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Symptoms of nausea
and vomiting of pregnancy (NVP) has been widely documented for the past several
years already. It can range from mild nausea and vomiting, which we commonly
term as “morning sickness”, to hyperemesis
gravidarum, an extreme case of nausea and vomiting that needs medical
attention. Although the usual nausea and vomiting in pregnancy, is commonly
known as “morning sickness” the National Health Service (NHS) stated that the
term can be misleading because the feeling of nausea and vomiting can affect
the mother anytime of the day or even throughout the day. This not only bring
discomforts to the mother, but in extreme cases such as the hyperemesis
gravidarum, it puts both the mother and baby at risk for depletion of nutrients
and dehydration. In a study by Lee and Saha (2011), 70% – 80% of all pregnant
women experience “morning sickness”. With regards to demographic variables and
its relationship to NVP, it is more prevalent in younger women, first time
mothers, women with less than 12 years of schooling, obese, and non-smokers. Although
the factors that lead to such condition cannot be pinpointed to only one, it
has been linked with metabolic and endocrinal factors, and most of it originates
from the placenta. We, however, are talking about the continuous presence of
hormones in the woman’s circulation.

For several
years, female hormones are well researched on its importance and functionality
on the female’s body. Produced by the different glands in the body such as the
pituitary glands and ovaries, it is carried all throughout the circulation and
releases its full effects on the woman’s body affecting her emotions,
physiologic cycles, and sensations. We might probably think that during
pregnancy, hormones are being suppressed by the development of a growing fetus
and the cessation of the menstrual cycle but unfortunately no. In fact,
additional hormones are being produced even at the start of implantation, one
of which is what we call the human chorionic gonadotropic hormone (hCG), which
also clinically indicates a positive pregnancy. In most cases, nausea and
vomiting have been associated with the presence of hCG in the system of the
mother. The peak of hCG usually happens in the 12-14th week of
pregnancy (Lee and Saha, 2011), thus “morning sickness” usually takes place in
the first trimester of pregnancy specifically in the first 16 weeks of

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Human chorionic
gonadotropin may not be the only culprit in the occurrence of a pregnant
mother’s episodes of “morning sickness” hormones such as estrogen and
progesterone were also linked to have caused the episodes. Progesterone when combined with estrogen
influences the condition by decreasing smooth muscle contractility of the
gastro-intestinal system (which is of course made up of smooth muscles) and thus
alter gastric emptying which then leads to increased nausea and vomiting. Other
chemical mediators in the body that have an effect on gastric contractility are
placental prostaglandin E2 (PGE2) which is increased in level’s within the 9th
to 12th week of pregnancy, and mother’s level of interleukin-1 beta.

There are a
number of ways that doctors (or even blogs across the net) may advice pregnant
women so as to decrease the effects of the “morning sickness”. One way is to
have frequent small food intake, another is to avoid gastric irritating foods
such as fatty and acidic food. As mentioned by Lee and Saha (2011), Jednak,
Shadigian, Kim, in 1999, presented that meals with high protein
were linked to decreased occurrence of the symptoms of nausea and vomiting Fluids
should also be frequently taken to avoid dehydration, avoid odors that can
trigger. The doctor may also prescribe antiemetic medications that can prevent
nausea and vomiting but this can have side effects. Phenothiazines for example,
which is a form of antiemetic, was found to have slightly increased the risk of
birth defects in the fetus in the first three months of pregnancy. In addition
to that, pregnant women who took another form of antiemetic, chlorpromazine,
have infants who manifested extrapyramidal signs and yellowing of the skin.
However, since the condition is also related with the occurrence of heartburn
and acid reflux during pregnancy, the doctor can also prescribe antacids as
there are no written conclusions that it has untoward effects on the fetal
development (Law, 2010). Antihistamines may also work as antiemetics and are
safe to take during pregnancy. Nevertheless, with regards to pharmacologic
management, the most important thing is, pregnant mothers should see their
doctors first before taking in medications. There are also sources that speak
on the alternative remedies to counteract the effects of NVP. In a systematic
review done by Festin in 2009 on “morning sickness” in the early part of pregnancy,
it found out that ginger and the use of P6 acupressure (an acupressure that
stimulates the P6 acupoint on the wrist) may reduce nausea and vomiting
compared to placebo, although with regards to ginger, results of studies regarding
the remedy were inconclusive, also, in some countries like the UK, ginger
products are not licensed so it is better to purchase them from a trusted
source like the pharmacy or supermarket. The NHS posted on their webpage on
additional advice. Getting plenty of rest and avoiding being tired may minimize
the effects of nausea. Also, in the morning, if a mother feels nauseous, it is
wise to just move up slowly and, if tolerable, consume plain and dry toasts (or
a soda cracker perhaps) before getting up in bed.  Instances which requires further management in
extreme cases of NVP includes inability to keep any food or drinks for 24
hours, dark colored urine, severely weak and dizzy, pain in the abdomen,
presence of fever or when vomiting blood.


Pregnancy is basically a wonderful thing for an
expecting mother and family, however with the presence of this “morning
sickness” it can be very uncomfortable. A person’s understanding (which of
course should include the significant others of the pregnant mother) on the
causes and management of “morning sickness” is very important in having a
positive experience during pregnancy. 

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