Morning Sickness

What is Morning Sickness?

Morning sickness, medically called nausea and vomiting of pregnancy, is a very common condition in early pregnancy that is not limited to the morning. It affects most pregnant women to some degree, and its severe form is called hyperemesis gravidarum.^[1]

Common symptoms

Nausea and vomiting usually begin shortly after a missed period, peak between about 8 and 12 weeks, and improve as the second trimester approaches.^[1] Many women also notice food and smell aversions and tiredness.

Hyperemesis gravidarum is different. It involves persistent vomiting, significant weight loss (typically 5% or more of pre-pregnancy weight), dehydration and metabolic disturbances, and is a leading cause of early pregnancy hospitalization.^[1]

Causes and risk factors

The cause is not fully understood. Recent genetic research points to a placental component, including genes for placental proteins and hormone receptors.^[2] Pregnancy hormones such as hCG are thought to play a role. Being pregnant for the first time, carrying twins, and a history of motion sickness or migraine are commonly listed risk factors.

How it is diagnosed and treated conventionally

Nausea and vomiting of pregnancy should be told apart from nausea and vomiting from other causes, and treatment early on may prevent hospitalization.^[3] Mild cases may settle with lifestyle and dietary changes, and safe, effective treatments are available for more severe cases.^[3]

Medicines include the combination of doxylamine and pyridoxine (vitamin B6), which is not teratogenic, and ondansetron is often used for hyperemesis.^[2] A systematic review of 35 low-risk-of-bias trials found that ginger, vitamin B6, antihistamines and other drugs were linked to better symptoms than placebo, though overall evidence quality was low.^[4] Hyperemesis may need intravenous fluids, electrolyte correction and thiamine in hospital.^[1]

Why Morning Sickness calls for a whole-person approach

Nausea in pregnancy is more than a stomach upset. It can affect eating, sleep, work and mood, and when it is severe it can have effects on the mother and the baby.^[2] Because of this, every person with persistent vomiting needs medical assessment first, and any complementary care is added to that.

Hormonal and placental factors

Current research suggests that placental proteins and hormone receptors play a part in the condition.^[2]

Dehydration and nutrition

Persistent vomiting can cause dehydration, weight loss and nutritional deficiencies, and rarely serious complications such as Wernicke encephalopathy.^[1]

Quality of life and mental well-being

Nausea and vomiting of pregnancy can lower quality of life and affect daily function. It can be undertreated because it is seen as normal, and some women hesitate to seek treatment because of worries about medicine safety.^[3] One small trial found psychotherapy improved moderate symptoms.^[4]

Acupuncture as supportive care in Morning Sickness

What the research shows

Acupuncture has been studied for morning sickness, with mixed and generally low-quality results. Research on severe vomiting is thinner still.

A 2023 trial in 13 hospitals in China randomized 352 women with moderate to severe symptoms to daily active or sham acupuncture and to doxylamine-pyridoxine or placebo for 14 days. Acupuncture reduced the symptom score slightly more than sham, and the authors noted that the size of the effect was modest and its clinical importance uncertain.^[5] An earlier trial of 593 women in Australia found that traditional and P6 acupuncture reduced nausea more than no acupuncture, but sham acupuncture did too, suggesting a placebo effect, and vomiting did not differ.^[6]

Reviews are cautious. A Cochrane review of 41 trials found that acupuncture showed no significant benefit and evidence for acupressure was limited, with a lack of high-quality evidence for any intervention.^[7] A review of 29 trials of acustimulation found some evidence of benefit but called the results not conclusive.^[8] A 2023 meta-analysis of 33 trials found acupuncture and acupressure superior to conventional medicine on some measures, with low-quality evidence.^[9]

For hyperemesis gravidarum, a systematic review rated certainty as very low for all treatments except acupressure added to standard care, which showed a possible moderate decrease in nausea and vomiting with low certainty.^[10] A small trial of 90 hospitalized women found a P6 wristband gave lower symptom scores than intravenous antiemetics.^[11] Acupressure is not the same as acupuncture.

How acupuncture may work

How acupuncture or acupressure might ease pregnancy nausea is not established. In the Australian trial, women given sham acupuncture also had less nausea and dry retching than women given no acupuncture, and the authors described a time-related placebo effect, so part of any benefit may come from expectation rather than the needling itself.^[6]

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. The large trial gave 30-minute sessions daily for 14 days, and the Australian trial gave weekly sessions for 4 weeks.^{[5, 6]} We would reassess often and coordinate with your obstetric provider.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[12] Tell the practitioner first about your pregnancy and its stage, any bleeding disorder, and any blood thinners. Electroacupuncture is not suited to some situations such as a pacemaker.

Ayurvedic medicine as supportive care in Morning Sickness

The Ayurvedic view

Ayurveda traditionally calls pregnancy nausea and vomiting Garbhini Vyadhi or Chardi, and links it to Pitta and Vata disturbance and weak digestive fire (agni). This is a traditional framework, not a biomedical diagnosis.

Therapies that may be used

Care in pregnancy is traditionally gentle and centered on food and routine:

• Small, light, warm meals taken at regular times, with cooling or soothing drinks
• Rest, calm surroundings and avoiding strong smells that trigger nausea
• Ginger, which is used in many food traditions and has been studied, discussed with your obstetric provider first

Panchakarma is not appropriate during pregnancy. Ayurvedic herbal preparations should not be taken for pregnancy nausea without your obstetric provider's agreement.

What the research shows

We found no clinical trials of Ayurvedic medicine as a system for morning sickness or hyperemesis. Ginger is covered in the herbal section below.

There is a safety reason for caution. One published case report describes a woman with hyperemesis and anemia whose investigation found lead toxicity, most likely from an Ayurvedic powder she had recently stopped.^[13] A study of Ayurvedic medicines sold online found that about one fifth contained detectable lead, mercury or arsenic.^[14]

Herbal medicine as supportive care in Morning Sickness

Herbs and formulas that have been studied

The best-studied herb for pregnancy nausea is ginger. Other products included in trials are chamomile, lemon oil and mint oil, and the Cochrane review found no strong evidence for any single intervention.^[7] Chinese medicine uses herbs such as Banxia (Pinellia ternata) for vomiting, but its safety in pregnancy is uncertain.^[15]

What the research shows

The evidence for ginger is limited and of low quality, but fairly consistent for nausea. A meta-analysis of 12 trials with 1,278 women found ginger improved nausea compared with placebo but did not significantly reduce vomiting episodes.^[16] Another meta-analysis of 13 trials with 1,174 women reached the same conclusion and found ginger not significantly different from vitamin B6.^[17] A 2023 meta-analysis rated ginger's effect against placebo as low-quality evidence.^[9]

A Canadian family physician summary reported that ginger might improve nausea and vomiting in the first trimester.^[18] The Cochrane review said ginger may be helpful but that evidence was limited and not consistent.^[7]

Safety and herb-drug interactions

Safety data for herbs in pregnancy are limited. A meta-analysis found ginger did not raise the risk of spontaneous abortion compared with placebo.^[16] However, one summary noted that the largest study suggests no increase in fetal malformations or stillbirths, but smaller studies suggest otherwise.^[18] An animal study found that Pinellia can disturb the metabolism of the placenta and amniotic fluid in pregnant rats, and its safety for pregnant women is contradictory and unclear.^[15]

Herbs can also interact with medicines.^[19] For these reasons we do not prescribe herbs for pregnancy nausea without your obstetric provider's agreement, and we ask for a full list of everything you take.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine often describes pregnancy nausea as stomach qi rising against its normal downward direction, and the P6 point on the forearm is traditionally used for it. Researchers study related ideas such as nausea signaling, hormone and placental factors, and expectation effects.^{[2, 6]}

Ayurveda's view of weak digestion and Pitta disturbance loosely parallels the nausea, food aversion and sensitivity to smells that many women report. No study has shown that a dosha or a TCM pattern corresponds to a specific biological process.

How this care fits with your medical care

Morning sickness needs the attention of your obstetrician, midwife or primary care provider. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. We do not diagnose or manage pregnancy, and we do not prescribe or change medicines.

Do not stop or change anti-nausea medicine, vitamins or prenatal care because of acupuncture. Please bring your pregnancy stage, any hospital visits or diagnosis of hyperemesis, your medication and supplement list, and your provider's contact details.

When to seek urgent medical care

Persistent vomiting in pregnancy can lead to dehydration and malnutrition, so these signs need prompt medical attention.^[1]

• Unable to keep down fluids or food for 24 hours
• Signs of dehydration, such as dark urine, dizziness, fainting, or a racing heart
• Weight loss of more than a few pounds
• Vomiting blood, severe abdominal pain, fever or vaginal bleeding
• Confusion, trouble walking or changes in vision (rare signs of Wernicke encephalopathy)
• Severe headache or symptoms that begin or worsen after the first trimester

If any of these occur, call your obstetric provider promptly, and call 911 or go to the nearest emergency department for emergencies.