How common is morning sickness?

Otherwise known as “morning sickness,” nausea and vomiting of pregnancy (NVP) is one of the most common symptoms of pregnancy, affecting up to 85% of women. Welcome to the club.

The severity of NVP can vary widely among women. For most, it begins around weeks 2-4, peaks between weeks 9-16, and stops by week 22. An estimated 10% of women, however, can experience NVP through their entire pregnancy.

Because NVP (a.k.a. morning sickness) can range from being a minor annoyance to completely debilitating, some doctors measure how bad your case is using the “Pregnancy-Unique Quantification of Emesis/Nausea” score, also known as PUQE. (Cheeky.) See the scorecard below:

The Pregnancy Unique Quantification of Emesis/nausea score (a.k.a. grading how bad the morning sickness is) 

On an average day, for how long do you feel nauseated or sick to your stomach? 

• More than 6 hours: 5 points
• 4 to 6 hours: 4 points
• 2 to 3 hours: 3 points
• 1 hour or less: 2 points
• Not at all: 1 point

On an average day, how many times do you vomit or throw up? 

• 7 or more: 5 points
• 5 to 6: 4 points
• 3 to 4: 3 points
• 1 to 2: 2 points
• None: 1 point

On an average day, how many times do you dry heave without bringing anything up?

• 7 or more: 5 points
• 5 to 6: 4 points
• 3 to 4: 3 points
• 1 to 2: 2 points
• None: 1 point

Depending on your PUQE score, your doctor may determine if your case is mild, moderate, or severe.

• Mild: 6 points or less
• Moderate: 7 to 12 points
• Severe: 13 points or more

If you have a moderate or severe score, your doctor may assess whether you’ve lost any weight, if you are dehydrated, or if lab work shows you have electrolyte imbalances. 

What can I do about NVP/morning sickness?

If you are dealing with NVP (a.k.a. morning sickness), the number one thing you probably want to know is what you can do about it. 

The good news is that there is some evidence showing different treatments can be effective. But it’s important to keep in mind that most of these options were shown to reduce the severity of symptoms, not eliminate them. (Sorry.)

Below is a list of what your doctor might suggest, depending on how severe your NVP is and what approaches you’ve already tried.

• Small meals: The first recommendation many pregnant women get is to change their diet to eat small, frequent meals of bland, low-fat foods. There isn’t gold-standard evidence showing this works specifically for NVP (a.k.a. morning sickness), but is a common first recommendation to treat any nausea, pregnancy related or not.
  
• Ginger: Yes, the ingredient that comes as a side with your sushi (that you may not be eating right now) has been shown to improve mild symptoms of NVP. The American Congress of Obstetricians and Gynecologists recommends trying ginger ale, ginger tea, ginger capsules, or ginger candies.
  
• Acupressure: A recent review of studies found there is evidence that wearing acupressure bands, sometimes called “sea bands,” can improve NVP symptoms.
  
• Vitamin B6: This over-the-counter supplement, also known as pyridoxine, has also been shown to reduce nausea symptoms in mild cases of NVP.

If these approaches don’t work, there are prescription drugs your doctor can prescribe to treat NVP. 

• Diclegis: This drug is approved by the FDA to treat NVP, and is considered a “Class A” drug for pregnant women. It combines Vitamin B6 and doxylamine, an antihistamine, and has been around since the 1956. It has been shown to reduce symptoms in both mild and moderate NVP cases.
  
• Zofran: Otherwise known as ondansetron, this drug has been shown to reduce NVP symptoms, even in severe cases. It is considered a “Class B” drug by the FDA, and whether it should be prescribed has been a topic of debate in the medical community. Two reviews in OB-GYN journals in early 2016 said there was not enough strong evidence tying the drug to any birth defects.
  

Why is it happening?

No one really knows why nausea and vomiting is so common in early pregnancy. But there are a few theories that have some research to back them up.

• HcG horomone: This is the most commonly cited theory. When you get pregnant the levels of human chorionic gonadotropin, aka hcG, start increasing rapidly. (This is the “number” your doctor might test after you get a positive pregnancy test.) These hormones happen to increase, and then decrease, at the same time that NVP generally starts and stops for most women. And women with higher hcG levels (like those having twins, for example) have been shown to experience worse NVP (a.k.a. morning sickness).
  
• Genetics: If your Mom dealt with NVP, then there’s some evidence you are more likely to experience nausea and vomiting too. The study that backs this up found identical twins (meaning they have the exact same DNA) were more likely to both take medication for NVP when compared to female twins that are not identical.
  
• Placenta size: In this theory, a larger placenta can lead to more severe NVP. Researchers landed on this theory because women who had pregnancies with no fetus (i.e. a placenta formed, but a fetus did not) still reported NVP symptoms.
  
• Gut bacteria: This is a more controversial explanation, but some studies found high correlation between women who have the gut bateria H. pylori with NVP versus those who do not have the bacteria present. Other studies, however, have not found the same results.

For further reading, see:

• Evidence-Based Approaches to Managing Nausea and Vomiting in Early Pregnancy by Tekoa King at Medscape
  
• Nausea and Vomiting of Pregnancy — What’s New? by M. Bustos, et al., at PubMed
  
• Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy: A Systematic Review by Catherine McParlin, et al., at JAMA

As always, this article is for informational purposes only, consult a health professional before making any decisions.