Evidence-based strategies for battling nausea and vomiting during pregnancy

If you are pregnant, there’s a good chance you’re experiencing Nausea and Vomiting of Pregnancy (NVP), sometimes commonly referred to as “morning sickness.”

What is NVP? According to (Bustos et al 2017), up to 80% of pregnant women experience NPV. It can start before you even realize you are pregnant, peaks toward the end of the first trimester, and for many women gets better by the midpoint of the pregnancy. However, up to 10% of pregnant women have NVP until they give birth (Hasler et al., 1995). Also, Bustos et al found that “NVP persists throughout the day in as many as 98% of women with NVP” and concluded that “therefore, the popular term “morning sickness” doesn’t properly reflect this condition.”

No kidding! My personal experience with “morning sickness” involved a lot of nausea at all times of day. Also, I was one of the 10% that experienced symptoms throughout my entire pregnancy. For me, NVP looked like losing a lot of weight when I wanted to be gaining it, getting dehydrated, and (on several occasions at work) abruptly switching from my lecture plan to small group discussions so I could run to the nearby bathroom to vomit.

I took some solace in the fact that some studies (such as this one) found an association between NVP and positive pregnancy outcomes. But there were times when I didn’t need solace; I needed to keep down food or water. Or I needed to make it through a meeting. Or I just wanted a break.

Photo by Jordan Bauer on Unsplash

Constantly feeling ill takes a very real toll. One study found that in 712 women in Norway with NVP, “NVP was significantly associated with several characteristics, including daily life functioning, quality of life and willingness to become pregnant again. The negative impact was greater the more severe the symptoms were, although considerable adverse effects were also seen among women with mild and moderate NVP symptoms. Over one fourth of the women with severe NVP considered terminating the pregnancy due to NVP, and three in four considered not to get pregnant again.”

How do you make it stop? Honestly – you can’t. And anyone who tells you they have found the silver bullet is probably wrong. But relief is important; your comfort is important. Finding ways to minimize the symptoms is an important and worthwhile endeavor.
So here is a non-exaustive list of scientifically-backed sources of relief. Not everything works for a single person, and not a single thing works for everyone. It’ll take some experimenting to figure out what helps you.

The fact that these strategies are effective does not mean they are safe, particularly for all people. I encourage you to talk to your care provider before trying any of these strategies, especially those that would be out of the ordinary for you. Also, be sure to talk to your care provider about how frequently you experience nausea and vomiting, as severe NVP (called hyperemesis gravidarum) can be harmful to you and your baby (let alone terrible to deal with!).

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Some Evidence-Based Ideas for Relief from Morning Sickness:

Wearing acupressure bands (around your wrists, like bracelets). Do be warned that random people will realize you are pregnant if they see you wearing these (personal experience!). 

Trying acupuncture.

Using aromatherapy, particularly lemon aromas. Mint aromas seem to have mixed results in the literature (mint helps, mint does not help, mint helps with nausea but not with vomiting).

Brushing your teeth after a meal.

Ingesting cardamom powder. This article also mentions that aromatherapy with cardamom oil has been successful in combating nausea and vomiting in chemotherapy patients, but I wasn’t able to find an article testing this for pregnant people.

Ingesting chamomile.

Starting your day off with crackers or other simple dry carbohydrates.

Ingesting cold things (such as ice, popsicles, and cold beverages).

Avoiding fatty foods.

Eating frequent small meals instead of a few big ones. One guideline listed in the cited study is to prevent a full stomach and to graze instead.

Ingesting ginger (second source here). Ginger in drink form (250mg of ginger, 250mL hot water, 1 TBSP sugar) also may work.

Hydrating (drinking at least two liters of water a day, according to these guidelines).

Reconsider your iron supplements. They are a common trigger for NVP, and some guidelines even suggest skipping them altogether; as always, check with your care provider before implementing a change in your routine.

Taking a medication. Talk to your care provider about your options, which include antihistimines, antimetics, benzamides, serotonin receptor antagonists, acid-reducing agents, and corticosteroids (see more information here and here). The American College of Obstetricians and Gynecologists recommends talking with your care provider about vitamin B6 or a combination of vitamin B6 and doxylamine. Also, there is some evidence that starting medication before NVP symptoms actually set in can help lessen the severity of the NVP.

Drinking mint tea or enjoy a mint hard candy.

Eating protein-heavy meals. Proteins include meats, seafood, dairy, processed soy products, eggs, nuts and seeds, beans, peas, and protein powders or shakes; for more information about proteins, check out this resource.

Ingesting quince (a fruit), tested in syrup form.

Avoiding spicy foods.

Avoid your trigger foods, odors, or supplements.

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I hope that one or more of these provides you some relief!

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Is there another evidence-based strategy you think I should include? Let me know at the Contact form above!

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References:

ACOG. n.d. “Morning Sickness: Nausea and Vomiting of Pregnancy.” ACOG: The American College of Obstetricians and Gynecologists. Retrieved December 9, 2020 (https://www.acog.org/en/Womens Health/FAQs/Morning Sickness Nausea and Vomiting of Pregnancy).
Amzajerdi, Azam, Maryam Keshavarz, Ali Montazeri, and Reza Bekhradi. 2019. “Effect of Mint Aroma on Nausea, Vomiting and Anxiety in Pregnant Women.” Journal of Family Medicine and Primary Care 8(8):2597–2601. doi: 10.4103/jfmpc.jfmpc_480_19.
Bischoff, Stephan C., and Cornelia Renzer. 2006. “Nausea and Nutrition.” Autonomic Neuroscience: Basic & Clinical 129(1–2):22–27. doi: 10.1016/j.autneu.2006.07.011.
Brandes, Joseph M. 1967. “First-Trimester Nausea and Vomiting as Related to Outcome of Pregnancy.” Obstetrics & Gynecology 30(3):427–431. Broussard, Crystal N., and Joel E. Richter. 1998. “Nausea and Vomiting of Pregnancy.” Gastroenterology Clinics of North America 27(1):123–51. doi: 10.1016/S0889-8553(05)70350-2.
Bustos, Martha, Raman Venkataramanan, and Steve Caritis. 2017. “Nausea and Vomiting of Pregnancy-What’s New?” Autonomic Neuroscience : Basic & Clinical 202:62–72. doi: 10.1016/j.autneu.2016.05.002.
Ebrahimi, Neda, Caroline Maltepe, and Adrienne Einarson. 2010. “Optimal Management of Nausea and Vomiting of Pregnancy.” International Journal of Women’s Health 2:241–48.
Gadsby, R., A. M. Barnie-Adshead, and C. Jagger. 1993. “A Prospective Study of Nausea and Vomiting during Pregnancy.” British Journal of General Practice 43(371):245–48.
Hasler, William L., Hani C. Soudah, Gareth Dulai, and Chung Owyang. 1995. “Mediation of Hyperglycemia-Evoked Gastric Slow-Wave Dysrhythmias by Endogenous Prostaglandins.” Gastroenterology 108(3):727–36. doi: 10.1016/0016-5085(95)90445-X.
Heitmann, Kristine, Hedvig Nordeng, Gro C. Havnen, Anja Solheimsnes, and Lone Holst. 2017. “The Burden of Nausea and Vomiting during Pregnancy: Severe Impacts on Quality of Life, Daily Life Functioning and Willingness to Become Pregnant Again – Results from a Cross-Sectional Study.” BMC Pregnancy and Childbirth 17(1):75. doi: 10.1186/s12884-017-1249-0.
Hinkle, Stefanie N., Sunni L. Mumford, Katherine L. Grantz, Robert M. Silver, Emily M. Mitchell, Lindsey A. Sjaarda, Rose G. Radin, Neil J. Perkins, Noya Galai, and Enrique F. Schisterman. 2016. “Association of Nausea and Vomiting During Pregnancy With Pregnancy Loss: A Secondary Analysis of a Randomized Clinical Trial.” JAMA Internal Medicine 176(11):1621–27. doi: 10.1001/jamainternmed.2016.5641.
Hu, Youchun, Adwoa N. Amoah, Han Zhang, Rong Fu, Yanfang Qiu, Yuan Cao, Yafei Sun, Huanan Chen, Yanhua Liu, and Quanjun Lyu. 2020. “Effect of Ginger in the Treatment of Nausea and Vomiting Compared with Vitamin B6 and Placebo during Pregnancy: A Meta-Analysis.” The Journal of Maternal-Fetal & Neonatal Medicine 0(0):1–10. doi: 10.1080/14767058.2020.1712714.
Jednak, Michelle A., Elizabeth M. Shadigian, Michael S. Kim, Michelle L. Woods, Forrest G. Hooper, Chung Owyang, and William L. Hasler. 1999. “Protein Meals Reduce Nausea and Gastric Slow Wave  Dysrhythmic Activity in First Trimester Pregnancy.” American Journal of Physiology-Gastrointestinal and Liver Physiology 277(4):G855–61. doi: 10.1152/ajpgi.1999.277.4.G855.
Joulaeerad, Narges, Giti Ozgoli, Homa Hajimehdipoor, Erfan Ghasemi, and Fatemeh Salehimoghaddam. 2018. “Effect of Aromatherapy with Peppermint Oil on the Severity of Nausea and Vomiting in Pregnancy: A Single-Blind, Randomized, Placebo-Controlled Trial.” Journal of Reproduction & Infertility 19(1):32–38.
Khorasani, Fahimeh, Hossein Aryan, Abousaleh Sobhi, Reihaneh Aryan, Arefeh Abavi-Sani, Masumeh Ghazanfarpour, Masumeh Saeidi, and Fatemeh Rajab Dizavandi. 2020. “A Systematic Review of the Efficacy of Alternative Medicine in the Treatment of Nausea and Vomiting of Pregnancy.” Journal of Obstetrics and Gynaecology 40(1):10–19. doi: 10.1080/01443615.2019.1587392.
Klebanoff, Koslowe, Kaslow, and Rhoads. 1985. “Epidemiology of Vomiting in Early Pregnancy.” Obstetrics and Gynecology 66(5):612–16.
Kusumawardani, P. A., S. Cholifah, M. T. Multazam, A. B. D. Nandiyanto, A. G. Abdullah, and I. Widiaty. 2018. “Effect of Ginger Drinks on Nausea Vomiting in The First Trimester of Pregnancy.” IOP Conference Series: Materials Science and Engineering 288:012161. doi: 10.1088/1757-899X/288/1/012161.
Lacroix, Renée, Erica Eason, and Ronald Melzack. 2000. “Nausea and Vomiting during Pregnancy: A Prospective Study of Its Frequency, Intensity, and Patterns of Change.” American Journal of Obstetrics and Gynecology 182(4):931–37. doi: 10.1016/S0002-9378(00)70349-8.
Lee, Noel M., and Sumona Saha. 2011. “Nausea and Vomiting of Pregnancy.” Gastroenterology Clinics 40(2):309–34. doi: 10.1016/j.gtc.2011.03.009.
Maltepe, Caroline, and Gideon Koren. 2013. “Preemptive Treatment of Nausea and Vomiting of Pregnancy: Results of a Randomized Controlled Trial.” Obstetrics and Gynecology International 2013:e809787. doi: https://doi.org/10.1155/2013/809787.
Modares, M., S. Besharat, F. Rahimi Kian, S. Besharat, M. Mahmoudi, and H. Salehi Sourmaghi. 2012. “Effect of Ginger and Chamomile Capsules on Nausea and Vomiting in Pregnancy.” 14(141):46–51. Niebyl, Jennifer R. 2010. “Nausea and Vomiting in Pregnancy.” New England Journal of Medicine 363(16):1544–50. doi: 10.1056/NEJMcp1003896.
Norheim, Arne Johan, Lillian Berge, Vinjar Fønnebø, and Erik Jesman Pedersen. 2001. “Acupressure Treatment of Morning Sickness in Pregnancy: A Randomised, Double-Blind, Placebo-Controlled Study.” Scandinavian Journal of Primary Health Care 19(1):43–47. doi: 10.1080/02813430120819.
Ozgoli, Giti, and Marzieh Saei Ghare Naz. 2018. “Effects of Complementary Medicine on Nausea and Vomiting in Pregnancy: A Systematic Review.” International Journal of Preventive Medicine 9. doi: 10.4103/ijpvm.IJPVM_430_16.
Pasha, Hajar, Fereshteh Behmanesh, Farideh Mohsenzadeh, Mahmood Hajahmadi, and Ali Akbar Moghadamnia. 2012. “Study of the Effect of Mint Oil on Nausea and Vomiting During Pregnancy.” Iranian Red Crescent Medical Journal 14(11):727–30. doi: 10.5812/ircmj.3477.
Smith, Caroline, Caroline Crowther, and Justin Beilby. 2002. “Acupuncture To Treat Nausea and Vomiting in Early Pregnancy: A Randomized Controlled Trial.” Birth 29(1):1–9. doi: https://doi.org/10.1046/j.1523-536X.2002.00149.x.
US Department of Agriculture. n.d. “All about the Protein Foods Group.” ChooseMyPlate. Retrieved December 9, 2020 (https://www.choosemyplate.gov/eathealthy/protein-foods).
Yavari kia, Parisa, Farzaneh Safajou, Mahnaz Shahnazi, and Hossein Nazemiyeh. 2014. “The Effect of Lemon Inhalation Aromatherapy on Nausea and Vomiting of Pregnancy: A Double-Blinded, Randomized, Controlled Clinical Trial.” Iranian Red Crescent Medical Journal 16(3). doi: 10.5812/ircmj.14360.
Zur, E. 2013. “Nausea and Vomiting in Pregnancy: A Review of the Pathology and Compounding Opportunities.” International Journal of Pharmaceutical Compounding 17(2):113–23.

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