Morning Sickness

1. See Also
   1. Hyperemesis Gravidarum
2. Pathophysiology
   1. Hormonally related changes in early pregnancy
      1. High bHCG levels
      2. High Estrogen levels
   2. Gastrointestinal function changes in early pregnancy
      1. Gastrointestinal motility decreased
      2. Lower esophageal sphincter relaxed
3. Symptoms
   1. Gastrointestinal upset
      1. Nausea
      2. Vomiting
   2. Timing
      1. Often in morning hours (but not limited to this time)
      2. Onset at 4-7 weeks gestation
      3. Usually resolves by 13 weeks gestation
      4. Resolves by 20 weeks gestation in 90% of women
4. Differential Diagnosis
   1. Hyperemesis Gravidarum
5. Management: Dietary recommendations
   1. Bedrest 15 minutes after awakening
   2. Crackers before arising from bed
   3. Clear liquids and advance as tolerated
   4. Small, frequent meals (6 meals/day)
   5. Suck on Hard Candy
   6. Avoid greasy and spicy foods
   7. Minimize fluid with meals (maximize fluid other times)
   8. Better tolerated foods
      1. Carbohydrate and fiber rich meals
      2. Eat low-fat, bland foods
      3. Salty foods (e.g. potato chips)
      4. Sour liquids (e.g. lemonade)
      5. Consider salty and tart foods together
         1. Example: potato chips with Lemonade
6. Management: Other options
   1. See Hyperemesis Gravidarum for medications
   2. Pyridoxine (Vitamin B6) 25-50 mg PO tid
   3. Ginger (effective, but possible safety concerns)
   4. Acupressure, Acupuncture or Acustimulation
      1. Applied at Pericardium 6 (Neiguan point)
      2. Located 3 finger breadths above the wrist (volar)
      3. Examples
         1. Sea-Band elastic band worn on wrists
         2. Electrical nerve stimulation (Acustimulation)
      4. Recent studies suggest effective in Nausea reduction
         1. Rosen (2003) 102:129-35
   5. References
      1. Fugh-Bergman (1999) Altern Ther Womens Health, 1:9
      2. Larimore (2000) Prim Care 27(1): 35-53
7. Prevention: Dental Erosion from recurrent Stomache acid exposure
   1. Rinse mouth with a teaspoon of baking soda in one cup of water after Vomiting
   2. Use a soft tooth brush only
      1. Avoid toothbrusing immediately after Vomiting
   3. Use fluoride rinse (e.g. ACT) nightly
   4. Silk (2008) Am Fam Physician 77:1139-44
8. References
   1. Broussard (1998) Gastroenterol Clin North Am 27(1):123
   2. Kuscu (2002) Postgrad Med 78(916):76-9
   3. Larimore (2000) Prim Care 27(1): 35-53