|s2cid=32242306|url=http://www.bmj.com/cgi/content/short/342/jun28_3/d4018}}</ref><ref name="Clark2014"/> With respect to effectiveness it is unknown if one is superior to another.<ref name=BMJ2011/> 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.<ref name="Clark2014">{{cite journal|vauthors=Clark SM, Dutta E, Hankins GD |title=The outpatient management and special considerations of nausea and vomiting in pregnancy|journal=Semin Perinatol|date=September 2014|volume=38|issue=14|pages=496–502|pmid=25267280|doi=10.1053/j.semperi.2014.08.014}}</ref>
A number of [[antiemetic]]s are effective and safe in pregnancy including: [[pyridoxine/doxylamine]], [[antihistamines]] (such as [[diphenhydramine]]), [[metoclopramide]], and [[phenothiazines]] (such as [[promethazine]]).<ref name="BMJ2011">{{cite journal |vauthors=Jarvis S, Nelson-Piercy C |date=June 2011 |title=Management of nausea and vomiting in pregnancy |url=https://www.bmj.com/content/342/bmj.d3606 |journal=[[The BMJ]] |type=Review <!-- from pubmed --> |volume=342 |pages=d3606 |doi=10.1136/bmj.d3606 |pmid=21685438 |s2cid=32242306 |url-access=subscription}}</ref><ref name="Clark2014"/> With respect to effectiveness it is unknown if one is superior to another.<ref name=BMJ2011/> 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.<ref name="Clark2014">{{cite journal |vauthors=Clark SM, Dutta E, Hankins GD |date=December 2014 |title=The outpatient management and special considerations of nausea and vomiting in pregnancy |url=https://www.sciencedirect.com/science/article/abs/pii/S0146000514001025 |journal=[[Seminars in Perinatology]] |type=Review <!-- from Pubmed --> |volume=38 |issue=8 |pages=496–502 |doi=10.1053/j.semperi.2014.08.014 |pmid=25267280 |url-access=subscription}}</ref>


[[Ondansetron]] may be beneficial, but there are some concerns regarding an association with [[cleft palate]],<ref>{{cite journal|last=Koren|first=G|title=Motherisk update. Is ondansetron safe for use during pregnancy?|journal=Canadian Family Physician |date=October 2012 |volume=58 |issue=10 |pages=1092–3 |pmid=23064917 |pmc=3470505}}</ref> and there is little high quality data.<ref name=BMJ2011/> [[Metoclopramide]] is also used and relatively well tolerated.<ref>{{cite journal|last1=Tan|first1=PC|author2=Omar, SZ|title=Contemporary approaches to hyperemesis during pregnancy|journal=Current Opinion in Obstetrics and Gynecology|date=April 2011|volume=23|issue=2|pages=87–93|pmid=21297474|doi=10.1097/GCO.0b013e328342d208|s2cid=11743580}}</ref> Evidence for the use of [[corticosteroid]]s is weak.<ref>{{cite journal|last=Poon|first=SL|title=Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 2: Steroid therapy in the treatment of intractable hyperemesis gravidarum|journal=Emergency Medicine Journal |date=October 2011|volume=28|issue=10|pages=898–900|pmid=21918097|doi=10.1136/emermed-2011-200636|s2cid=6667779}}</ref>
[[Ondansetron]] may be beneficial, but there are some concerns regarding an association with [[cleft palate]],<ref>{{cite journal |vauthors=[[Gideon Koren|Koren G]] |date=October 2012 |title=Is ondansetron safe for use during pregnancy? |url=https://www.cfp.ca/content/58/10/1092 |department=Motherisk update |journal=[[Canadian Family Physician]] |volume=58 |issue=10 |pages=1092–1093 |doi=<!-- have not found for this article --> |pmc=3470505 |pmid=23064917 |url-access=}}</ref> and there is little high quality data.<ref name=BMJ2011/> [[Metoclopramide]] is also used and relatively well tolerated.<ref>{{cite journal |vauthors=Tan PC, Omar SZ |date=April 2011 |title=Contemporary approaches to hyperemesis during pregnancy |url=https://journals.lww.com/co-obgyn/abstract/2011/04000/contemporary_approaches_to_hyperemesis_during.6.aspx |department=Maternal-Fetal Medicine |journal=[[Current Opinion in Obstetrics & Gynecology]] |type=Review<!-- from pubmed --> |volume=23 |issue=2 |pages=87–93 |doi=10.1097/GCO.0b013e328342d208 |pmid=21297474 |s2cid=11743580 |url-access=subscription}}</ref> Evidence for the use of [[corticosteroid]]s is weak.<ref>{{cite journal |vauthors=Poon SL |date=October 2011 |title=BET 2: Steroid therapy in the treatment of intractable hyperemesis gravidarum |url=https://emj.bmj.com/content/28/10/898.3 |department=Best Evidence Topic reports |journal=[[Emergency Medicine Journal]] |type=Review <!-- from pubmed --> |volume=28 |issue=10 |pages=898–900 |doi=10.1136/emermed-2011-200636 |pmid=21918097 |s2cid=6667779 |url-access=subscription}}</ref>


===Alternative medicine===
===Alternative medicine===
A recent review of studies has found [[acupuncture]] to be safe and effective for NVP.<ref>{{Cite journal |last1=Hu |first1=Yao |last2=Yang |first2=Qian |last3=Hu |first3=Xianjin |date=2024 |title=The efficacy and safety of acupuncture and moxibustion for the management of nausea and vomiting in pregnant women: A systematic review and meta-analysis |journal=Heliyon |volume=10 |issue=2 |pages=e24439 |doi=10.1016/j.heliyon.2024.e24439 |doi-access=free |pmid=38298660 |issn=2405-8440|pmc=10828706 |bibcode=2024Heliy..1024439H }}</ref> [[Acupressure]] applied at the acupuncture point PC6 with finger pressure or a nausea band has some evidence of effectiveness,<ref>{{Cite journal |date=2018 |title=ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy |url=https://journals.lww.com/00006250-201801000-00039 |journal=Obstetrics & Gynecology |language=en |volume=131 |issue=1 |pages=e15–e30 |doi=10.1097/AOG.0000000000002456 |pmid=29266076 |issn=0029-7844 |author1=Committee on Practice Bulletins-Obstetrics }}</ref><ref>{{Cite book |title=Management of nausea and vomiting in pregnancy: Antenatal care: Evidence review (NICE Guideline No. 201) |publisher=National Guideline Alliance (UK) |year=2021 |isbn=978-1-4731-4227-5 |location=London, UK}}</ref><ref name="ReferenceB" /> as does auricular (ear acupuncture).<ref name="ReferenceB" />
⚫
Some studies support the use of [[ginger]], but overall the evidence is limited and inconsistent.<ref name=ACOG2015/><ref name="ReferenceA"/><ref name="ReferenceB"/><ref name="ThomsonCorbin2014">{{cite journal|last1=Thomson|first1=M.|last2=Corbin|first2=R.|last3=Leung|first3=L.|title=Effects of Ginger for Nausea and Vomiting in Early Pregnancy: A Meta-Analysis|journal=The Journal of the American Board of Family Medicine|volume=27|issue=1|year=2014|pages=115–122|issn=1557-2625|doi=10.3122/jabfm.2014.01.130167|pmid=24390893|doi-access=free}}</ref><ref name=":0" /> Safety concerns have been raised regarding its [[anticoagulant]] properties.<ref name="pmid15802416">{{cite journal |vauthors=Borrelli F, Capasso R, Aviello G, Pittler MH, Izzo AA |title=Effectiveness and safety of ginger in the treatment of pregnancy-induced nausea and vomiting |journal=Obstetrics and Gynecology |volume=105 |issue=4 |pages=849–56 |year=2005 |pmid=15802416 |doi=10.1097/01.AOG.0000154890.47642.23|s2cid=1607109 }}</ref><ref>{{cite journal |last=Tiran |first=Denise |date=Feb 2012 |title=Ginger to reduce nausea and vomiting during pregnancy: Evidence of effectiveness is not the same as proof of safety |journal=Complementary Therapies in Clinical Practice |volume=18 |issue=1 |pages=22–25 |doi=10.1016/j.ctcp.2011.08.007 |pmid=22196569 |issn=1744-3881}}</ref><ref name=":0" /><ref>{{Cite journal|last1=Hu|first1=Youchun|last2=Amoah|first2=Adwoa N.|last3=Zhang|first3=Han|last4=Fu|first4=Rong|last5=Qiu|first5=Yanfang|last6=Cao|first6=Yuan|last7=Sun|first7=Yafei|last8=Chen|first8=Huanan|last9=Liu|first9=Yanhua|last10=Lyu|first10=Quanjun|date=2020-01-14|title=Effect of ginger in the treatment of nausea and vomiting compared with vitamin B6 and placebo during pregnancy: a meta-analysis|url=https://doi.org/10.1080/14767058.2020.1712714|journal=The Journal of Maternal-Fetal & Neonatal Medicine|volume=0|pages=1–10|doi=10.1080/14767058.2020.1712714|issn=1476-7058|pmid=31937153}}</ref>

⚫
Some studies support the use of [[ginger]], but overall the evidence is limited and inconsistent.<ref name="ACOG2015" /><ref name="ReferenceB" /><ref name=":0" /><ref name="ThomsonCorbin2014">{{cite journal |vauthors=Thomson M, Corbin R, Leung L |year=2014 |title=Effects of ginger for nausea and vomiting in early pregnancy: a meta-analysis |url=https://www.jabfm.org/content/27/1/115 |journal=[[Journal of the American Board of Family Medicine]] |type=Meta-analysis<!-- from pubmed and title --> |volume=27 |issue=1 |pages=115–122 |doi=10.3122/jabfm.2014.01.130167 |pmid=24390893 |doi-access=free}}</ref> Safety concerns have been raised regarding its [[anticoagulant]] properties.<ref name=":0" /><ref name="pmid15802416">{{cite journal |vauthors=Borrelli F, Capasso R, Aviello G, Pittler MH, Izzo AA |date=April 2005 |title=Effectiveness and safety of ginger in the treatment of pregnancy-induced nausea and vomiting |url=https://journals.lww.com/greenjournal/abstract/2005/04000/effectiveness_and_safety_of_ginger_in_the.27.aspx |journal=[[Obstetrics & Gynecology (journal)|Obstetrics and Gynecology]] |volume=105 |issue=4 |pages=849–856 |doi=10.1097/01.AOG.0000154890.47642.23 |pmid=15802416 |s2cid=1607109 |url-access=subscription}}</ref><ref>{{cite journal |vauthors=Tiran D |date=February 2012 |title=Ginger to reduce nausea and vomiting during pregnancy: evidence of effectiveness is not the same as proof of safety |url=https://www.sciencedirect.com/science/article/abs/pii/S1744388111000739 |journal=[[Complementary Therapies in Clinical Practice]] |type=Review |volume=18 |issue=1 |pages=22–25 |doi=10.1016/j.ctcp.2011.08.007 |pmid=22196569 |url-access=subscription}}</ref><ref>{{cite journal |display-authors=6 |vauthors=Hu Y, Amoah AN, Zhang H, Fu R, Qiu Y, Cao Y, Sun Y, Chen H, Liu Y, Lyu Q |date=January 2022 |title=Effect of ginger in the treatment of nausea and vomiting compared with vitamin B6 and placebo during pregnancy: a meta-analysis |url=https://www.tandfonline.com/doi/full/10.1080/14767058.2020.1712714 |journal=[[The Journal of Maternal-Fetal & Neonatal Medicine]] |type=Meta-analysis<!-- from title and pubmed --> |volume=35 |issue=1 |pages=187–196 |doi=10.1080/14767058.2020.1712714 |pmid=31937153 |s2cid=210827751 |url-access=subscription}}</ref>


==History==
==History==
===Thalidomide===
===Thalidomide===
{{Main|Thalidomide scandal}}
[[Thalidomide]] was originally developed and prescribed as a cure for morning sickness in [[West Germany]], but its use was discontinued when it was found to cause [[congenital disorder|birth defect]]s.<ref>{{cite book|editor-last=Cohen|editor-first=Wayne R.|title=Cherry and Merkatz's complications of pregnancy|year=2000|publisher=Lippincott Williams & Wilkins|isbn=9780683016734|pages=124|edition=5th}}</ref> The [[United States]] [[Food and Drug Administration]] never approved thalidomide for use as a cure for morning sickness.<ref name="Bren">{{cite news | author = Bren L | title =Frances Oldham Kelsey: FDA Medical Reviewer Leaves Her Mark on History | url =http://permanent.access.gpo.gov/lps1609/www.fda.gov/fdac/features/2001/201_kelsey.html | work =FDA Consumer|publisher =U.S. [[Food and Drug Administration]] | date =2001-02-28 | access-date =2009-12-23 }}</ref>
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.<ref>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</ref><ref name="Bren">{{cite news | author = Bren L | title =Frances Oldham Kelsey: FDA Medical Reviewer Leaves Her Mark on History | url =http://permanent.access.gpo.gov/lps1609/www.fda.gov/fdac/features/2001/201_kelsey.html | work =FDA Consumer|publisher =U.S. [[Food and Drug Administration]] | date =28 February 2001 | access-date =23 December 2009}}</ref>


Thalidomide was introduced in 1953 as a tranquilizer, and was later marketed by the German pharmaceutical company [[Grünenthal GmbH|Chemie Grünenthal]] under the [[trade name]] '''Contergan''' as a medication for [[anxiety]], [[insomnia|trouble sleeping]], "tension", and morning sickness.<ref name=Mill1991>{{cite journal | last = Miller | first = Marylin T. | name-list-style = vanc | title = Thalidomide Embryopathy: A Model for the Study of Congenital Incomitant Horizontal Strabismus | journal = Transactions of the American Ophthalmological Society | year = 1991 | volume = 81 | pages = 623–674 | pmid = 1808819 | pmc = 1298636 }}</ref><ref name=Lou2004>{{cite book |last1=Loue |first1=Sana |last2=Sajatovic |first2=Martha | name-list-style = vanc |title=Encyclopedia of Women's Health |date=2004 |publisher=Springer Science & Business Media |isbn=9780306480737 |pages=643–644 |url=https://books.google.com/books?id=LbHWgd-mDbsC&pg=PA644 |language=en}}</ref> It was introduced as a sedative and medication for morning sickness without having been tested on pregnant women.<ref>{{cite book|last1=Sneader|first1=Walter | name-list-style = vanc |title=Drug discovery: a history|url=https://archive.org/details/drugdiscoveryhis00snea|url-access=limited|date=2005|publisher=Wiley|location=Chichester|isbn=978-0-471-89979-2|page=[https://archive.org/details/drugdiscoveryhis00snea/page/n380 367]|edition=Rev. and updated}}</ref> 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.<ref name=Mill1991/><ref name=OUP2003>{{cite book | title = The Oxford Companion to the Body | last = Cuthbert | first = Alan | name-list-style = vanc | year = 2003 | publisher = Oxford University Press | url = https://archive.org/details/oxfordcompaniont0000unse_z0k4/page/682 | doi = 10.1093/acref/9780198524038.001.0001 | isbn = 9780198524038 | url-access = registration | page = [https://archive.org/details/oxfordcompaniont0000unse_z0k4/page/682 682] }}</ref>
⚫
==References==

{{Reflist|refs=Flaxman SM, Sherman PW. Morning sickness: a mechanism for protecting mother and embryo. Q Rev Biol. 2000 Jun;75(2):113-48. doi: 10.1086/393377. PMID: 10858967.}}
⚫
== References ==
{{Reflist}}


{{Medical resources
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| ICD9 = {{ICD9|643.0}}
| MedlinePlus = 003119
| MedlinePlus = 003119
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{{Pathology of pregnancy, childbirth and the puerperium}}
{{Pathology of pregnancy, childbirth and the puerperium}}
{{Authority control}}
{{Authority control}}

Latest revision as of 05:45, 10 October 2024

Not to be confused with Mourning sickness.
Morning sickness
Other namesNausea and vomiting of pregnancy, nausea gravidarum, emesis gravidarum, pregnancy sickness
SpecialtyObstetrics
SymptomsNausea, vomiting[1]
ComplicationsWernicke encephalopathy, esophageal rupture[1]
Usual onset4th week of pregnancy[2]
DurationUntil 16th week of pregnancy[2]
CausesUnknown[2]
Diagnostic methodBased on symptoms after other causes have been ruled out[3]
Differential diagnosisHyperemesis gravidarum[1]
PreventionPrenatal vitamins[3]
TreatmentDoxylamine 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]

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

[edit]

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

[edit]

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

[edit]

Hormone changes

[edit]
Pathophysiology of vomiting in pregnancy

Defense mechanism

[edit]

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]

  • Morning sickness is very common among pregnant women, which argues in favor of its being a functional adaptation and against the idea that it is a pathology.
  • Fetal vulnerability to toxins peaks at around 3 months, which is also the time of peak susceptibility to morning sickness.
  • There is a good correlation between toxin concentrations in foods, and the tastes and odors that cause revulsion.

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

[edit]

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

Medications

[edit]

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

[edit]

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][7] as does auricular (ear acupuncture).[7]

Some studies support the use of ginger, but overall the evidence is limited and inconsistent.[3][7][9][30] Safety concerns have been raised regarding its anticoagulant properties.[9][31][32][33]

History

[edit]

Thalidomide

[edit]
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]

References

[edit]
  1. ^ a b c d e f g h i j k l m n "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. ^ a b c d e f g h i j Festin M (June 2009). "Nausea and vomiting in early pregnancy". BMJ Clinical Evidence. 2009. PMC 2907767. PMID 21726485.
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