Morning sickness 236300 225635977 2008-07-14T17:45:45Z Davidruben 101637 rv spam '''Morning sickness''', also called '''[[nausea]]''', '''[[vomiting]] of [[pregnancy]]''' ('''emesis gravidarum''' or '''NVP'''), or '''pregnancy sickness''', affects between 50<ref>{{cite web |author=American Pregnancy Association |title=Morning Sickness |url=http://www.americanpregnancy.org/pregnancyhealth/morningsickness.html |publisher=www.AmericanPregnancy.org |accessdate=2007-04-08}}</ref> and 95 percent 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 may be required to treat the resulting [[dehydration]], which occurs in about 1% of pregnancies. ==Duration of condition== Morning sickness can occur at any time of the day, though it occurs most often upon waking, 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 may 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.<ref> {{cite web |url=http://www.visembryo.com/baby/pregnancy1.html |title=The Visible Embryo - First Trimester Pregnancy |publisher=www.visembryo.com |accessdate=2008-07-06 |last= |first= }} </ref> However, there is no consistent evidence of differences in estrogen levels between women who experience sickness and those who don't.<ref> {{cite web |url=http://www.nymetroparents.com/newarticle.cfm?colid=7114 |title=Morning Sickness: Coping With The Worst (NY Metro Parents Magazine) |publisher=www.nymetroparents.com |accessdate=2008-07-06 |last= |first= }} </ref> * Low blood sugar ([[hypoglycemia]]) due to the [[placenta]] draining energy from the mother. Though studies have not confirmed this.<ref> {{cite web |url=http://books.google.co.uk/books?id=SdVW-61bJVAC&pg=PA44&lpg=PA44&dq=morning+sickness+Low+blood+sugar&source=web&ots=v1ucYI2cLq&sig=rM3tav7w2BhV6Bajj7pPdowQzdE&hl=en&sa=X&oi=book_result&resnum=3&ct=result |title=Managing Morning Sickness: A ... - Google Book Search |publisher=books.google.co.uk |accessdate=2008-07-06 |last= |first= }} ''Managing Morning Sickness: A Survival Guide for Pregnant Women'', Miriam Erick, Bull Publishing Company (2004), ISBN 0923521828 </ref> * 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. * An increase in [[human chorionic gonadotropin]]. * An increase in [[sensitivity (human)|sensitivity]] to [[odor]]s, 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.<ref name="pmid17002954">{{cite journal |author=Pepper GV, Craig Roberts S |title=Rates of nausea and vomiting in pregnancy and dietary characteristics across populations |journal=Proc. Biol. Sci. |volume=273 |issue=1601 |pages=2675–9 |year=2006 |pmid=17002954 |doi=10.1098/rspb.2006.3633 |url=http://www.journals.royalsoc.ac.uk/content/1q827413q054m375/fulltext.html |quote=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.}}</ref> According to [[Margie Profet]], eating [[vegetable]]s may be a factor as well,<ref>Profet, Margie. (1992) Pregnancy sickness as adaptation: a deterrent to maternal ingestion of teratogens.</ref> 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 [[embryo]]s.<ref name="pinker">{{cite book |last=Pinker |first=Steven |authorlink=Steven Pinker |title=How the Mind Works |year=1997 |publisher=W. W. Norton & Company, Inc. |location=New York |isbn=0-393-31848-6 }}</ref> 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".<ref name="pmid9024110">{{cite journal |author=Brown JE, Kahn ES, Hartman TJ |title=Profet, profits, and proof: do nausea and vomiting of early pregnancy protect women from "harmful" vegetables? |journal=Am. J. Obstet. Gynecol. |volume=176 |issue=1 Pt 1 |pages=179–81 |year=1997 |pmid=9024110|doi=10.1016/S0002-9378(97)80032-4}}</ref> 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,<ref name="pmid7701232">{{cite journal |author=Deutsch JA |title=Pregnancy sickness as an adaptation to concealed ovulation |journal=Riv. Biol. |volume=87 |issue=2-3 |pages=277–95 |year=1994 |pmid=7701232 |doi=}}</ref> 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".<ref name="pmid10858967">{{cite journal |author=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=113–48 |year=2000 |pmid=10858967|doi=10.1086/393377}}</ref> 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.<ref name="pinker" /> 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.<ref>{{cite web |title="%22morning sickness%22 & Cabbage & Ginger" | url=http://www.google.ca/search?source=ig&hl=en&rlz=&q=%22morning+sickness%22+%26+cabbage+%26+ginger&meta=| publisher=Google.com| accessdate=2008-05-05}}</ref><ref name="pmid2515396">{{cite journal |author=Akhtar MS, Munir M |title=Evaluation of the gastric anti-ulcerogenic effects of Solanum nigrum, Brassica oleracea and Ocimum basilicum in rats. |volume=27 |pages=163–176 |year=1989 |pmid=2515396 |url=http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=DetailsSearch&Term=((%22brassica%22%5BTIAB%5D+NOT+Medline%5BSB%5D)+OR+%22brassica%22%5BMeSH+Terms%5D+OR+cabbage%5BText+Word%5D)+AND+(%22ulcer%22%5BMeSH+Terms%5D+OR+ulcer%5BText+Word%5D) |quote=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. }}</ref> * Trying the [[BRAT diet|BRATT diet]]: bananas, rice, applesauce, toast and tea.<ref>{{cite web |author=Warhus, Susan |title=Tips to ease pregnancy's morning sickness |url=http://pregnancyandbaby.com/pregnancy/baby/Tips-to-ease-pregnancys-morning-sickness-4495.htm |publisher=PregnancyAndBaby.com |accessdate=2007-03-05}}</ref> * [[Ginger]], in capsules, [[tea]], [[ginger ale]], or [[ginger snaps]].<ref name="pmid15802416">{{cite journal |author=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 |doi_brokendate=2008-06-28}}</ref> * 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 [[Antiemetic|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]].<!-- --><ref name="BNF">{{cite book | author=British National Formulary | authorlink=British National Formulary | title="BNF" | edition=45 | year=2003 | month=March | chapter=4.6 Drugs used in nausea and vertigo - Vomiting of pregnancy}}</ref> ===Thalidomide tragedy=== {{see|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,<!-- --><ref name="pmid16401527">{{cite journal |author=Westfall RE, Janssen PA, Lucas P, Capler R |title=Survey of medicinal cannabis use among childbearing women: patterns of its use in pregnancy and retroactive self-assessment of its efficacy against 'morning sickness' |journal=Complementary therapies in clinical practice |volume=12 |issue=1 |pages=27–33 |year=2006 |pmid=16401527 |doi=10.1016/j.ctcp.2005.09.006}}</ref> although the researchers noted that their survey was not conclusive.<!-- --><ref name="NationalPost-Blackwell">{{cite news | author = Tom Blackwell | url=http://www.canada.com/nationalpost/news/story.html?id=749e9fc9-e581-4acd-9ee0-fcef72bc0825 | title = More pregnancy highs than lows | publisher = National Post | date=[[2006-01-17]] | accessdate = 2006-06-07}}</ref> There has been concern that marijuana exposure might be a [[teratogen]] (cause of birth defects),<ref name="pmid5774073">{{cite journal |author= |title=Cannabis--yet another teratogen? |journal=Br Med J |volume=1 |issue=5647 |pages=797 |year=1969 |month=March |pmid=5774073 |pmc=1982439 |doi= |url=}}</ref> and while human studies have shown effects "not as readily ascertained" as those of from cigarettes,<ref name="pmid2626219">{{cite journal |author=Fried PA |title=Cigarettes and marijuana: are there measurable long-term neurobehavioral teratogenic effects? |journal=Neurotoxicology |volume=10 |issue=3 |pages=577–83 |year=1989 |pmid=2626219 |doi= |url=}}</ref> it "might have subtle negative effects on neurobehavioural outcomes".<ref name="pmid11228023">{{cite journal |author=Kozer E, Koren G |title=Effects of prenatal exposure to marijuana |journal=Can Fam Physician |volume=47 |issue= |pages=263–4 |year=2001 |month=February |pmid=11228023 |pmc=2016243 |doi= |url=http://www.cfp.ca/cgi/reprint/47/2/263.pdf |format=PDF}}</ref> ==Associations with miscarriage risk== Studies have shown that women who suffer from morning sickness are less likely to have [[miscarriage]]s as well as less likely to give birth to a baby with [[birth defects]].<ref name="pinker">{{cite book |last=Pinker |first=Steven |authorlink=Steven Pinker |title=How the Mind Works |year=1997 |publisher=W. W. Norton & Company, Inc. |location=New York |isbn=0-393-31848-6 }}</ref> 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.{{Fact|date=February 2007}} It is also mentioned that many women having a [[molar pregnancy]] or an [[ectopic pregnancy]] suffer strong nausea. ==References== ===Notes=== {{reflist|2}} ===Bibliography=== *''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 ===External links=== * [http://www.sosmorningsickness.org Help and medical advice about nausea and vomiting of pregnancy, NVP] * [http://www.dmoz.org/Health/Reproductive_Health/Pregnancy_and_Birth/Morning_Sickness/ Open Directory] [[Category:Pregnancy]] [[Category:Malnutrition]] [[de:Schwangerschaftserbrechen]] [[he:בחילת בוקר]] [[ja:つわり]] [[nl:Zwangerschapsmisselijkheid]]