Navigating the Waves of Morning Sickness: Understanding and Managing the Complex Landscape of Pregnancy Nausea

Embarking on the incredible journey of pregnancy brings with it the challenge of morning sickness, a term that encompasses a spectrum from common nausea to the more intense condition known as hyperemesis gravidarum (HG).

Understanding the Mechanisms: Morning sickness is not a one-size-fits-all experience, and insights into maternal genetics reveal fascinating connections. Data from a large Norwegian twin population suggests a genetic predisposition, with higher medication use observed in genetically identical twins compared to non-identical twins. Furthermore, a familial link surfaces, as daughters of mothers who experienced significant nausea are more prone to heightened nausea levels during their pregnancies.

Personal History: Your own history plays a role in this symphony of symptoms. If you've battled morning sickness in a previous pregnancy, the chances of experiencing it again in subsequent pregnancies are heightened. However, it's crucial to note that individual experiences may vary, and this finding isn't consistent across all studies.

Other Risk Factors: Beyond genetics and personal history, various other factors influence the morning sickness narrative. If you have a personal history of motion sickness, migraine headaches, or have experienced nausea with estrogen-containing oral contraceptives, you may be at an increased risk for morning sickness.

Corpus Luteum Location: Even the location of the corpus luteum, the temporary endocrine structure in the ovaries that is left after the fertilised egg is implanted, can influence the severity of morning sickness. Studies suggest that its presence in the right ovary may lead to higher levels of nausea and vomiting, possibly due to differences in venous drainage and hormonal concentrations.

Dietary Factors: Diet plays a crucial role, as evidenced by research indicating that a higher daily intake of total fat, especially saturated fat, prior to pregnancy increases the risk of hospitalisation for morning sickness. 

H. Pylori infection: Research indicates a significant association between Helicobacter pylori (H. pylori) infection and Hyperemesis Gravidarum (HG), a severe form of morning sickness during pregnancy. Studies reveal a higher prevalence of H. pylori in women with HG compared to controls, with H. pylori density possibly correlating with symptom severity. The infection's occurrence in pregnancy is attributed to hormonal changes affecting gastric pH and altered immunity. While infection doesn't always correlate with symptoms, treatment eradicates H. pylori in the majority of cases.

Blood Sugar Regulation:The hormonal shifts during pregnancy, especially the influence of human chorionic gonadotropin (hCG), can impact insulin processing, leading to fluctuations in blood sugar levels. Maintaining stable blood sugar levels through frequent, small meals and proactive snacking becomes crucial to minimising triggers for nausea.

Simple Management Strategies

Frequent, Small Meals: Opt for small, regular meals spaced every 2-3 hours. This approach helps maintain stable blood sugar levels, thereby minimising triggers for nausea.

Pre-Emptive Snacking: Eat proactively, before the onset of hunger, to prevent blood sugar drops that often lead to feelings of nausea, fatigue, and a lack of motivation to prepare food

On-the-Go Snacks: Keep a stash of healthy snacks, such as almonds or a piece of fruit, in your bag. This ensures easy access to nourishing food when you're on the move.

Morning Snack by the Bed: Establish a morning ritual of consuming a nutritious snack, like wholegrain crackers or nuts, before getting out of bed. This preemptive measure can help ward off nausea before it sets in.

Ginger: a potent anti-nausea that will calm function herb Make up some ginger tea (made by grating 1tsp fresh ginger into boiled water), incorporate ginger into meals, savour pickled or crystallized ginger, or talk to your naturopath about ginger liquid extract or tablets.

B6: As a vital cofactor in neurotransmitter synthesis, particularly serotonin, it actively contributes to mood regulation and nausea management. Its influence extends to glucose metabolism and energy production, potentially aiding in stabilising blood sugar levels. Additionally, B6 plays a role in hormonal regulation of progesterone and elevated human chorionic gonadotropin (hCG) levels. Talk with your naturopath or nutritionist about the correct dosage that works for you.

Nausea during pregnancy can be complex and what has worked for a friend might not work for you. There really are a few different mechanisms at play. And some of those mechanisms haven’t been worked out yet. These strategies may not entirely eliminate nausea, they can significantly enhance manageability, reducing both frequency and severity. If you find yourself experiencing excessive vomiting or if nausea is significantly impacting your daily life, seeking guidance from a healthcare professional is crucial. Persistent and severe nausea can sometimes be an indication of a more complex issue, such as hyperemesis gravidarum. Don't hesitate to reach out and flag your symptoms with your naturopath, doctor, midwife or obstetrician to ensure you are well nurtured and rested. 

References

Firouzbakht, M., Nikpour, M., Jamali, B., & Omidvar, S. (2014). Comparison of ginger with vitamin B6 in relieving nausea and vomiting during pregnancy. Ayu, 35(3), 289–293. https://doi.org/10.4103/0974-8520.153746

Lee, N. M., & Saha, S. (2011). Nausea and vomiting of pregnancy. Gastroenterology clinics of North America, 40(2), 309–vii. https://doi.org/10.1016/j.gtc.2011.03.009

Liu, C., Zhao, G., Qiao, D., Wang, L., He, Y., Zhao, M., Fan, Y., & Jiang, E. (2022). Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities. Frontiers in medicine, 8, 809270. https://doi.org/10.3389/fmed.2021.809270

Maslin, K., Shaw, V., Brown, A., Dean, C., & Shawe, J. (2021). What is known about the nutritional intake of women with Hyperemesis Gravidarum?: A scoping review. European journal of obstetrics, gynecology, and reproductive biology, 257, 76–83. https://doi.org/10.1016/j.ejogrb.2020.12.003