Morning Sickness During Pregnancy: What to Expect and How to Treat It

What is morning sickness?

If you've ever been pregnant, you know the feeling: You’re busy about your day, then you suddenly feel that terrible wave up your chest, and you sprint to the nearest trash can. Or it’s an uncomfortable gnawing in your abdomen, making it difficult to eat anything at all.

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Our Author:

Audrey Nath, MD, PhD

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Dr. Audrey Nath is a board-certified neurologist who has treated neurological conditions in many pregnant women. She also has two children of her own, and she vividly remembers the discomfort of nausea and vomiting in the first trimester of pregnancy.

Morning sickness refers to nausea and vomiting that people experience during pregnancy. Up to 80% of pregnant people may experience nausea. Some deal with these symptoms mostly in the morning, before the first meal of the day. But they can also occur at any time of day. 

Up to 3% of pregnant people experience a severe form of morning sickness known as hyperemesis gravidarum. This causes vomiting that is difficult to control. It may lead to electrolyte disturbances and weight loss. 

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The exact cause of morning sickness isn’t known. It may be related, in part, to elevated levels of estrogen during pregnancy. Vomiting caused by morning sickness may have evolved to help pregnant people avoid dangerous or toxic food (back in times before modern refrigeration). 

When does morning sickness begin and end?

Morning sickness generally starts during the first trimester of pregnancy, between weeks 4 and 7. It usually ends by week 20, but it can continue through the entire pregnancy. 

Who is most at risk for morning sickness?

Anyone who is pregnant may experience morning sickness. A few circumstances may increase your risk, such as carrying multiple babies or a baby with trisomy 21 (Down syndrome). 

Here’s a guide to morning sickness and how to cope with it. 

Do you have morning sickness?

If you are pregnant and have nausea and vomiting, you probably have morning sickness. This is especially true if you are in the first trimester. 

It is important to note, however, that some other conditions may cause vomiting during pregnancy. 

These can include the following:

• Urinary tract infection (UTI)

• Gastrointestinal problems, such as intestinal obstruction or gallstones

• Metabolic disorders, such as diabetes

• Neurological problems, such as migraine headaches

• Nausea due to the iron present in many prenatal vitamins

If you have persistent vomiting, notify your healthcare provider. They can help determine if you have morning sickness, or if something else is causing your symptoms.

This guide is for anyone who wants to know more about morning sickness. We’ll review possible treatments, what to watch for, and when to ask for help. 

Is morning sickness dangerous?

Morning sickness is not always dangerous. In most cases, it settles over time. But if vomiting persists, it may present risks to the pregnant parent and the baby. 

Risks to the parent

Sometimes, vomiting can be so severe that it may be hard to keep any fluids down. This can lead to dehydration, which is when you don’t have enough fluid in your body. Dehydration can cause electrolyte imbalances, such as when sodium or potassium levels in your blood are too high or low. 

Also, if the vomiting is actually related to another health condition, such as a UTI, diabetes during your pregnancy, or a gallbladder condition, then there may be separate risks associated with these medical conditions. 

Risks to baby

If it’s severe, persistent vomiting results in dehydration — and if it’s not treated, it could affect the baby. Some evidence suggests that dehydration may be linked to low birth weight, but research is ongoing. 

When should I see my healthcare provider for morning sickness?

If you have ongoing vomiting and are unable to keep any fluids down, you could become dehydrated. 

Signs and symptoms of dehydration include:

• Dizziness 

• Not urinating as much as you normally do

• Urine appearing dark in color

• Feeling thirsty

• Dry mouth

Contact your healthcare provider right away if you notice these signs and symptoms. You may need intravenous (IV) fluids to replace your fluids. You may also need medication to help stop the vomiting. 

You should seek help if you have other symptoms, such as severe abdominal pain, persistent headache, or fever, which could mean something else is going on. Your provider can help work out the next best steps. 

How is morning sickness treated?

In most cases, it makes sense to start with changing your diet and avoiding nausea triggers (see below). But if those steps don’t work, there are medications available for morning sickness, including over-the-counter and prescription treatments. 

You might be worried about taking medications during pregnancy, and whether they might cause significant side effects for you or your baby. That’s normal. It is important to weigh the risks of a medication with the potential benefits. Sometimes the risks outweigh the benefits, but sometimes there are more benefits than risks. Each situation is different, and you should always speak to your healthcare provider about the risks of medications before taking them during pregnancy. 

Here, we will break down what we know about treatments for nausea and vomiting during pregnancy. We’ll go through the main classes of medication used to treat morning sickness, in order of preference.

Pyridoxine (vitamin B6)

Combination of pyridoxine (vitamin B6) with doxylamine (antihistamine)

Other antihistamines (meclizine, diphenhydramine, dimenhydrinate)

Dopamine antagonists (metoclopramide, promethazine)

Serotonin antagonist (ondansetron)

Last, if you had heartburn and acid reflux before pregnancy, be sure to tell your provider. This may increase the likelihood of nausea and vomiting of pregnancy. One study showed that acid-reducing medication helped reduce symptoms of morning sickness, as well as heartburn symptoms, in pregnant women.

If all of this information is overwhelming, ask your obstetrician for help. They can help you decide if medication is right for you. Be sure to speak with them before starting any supplements or over-the-counter treatments, especially if you take other medications.

Alternative remedies to treat morning sickness

There are other steps you can take to help morning sickness that don’t involve taking medication. These steps might not work for everyone, but they are certainly worth trying. 

Are there any home remedies that can help treat morning sickness?

The first thing you can do is avoid any nausea triggers. You may find that certain things, such as smells or situations, may make your nausea worse. If so, try to steer clear of them if you can. Even if you haven’t noticed any triggers, it may be helpful to avoid:

• Warm, stuffy rooms

• Strong smells (perfume, chemicals, food, or smoke)

• Heat and humidity 

• Noise and visual or physical motion (such as flickering lights and driving)

Foods

For many people with morning sickness, it helps to eat smaller, more frequent meals. This helps you avoid having an empty stomach and being overly full, both of which may trigger nausea. Other tips include:

• Have a small snack at night before bed.

• Eat small amounts slowly and regularly every few hours.

• If your morning sickness is a problem in the morning, try eating a bland snack in bed before you get up. 

• Try brushing your teeth or rinsing out your mouth after eating to get rid of lingering tastes.

• Don't lie down right after eating.

Trial and error may be the best way to find out what foods are best for you. Even if you only crave carbs, make sure you eat enough protein, fruit, and vegetables. Ginger is commonly recommended, but studies on safety and efficacy are conflicting.

Some foods are less likely to trigger morning sickness. If you’re experiencing morning sickness, you might try foods higher in protein (such as nuts, eggs, and meat) or bland foods (such as applesauce, crackers, and bananas). On the other hand, there are foods that can make the condition worse, including foods with high fat content or high fiber content. You should also avoid foods that are:

• Rich

• Smelly

• Spicy

• Sweet

• Acidic 

Drinks

Staying well-hydrated also helps to ease morning sickness. This means drinking plenty of fluids. If you are feeling nauseated, drinking a lot at once might not be possible. It may be easier to sip small amounts of water or a caffeine-free drink slowly, as the day progresses. You can also avoid drinking 30 minutes prior to eating and 30 minutes afterward, to keep your stomach from getting too full. Other tips include:

• Sipping slowly with a straw 

• Cutting out caffeine

• Trying herbal teas (lemon, mint, ginger)

Supplements

Last, consider whether your supplements might be to blame. It may help to take your vitamins with a small meal. Don’t take them on an empty stomach. Also, consider the size and shape of your prenatal vitamin. A smaller pill or a chewable vitamin might be a better option.

Some prenatal vitamins contain iron which can worsen nausea. If you find that’s the case, you could consider taking a prenatal vitamin without iron. Make sure to take a folic acid supplement to help with the development of the baby’s spinal cord. 

Exercise

Exercise may improve quality of life during pregnancy. In other words, it can make you feel better overall. But no large studies show that it helps with nausea and vomiting specifically. 

There's no reason why you can't keep a regular exercise routine when pregnant, but it is important to listen to your body. Be sure to speak with your healthcare provider before you start any new strenuous or weight-bearing exercise for the first time while pregnant. 

Can acupuncture or acupressure help treat morning sickness?

Acupuncture is a traditional Chinese medicine practice in which very thin needles are placed at specific points in the body. It can improve symptons of morning sickness in some people, but so far, studies have not shown a clear benefit. Larger trials are needed to better evaluate this treatment. 

There is some evidence that acupressure may help treat morning sickness. This is similar to acupuncture but involves massage instead of needles. Wristband devices, which provide pressure similar to acupressure, may help improve nausea and vomiting in pregnancy. 

Are there other alternative treatments?

Other therapies available for morning sickness include hypnosis, psychotherapy, and progressive muscle relaxation. While there are reports that these therapies can help with symptoms of morning sickness, a review of six clinical trials did not show clear evidence to support this. More studies are needed to better understand their effects.

You may have heard that marijuana can help with morning sickness. But the effects aren’t clear. In a retrospective study of over 270,000 pregnant people, those who had nausea during pregnancy were more likely to have tried marijuana. However, it is unclear if the marijuana helped their symptoms or made them worse. In any case, given concerns that marijuana use during pregnancy may affect the baby’s brain development, marijuana use is not recommended during pregnancy. 

Keep in mind

Morning sickness is no fun for anyone. Remember that in most cases, it does go away eventually. If not, easy lifestyle changes or medication can help.

It’s also helpful to know that being sick in pregnancy is unlikely to affect you or the baby in most cases. For example, this study did not find any link between hyperemesis gravidarum and pregnancy complications. This review of studies suggests that hyperemesis gravidarum might increase the risk for having a smaller birthweight baby. But there was no link to birth defects or signs of fetal distress at birth. 

When in doubt, contact your obstetrician. The goal is to have a happy, healthy pregnancy, and sometimes that means asking for help. 

Why trust our experts?

Written by:

Audrey Nath, MD, PhD

Audrey Nath, MD, PhD, is a pediatric neurologist and physician scientist, who completed training at the Boston Children's Hospital/Harvard Medical School child neurology residency program. Following subspecialty fellowship training in clinical neurophysiology and epilepsy, she was an assistant professor in the Department of Neurology at Texas Children’s Hospital/Baylor College of Medicine.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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