Morning sickness

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Morning sickness, also called nausea, vomiting of pregnancy (emesis gravidarum or NVP), or pregnancy sickness, affects more than half[1] of all pregnant women, as well as some women who use hormonal contraception or hormone replacement therapy. The nausea can be mild or induce actual vomiting. In extreme cases, known as hyperemesis gravidarum, hospitalization might be required to treat the resulting dehydration, which occurs in about 1% of pregnancies.

Contents

Duration of condition

Morning sickness can occur at any time of the day, though it occurs most often upon waking,citation needed because blood sugar levels are typically the lowest after a night without food.

Morning sickness usually starts in the first month of the pregnancy, peaking in the fifth to seventh weeks, and continuing until the 14th to 16th week. For half of the sufferers, it ends by the 16th week of pregnancy. It might take the others up to another month to get relief, and some women suffer intermittent episodes throughout their pregnancy.

Causes

There is insufficient evidence to find a single (or multiple) cause, but the leading theories for proximate causes include:

  • An increase in the circulating level of the hormone estrogen. Estrogen levels may increase by up to a hundredfold during pregnancy.[2] However, there is no consistent evidence of differences in estrogen levels between women who experience sickness and those who don't.[3]
  • Low blood sugar (hypoglycemia) due to the placenta draining energy from the mother. Though studies have not confirmed this.[4]
  • An increase in progesterone relaxes the muscles in the uterus, which prevents early childbirth, but may also relax the stomach and intestines, leading to excess stomach acids and Gastroesophageal reflux disease.
  • An increase in human chorionic gonadotropin.
  • An increase in sensitivity to odors, which overstimulates normal nausea triggers.
  • An increase in bowel movement.
  • The body's effort to detoxify thoroughly for the health of the unborn child. This is supported by evidence that the liver and kidneys become more active than usual at the start of a pregnancy.

As for root causes, this issue is still somewhat controversial. A notable current scientific hypothesis is that morning sickness exists as a safeguard for the embryo's health. Biologists Gillian V. Pepper and S. Craig Roberts have done a study that indicates that the intake of alcohol, sugar, oils, and meat can trigger morning sickness. This then acts as a way of discouraging ingestion of less healthy foods.[5]

According to Margie Profet, eating vegetables might be a factor as well,[6] due to their small amount of toxins to deter insect infestation; while these toxins are normally harmless to adult humans, they are potentially dangerous to embryos.[7] However, this idea has been rejected by a prospective, population-based study which concluded that "claims made in the popular press about food and health relationships should be evaluated by the media as fiction unless supported by scientific research".[8] Both Profet's vegetable theory and Deutsch's suggestion morning sickness's role is to reduce frequency of sexual intercourse, so preventing sexual uterine cramping that might be a cause spontaneous abortion,[9] have been rejected by a cross-cultural study that suggested morning sickness is more frequently observed in societies that have animal products as dietary staples which may "be dangerous to pregnant women and their embryos because they often contain parasites and pathogens" and hence "that morning sickness serves an adaptive, prophylactic function".[10]

Many other non-scientific theories for morning sickness have been proposed in the past. Notably, according to psychologist Sigmund Freud, morning sickness is the result of the mother's loathing of her husband. The subconscious manifestation of this is a desire to abort the fetus through vomiting.[7] In general, such theories are not accepted by modern scientists.

Treatments

Treatments for morning sickness typically aim to lessen the symptoms of nausea, rather than attacking the root cause(s) of the nausea. Treatments include:

  • Lemons, particularly the smelling of freshly cut lemons.
  • Avoiding an empty stomach.
  • Accommodating food cravings and aversions.
  • Eating five or six small meals per day, rather than three large ones.
  • Many sources recommend Cabbage.[11][12]
  • Trying the BRATT diet: bananas, rice, applesauce, toast and tea.[13]
  • Ginger, in capsules, tea, ginger ale, or ginger snaps.[14]
  • Eating dry crackers in the morning.
  • Drinking liquids 30 to 45 minutes after eating solid food.
  • If liquids are vomited, sucking ice cubes made from water or fruit juice.
  • Vitamin B6 (either pyridoxine or pyridoxamine), often taken in combination with the antihistamine doxylamine (Diclectin).

A doctor may prescribe anti-nausea medications if the expectant mother suffers from dehydration or malnutrition as a result of her morning sickness, a condition known as hyperemesis gravidarum. In the US, Zofran (ondansetron) is the usual drug of choice, though the high cost is prohibitive for some women; in the UK, older drugs with which there is a greater experience of use in pregnancy are preferred, with first choice being promethazine otherwise as second choice metoclopramide, or prochlorperazine.[15]

Thalidomide tragedy

Further information: Thalidomide#History

Thalidomide was originally developed and prescribed as a cure for morning sickness in West Germany, but its use was discontinued when the drug's teratogenic properties came to light. The United States Food and Drug Administration never approved thalidomide for use as a cure for morning sickness.

Research

A recent Canadian survey conducted by researchers at the University of British Columbia and the University of Victoria suggested that the use of medical marijuana may be effective in combating morning sickness,[16] although the researchers noted that their survey was not conclusive.[17] There has been concern that marijuana exposure might be a teratogen (cause of birth defects),[18] and while human studies have shown effects "not as readily ascertained" as those of from cigarettes,[19] it "might have subtle negative effects on neurobehavioural outcomes".[20]

Associations with miscarriage risk

Studies have shown that women who suffer from morning sickness are less likely to have miscarriages as well as less likely to give birth to a baby with birth defects.[7] Other doctors disagree with these links and claim that the mother's sensitivity to the changes in her body is not a variable that indicates risk of miscarriage.citation needed It is also mentioned that many women having a molar pregnancy or an ectopic pregnancy suffer strong nausea.

References

  • Morning Sickness: A Comprehensive Guide to the Causes and Treatments, Nicky Wesson, Vermilion (1997), ISBN 009181538X
  • Morning Sickness - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References, ICON Health Publications (2004), ISBN 0597840431

Notes

  1. ^ "Morning Sickness". American Pregnancy Association (03/2007). Retrieved on 2007-04-08.
  2. ^ "The Visible Embryo - First Trimester Pregnancy". www.visembryo.com. Retrieved on 2008-07-06.
  3. ^ "Morning Sickness: Coping With The Worst (NY Metro Parents Magazine)". www.nymetroparents.com. Retrieved on 2008-07-06.
  4. ^ "Managing Morning Sickness: A ... - Google Book Search". books.google.co.uk. Retrieved on 2008-07-06. Managing Morning Sickness: A Survival Guide for Pregnant Women, Miriam Erick, Bull Publishing Company (2004), ISBN 0923521828
  5. ^ Pepper GV, Craig Roberts S (2006). "Rates of nausea and vomiting in pregnancy and dietary characteristics across populations". Proc. Biol. Sci. 273 (1601): 2675–9. doi:10.1098/rspb.2006.3633. PMID 17002954. “Rates of nausea and vomiting in pregnancy were correlated with high intake of macronutrients (kilocalories, protein, fat, carbohydrate), as well as sugars, stimulants, meat, milk and eggs, and with low intake of cereals and pulses... However, factor analysis of dietary components revealed one factor significantly associated with NVP rate, which was characterized by low cereal consumption and high intake of sugars, oilcrops, alcohol and meat. The results provide further evidence for an association between diet and NVP prevalence across populations, and support for the idea that NVP serves an adaptive prophylactic function against potentially harmful foodstuffs.” 
  6. ^ Profet, Margie. (1992) Pregnancy sickness as adaptation: a deterrent to maternal ingestion of teratogens.
  7. ^ a b c Pinker, Steven (1997). How the Mind Works. New York: W. W. Norton & Company, Inc.. ISBN 0-393-31848-6. 
  8. ^ Brown JE, Kahn ES, Hartman TJ (1997). "Profet, profits, and proof: do nausea and vomiting of early pregnancy protect women from "harmful" vegetables?". Am. J. Obstet. Gynecol. 176 (1 Pt 1): 179–81. doi:10.1016/S0002-9378(97)80032-4. PMID 9024110. 
  9. ^ Deutsch JA (1994). "Pregnancy sickness as an adaptation to concealed ovulation". Riv. Biol. 87 (2-3): 277–95. PMID 7701232. 
  10. ^ Flaxman SM, Sherman PW (2000). "Morning sickness: a mechanism for protecting mother and embryo". The Quarterly review of biology 75 (2): 113–48. doi:10.1086/393377. PMID 10858967. 
  11. ^ ""%22morning sickness%22 & Cabbage & Ginger"". Google.com. Retrieved on 2008-05-05.
  12. ^ Akhtar MS, Munir M (1989). "Evaluation of the gastric anti-ulcerogenic effects of Solanum nigrum, Brassica oleracea and Ocimum basilicum in rats." 27: 163–176. PMID 2515396. “Brassica oleracea (leaf) powder did not affect the ulcer index significantly but its aqueous extract lowered the index and increased hexosamine levels, suggesting gastric mucosal protection.” 
  13. ^ Warhus, Susan. "Tips to ease pregnancy's morning sickness". PregnancyAndBaby.com. Retrieved on 2007-03-05.
  14. ^ Borrelli F, Capasso R, Aviello G, Pittler MH, Izzo AA (2005). "Effectiveness and safety of ginger in the treatment of pregnancy-induced nausea and vomiting". Obstetrics and gynecology 105 (4): 849–56. doi:10.1097/01.AOG.0000154890.47642.23 (inactive 2008-06-28). PMID 15802416. 
  15. ^ British National Formulary (March 2003). "4.6 Drugs used in nausea and vertigo - Vomiting of pregnancy", "BNF", 45. 
  16. ^ Westfall RE, Janssen PA, Lucas P, Capler R (2006). "Survey of medicinal cannabis use among childbearing women: patterns of its use in pregnancy and retroactive self-assessment of its efficacy against 'morning sickness'". Complementary therapies in clinical practice 12 (1): 27–33. doi:10.1016/j.ctcp.2005.09.006. PMID 16401527. 
  17. ^ Tom Blackwell (2006-01-17). "More pregnancy highs than lows", National Post. Retrieved on 2006-06-07. 
  18. ^ "Cannabis--yet another teratogen?" (March 1969). Br Med J 1 (5647): 797. PMID 5774073. 
  19. ^ Fried PA (1989). "Cigarettes and marijuana: are there measurable long-term neurobehavioral teratogenic effects?". Neurotoxicology 10 (3): 577–83. PMID 2626219. 
  20. ^ Kozer E, Koren G (February 2001). "Effects of prenatal exposure to marijuana" (PDF). Can Fam Physician 47: 263–4. PMID 11228023. PMC:2016243. 

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