Morning Sickness

Oct 6, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

The weather was beautiful. It was warm for September 27th. The sky was clear. I kept bringing the kids outside to see the shadow of the earth taking progressively bigger bites out of the moon. I took a few pictures, but they didn't turn out very well. I brought the whole family out when the moon had completely turned an eerie shade of crimson orange. I explained how the moon should be completely black, but the light from the sun was being bent by the earth's atmosphere. The longest wavelengths of visible light, the oranges and reds, were bent the most so only they hit the surface of the moon. I even stole an astronomer from the planetarium's awesome description of the moon being lit by all the sunrises and sunsets on the earth simultaneously. My family didn't care. As an amazing cosmic event that won't happen again until 2033 was bursting in red off to the south east, my family was looking north.

The formation of a new life is an amazing cosmic event as well. And pregnancy can be a wonderful experience for many women. However, up to 85% of pregnant women experience morning sickness. Morning sickness is more properly called nausea and vomiting of pregnancy as it can happen at any time of the day or night. Morning sickness is considered a normal, if annoying, part of pregnancy. It can be more than just annoying, though. The Society of Obstetricians and Gynaecologists of Canada describes the nausea and vomiting of pregnancy to be about as severe as a typical patient experiences during cancer chemotherapy. We don't really understand why morning sickness happens. It probably involves genetics, hormones, things in the pregnant woman's environment, factors in the gut and the pregnant woman's psychosocial situation. One interesting theory says morning sickness is a defense mechanism. Meat, fish, poultry and eggs are some of the foods most likely to trigger morning sickness. All of these foods could carry pathogens that cause infectious diseases. In our evolutionary past, these foods could potentially have harmed the fetus. There are other researchers that claim that some women with morning sickness have lower risk of miscarriages and preterm deliveries. That is also interesting, but not universally accepted.

About half of pregnant women develop morning sickness by 6 weeks gestation. Virtually all women have at least some symptoms of nausea and vomiting by 9 weeks gestation. Fortunately, most women have the symptoms of morning sickness pass by week 16. An unlucky 10% of pregnant women have nausea and vomiting that last beyond 20 weeks of gestation. Morning sickness really is a misnomer. The nausea and vomiting of pregnancy can happen at any time of the day or night or it can be constant throughout the day.

Hyperemesis gravidarum is a serious condition that affects 0.3 to 2% of pregnant women. It is vomiting during pregnancy that can't be stopped. The vomiting starts in the first trimester and can continue throughout the pregnancy. This type of continuous vomiting is not a normal part of pregnancy. The continuous vomiting can lead to dehydration, electrolyte disturbances, nutritional deficiencies and maternal weight loss. Hyerpemesis gravidarum can threaten the life of mother and fetus.

To reduce morning sickness, the pregnant women can try to eat small, bland, frequent meals. She can avoid fried and spicy food and drink small amounts of fluid regularly between meals. In general, if something makes the pregnant woman nauseous, she should avoid it. For my wife, the smell of cooking ground beef was a trigger. Unfortunately, that was harder to avoid than you'd think, as she was working in a kitchen when she was pregnant with Emily. Also getting lots of sleep seems to help morning sickness symptoms.

Prenatal vitamins can be a trigger for some women. The problems are often due to the large table size and the iron content. If your prenatal vitamin is making you nauseous, call your pharmacist. In conjunction with your doctor, we can usually find a work around. Depending on your case, we might give you a tiny folic acid pill by itself for a few weeks. Or maybe we can give you a multivitamin without iron in it.

There have been some studies of using accupressure to treat morning sickness. Look at your wrist. Start at the crease below your palm and go three finger widths towards your elbow. Push the fourth finger down in the middle of your forearm between the two tendons you feel there. This is the accupressure spot to prevent nausea. You can try pushing there for about 5 minutes every fours hours. Or you can try placing a Sea-Band there continuously. People have had success with each, but it is uncertain if either of these methods are more effective than placebo. However, they are safe and inexpensive.

If medication is needed for morning sickness, the drug of choice in Canada is dicletin. Dicletin contains 10 mg of pyridoxine (Vitamin B6) and doxylamine (an antihistamine). If a woman wants to try something without a prescription, she can try Vitamin B6 (pyridoxine) by itself. Gravol or dimenhydrinate is safe and effective for morning sickness, but it is generally considered second line if someone fails on Dicletin. Ginger may also be effective in reducing morning sickness. There are some theoretical risks of ginger affecting the fetus as there are cytotoxic chemicals in ginger. However, there appears to be no harm to the fetus if the daily dose of ginger is kept at under 1 g per day.

I was staring at the super moon eclipse and it was spectacular. I fumbled with the tripod and tried to take a few pictures. As this once in 18 years event was going on to the south east, my family was looking in the opposite direction. Which one is the north star? Where is the little dipper? What is that band of white across the sky? The answers were: Find the big dipper. Start at the bottom of the laddle, draw a line up. You'll hit the north star. The little dipper starts at the north star as the end of the handle and curves down. That white streak is the Milky Way, which is the galaxy you are in now! Haven't these people been outside before? Haven't they ever looked at the night sky? What about the amazing red thingy the exact opposite direction from where you are looking! In 2033, I'm going sky watching with less annoying people. You wanna come?

As always if you have any questions or concerns about these or other products, ask your pharmacist.

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Mother Risk - How to Survive Morning Sickness -

The Management of Nausea and Vomiting of Pregnancy The Society of Obstetricians and Gynaecologists of Canada -

Super Moon Eclipse -


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