morning sickness


Summary: Symptoms of NAUSEA and VOMITING in pregnant women that usually occur in the morning during the first 2 to 3 months of PREGNANCY. Severe persistent vomiting during pregnancy is called HYPEREMESIS GRAVIDARUM.

Top Publications

  1. Davis M. Nausea and vomiting of pregnancy: an evidence-based review. J Perinat Neonatal Nurs. 2004;18:312-28 pubmed
    ..Despite the fact that it affects most pregnant women to some degree, it is poorly understood and often poorly treated. Specific suggestions for therapeutic interventions are outlined. ..
  2. Linseth G, Vari P. Nausea and vomiting in late pregnancy. Health Care Women Int. 2005;26:372-86 pubmed
    ..By being aware of prenatal factors that may affect nausea and vomiting in late pregnancy, health care providers will be better able to maximize the quality of life for these women. ..
  3. Lacasse A, Rey E, Ferreira E, Morin C, Berard A. Nausea and vomiting of pregnancy: what about quality of life?. BJOG. 2008;115:1484-93 pubmed publisher
    ..These findings show that presence and severity of NVP have a negative impact on health-related QOL, which emphasises the importance of an optimal management of NVP. ..
  4. Lacasse A, Rey E, Ferreira E, Morin C, Berard A. Determinants of early medical management of nausea and vomiting of pregnancy. Birth. 2009;36:70-7 pubmed publisher
  5. Carmichael S, Shaw G, Laurent C, Olney R, Lammer E. Maternal reproductive and demographic characteristics as risk factors for hypospadias. Paediatr Perinat Epidemiol. 2007;21:210-8 pubmed
    ..Although the potential contribution of underlying maternal endocrine parameters to the current findings are unknown, the results do provide clues regarding hypospadias aetiology that merit further investigation. ..
  6. Koren G. Motherisk update. Is ondansetron safe for use during pregnancy?. Can Fam Physician. 2012;58:1092-3 pubmed
    While I usually prescribe doxylamine-pyridoxine for morning sickness, some of my patients with severe nausea and vomiting of pregnancy (NVP) receive ondansetron in hospital...
  7. Westfall R, Janssen P, Lucas P, Capler R. Survey of medicinal cannabis use among childbearing women: patterns of its use in pregnancy and retroactive self-assessment of its efficacy against 'morning sickness'. Complement Ther Clin Pract. 2006;12:27-33 pubmed
    ..Our findings support the need for further investigations into cannabis therapy for severe nausea and vomiting during pregnancy. ..
  8. Raymond S. A survey of prescribing for the management of nausea and vomiting in pregnancy in Australasia. Aust N Z J Obstet Gynaecol. 2013;53:358-62 pubmed publisher
    ..A total of 495 responses were received (23%). For morning sickness, 89% of those replying give dietary advice frequently or always, and 70% prescribe metoclopramide frequently ..
  9. Louik C, Hernandez diaz S, Werler M, Mitchell A. Nausea and vomiting in pregnancy: maternal characteristics and risk factors. Paediatr Perinat Epidemiol. 2006;20:270-8 pubmed
    ..Together with selected demographic characteristics that differentiate early- vs. late-onset NVP, these findings warrant further investigation. ..

More Information


  1. Locock L, Alexander J, Rozmovits L. Women's responses to nausea and vomiting in pregnancy. Midwifery. 2008;24:143-52 pubmed
    ..Expressions of empathy by health-care professionals are frequently lacking and particularly desired. ..
  2. Einarson T, Piwko C, Koren G. Prevalence of nausea and vomiting of pregnancy in the USA: a meta analysis. J Popul Ther Clin Pharmacol. 2013;20:e163-70 pubmed
    ..Almost 70% of women suffer some form of the syndrome; 1.2% have the severe form, most of whom were hospitalized because of the HG. Future research should address issues of cost and resource utilization. ..
  3. Mizuno M, Hiura M, Kikkawa F, Numa F, Yaegashi N, Narahara H, et al. A prospective observational study on chemotherapy-induced nausea and vomiting (CINV) in patients with gynecologic cancer by the CINV Study Group of Japan. Gynecol Oncol. 2016;140:559-64 pubmed publisher
    ..The independent risk factors for delayed nausea were a morning sickness history (odds ratio [OR], 2.687; 95% confidence interval [95% CI], 1.450-4.976; p=0...
  4. Aitokallio Tallberg A, Pakarinen P. [Strong nausea during pregnancy]. Duodecim. 2005;121:1435-40; quiz 1441, 1446 pubmed
  5. Marwa K, Njalika A, Ruganuza D, Katabalo D, Kamugisha E. Self-medication among pregnant women attending antenatal clinic at Makongoro health centre in Mwanza, Tanzania: a challenge to health systems. BMC Pregnancy Childbirth. 2018;18:16 pubmed publisher
    ..56%, morning sickness 44 (25.55%) and headache 33(19.19%)...
  6. Lombardi D, Istwan N, Rhea D, O Brien J, Barton J. Measuring outpatient outcomes of emesis and nausea management in pregnant women. Manag Care. 2004;13:48-52 pubmed
    ..001). Oral dietary improvement was noted in 78.7 percent of patients during treatment. Outpatient management was effective in controlling NVP and was associated with a reduced need for hospital or emergency room treatment. ..
  7. Maltepe C, Einarson A, Koren G. The Pregnancy Unique Quantification of Emesis (PUQE) for morning sickness. Am J Obstet Gynecol. 2008;199:e10; author reply e10-1 pubmed publisher
  8. Patil C. Appetite sensations in pregnancy among agropastoral women in rural Tanzania. Ecol Food Nutr. 2012;51:431-43 pubmed publisher
  9. Chortatos A, Haugen M, Iversen P, Vikanes A, Magnus P, Veierød M. Nausea and vomiting in pregnancy: associations with maternal gestational diet and lifestyle factors in the Norwegian Mother and Child Cohort Study. BJOG. 2013;120:1642-53 pubmed publisher
    ..Whether higher intakes of carbohydrates are a response aimed to alleviate symptoms, or are actually provoking the condition, is not known. ..
  10. Bakermans Kranenburg M, van IJzendoorn M. Protective parenting: neurobiological and behavioral dimensions. Curr Opin Psychol. 2017;15:45-49 pubmed publisher
    ..Human protective parenting can be observed already during pregnancy, when mothers experiencing morning sickness avoid foods that are likely to carry pathogens and thus could be harmful to the fetus...
  11. Newbronner E, Atkin K. The changing health of Thalidomide survivors as they age: A scoping review. Disabil Health J. 2018;11:184-191 pubmed publisher
    ..and early 1960s the drug Thalidomide was given to thousands of pregnant women across the world to relieve morning sickness. The drug caused severe birth defects...
  12. Koren G. The return to the USA of doxylamine-pyridoxine delayed release combination (Diclegis®) for morning sickness--a new morning for American women. J Popul Ther Clin Pharmacol. 2013;20:e161-2 pubmed
    The US FDA approval in April 2013 of Diclegis®, the doxylamine-pyridoxine combination for morning sickness, is a major milestone, particularly since it is indicated for use in pregnancy and the FDA has labeled it a pregnancy category A ..
  13. Adlan A, Chooi K, Mat Adenan N. Acupressure as adjuvant treatment for the inpatient management of nausea and vomiting in early pregnancy: A double-blind randomized controlled trial. J Obstet Gynaecol Res. 2017;43:662-668 pubmed publisher
    ..We recommend the use of the acupressure band at the Neiguan point (P6) as an adjunct/supplementary therapy to co-exist with the standard care of management for hyperemesis gravidarum, particularly in low-risk pregnant women. ..
  14. Budur K, Mathews M, Mathews M. Couvade syndrome equivalent?. Psychosomatics. 2005;46:71-2 pubmed
  15. Nyaruhucha C. Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania. Tanzan J Health Res. 2009;11:29-34 pubmed
    ..Soil consumption was the pica observed in most women. Since aversions and cravings are closely linked to dietary intake of pregnant woman understanding these behaviours is important in addressing maternal nutrition. ..
  16. Lacasse A, Rey E, Ferreira E, Morin C, Berard A. Epidemiology of nausea and vomiting of pregnancy: prevalence, severity, determinants, and the importance of race/ethnicity. BMC Pregnancy Childbirth. 2009;9:26 pubmed publisher
    ..Caucasians OR: 0.13; 95%CI 0.02-0.73; and Blacks vs. Caucasians OR: 0.29; 95%CI 0.09-0.99). Our study showed that race/ethnicity was associated with the reporting of nausea and vomiting of pregnancy in the 1st trimester of pregnancy. ..
  17. Bouga M, Lean M, Combet E. Iodine and Pregnancy-A Qualitative Study Focusing on Dietary Guidance and Information. Nutrients. 2018;10: pubmed publisher
    ..Increased fish consumption was considered less achievable, with barriers around taste, smell, heartburn, and morning sickness. Community midwives were the main recognised provider of dietary advice...
  18. Heitmann K, Nordeng H, Havnen G, Solheimsnes A, Holst L. 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 Childbirth. 2017;17:75 pubmed publisher
    ..9 (-16.9, -4.9) for severe versus mild NVP. NVP as measured by PUQE had a major impact on various aspects of the women's lives, including global quality of life and willingness to become pregnant again. ..
  19. Bryer E. A literature review of the effectiveness of ginger in alleviating mild-to-moderate nausea and vomiting of pregnancy. J Midwifery Womens Health. 2005;50:e1-3 pubmed
    ..It also provides a dosage update for the various forms of ginger. ..
  20. Koren G, Piwko C, Ahn E, Boskovic R, Maltepe C, Einarson A, et al. Validation studies of the Pregnancy Unique-Quantification of Emesis (PUQE) scores. J Obstet Gynaecol. 2005;25:241-4 pubmed
    ..PUQE has been validated through 4 independent clinical outcomes of direct importance and relevance for NVP. The simplicity of PUQE and the ease of its execution make it a practical tool for both clinical follow-up and research. ..
  21. Brent R. How does a physician avoid prescribing drugs and medical procedures that have reproductive and developmental risks?. Clin Perinatol. 2007;34:233-62, v pubmed
    ..This article provides practical tips that obstetricians and perinatologists can use to reduce the likelihood of being a defendant in malpractice litigation. ..
  22. Latva Pukkila U, Isolauri E, Laitinen K. Dietary and clinical impacts of nausea and vomiting during pregnancy. J Hum Nutr Diet. 2010;23:69-77 pubmed publisher
    ..In view of the programming effect of early nutrition, these alterations may carry long-term health consequences. ..
  23. Boskovic R, Rudic N, Danieliewska Nikiel B, Navioz Y, Koren G. Is lack of morning sickness teratogenic? A prospective controlled study. Birth Defects Res A Clin Mol Teratol. 2004;70:528-30 pubmed
    ..Healthline enrolled two control groups of women with NVP treated with a doxylamine-pyridoxine combination for morning sickness. These women were exposed during the first trimester of gestation to either higher than the standard dose (5-..
  24. Almond D, Edlund L, Joffe M, Palme M. An adaptive significance of morning sickness? Trivers-Willard and Hyperemesis Gravidarum. Econ Hum Biol. 2016;21:167-71 pubmed publisher
  25. Kohl S, Kainer F, Schiefenhovel W. [Nausea and vomiting as evolutionary mechanisms of the complex adaptation reaction to pregnancy]. Z Geburtshilfe Neonatol. 2009;213:186-93 pubmed publisher
    ..To understand the functionality of NVP, one needs to consider the complex somato-psychoemotional interplay in the context of an environment of evolutionary adaptedness (EEA). ..
  26. Lowry P. Morning sickness is just the side-effect of a new tachykinin that the placenta secretes to improve local blood flow. J Mol Endocrinol. 2017;: pubmed publisher
    Although morning sickness is very unpleasant, the "old wives' tale" that it results in a healthy baby has now a credible scientific explanation.
  27. Piwko C, Koren G, Babashov V, Vicente C, Einarson T. Economic burden of nausea and vomiting of pregnancy in the USA. J Popul Ther Clin Pharmacol. 2013;20:e149-60 pubmed
    ..NVP results in a significant economic impact, and hence effective therapy should be sought. Future prospective research should determine in more detail what resources are utilized in the USA to manage women with NVP. ..
  28. Weigel M, Reyes M, Caiza M, Tello N, Castro N, Cespedes S, et al. Is the nausea and vomiting of early pregnancy really feto-protective?. J Perinat Med. 2006;34:115-22 pubmed
    ..Placental weight was slightly increased in women with NVP but this difference was not reflected in higher birth weights or other types of fetal growth except of marginally increased limb fat. ..
  29. Balik G, Tekin Y, Kagitci M. Is there relationship between social support, psychological distress, mood disorders and emesis gravidarum?. J Obstet Gynaecol. 2015;35:737-40 pubmed publisher
    ..Thus, psychiatric evaluation should be done in patients with EG. Obstetricians should encourage their patients to have psychiatric support. Further studies on relationship of psychosocial factors and EG are needed. ..
  30. Watson P, McDonald B. Major influences on nutrient intake in pregnant New Zealand women. Matern Child Health J. 2009;13:695-706 pubmed publisher
    ..investigated were education, age, occupational status, welfare dependence, smoking, number of children, morning sickness, activity level, height, weight, body mass index, and sum of skinfolds...
  31. Sturt J, Ali S, Robertson W, Metcalfe D, Grove A, Bourne C, et al. Neurolinguistic programming: a systematic review of the effects on health outcomes. Br J Gen Pract. 2012;62:e757-64 pubmed publisher
    ..Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning...
  32. Yu Y, Chung H, Hemingway L, Stoffregen T. Standing body sway in women with and without morning sickness in pregnancy. Gait Posture. 2013;37:103-7 pubmed publisher
    b>Morning sickness typically is attributed to hormonal changes in pregnancy. We asked whether morning sickness is associated with changes in standing postural equilibrium, as occurs in research on visually induced motion sickness...
  33. Lehmann A, Renbarger J, McCormick C, Topletz A, Rouse C, Haas D. Pharmacogenetic predictors of nausea and vomiting of pregnancy severity and response to antiemetic therapy: a pilot study. BMC Pregnancy Childbirth. 2013;13:132 pubmed publisher
    ..02) and final (p?=?0.02) PUQE scores than other subjects. HTR3B and HTR3A gene variants may contribute to variability in response to antiemetic therapy for NVP. ..
  34. Koren G, Pairaideau N. Compliance with prenatal vitamins. Patients with morning sickness sometimes find it difficult. Can Fam Physician. 2006;52:1392-3 pubmed
    Many pregnant patients cannot tolerate multivitamins because of morning sickness. Is it the tablet size or the iron content that causes the problems, and what can be done? Recent Motherisk studies have shown both tablet size and high iron ..
  35. Nayak A, Denny C, Veena K. Oral healthcare considerations for the pregnant woman. Dent Update. 2012;39:51-4 pubmed
    ..The dentist should be in a position to manage pregnant women in clinical practice effectively. ..
  36. Sherbet G. Therapeutic Potential of Thalidomide and Its Analogues in the Treatment of Cancer. Anticancer Res. 2015;35:5767-72 pubmed
    ..decades ago as a drug against respiratory infections and was administered to pregnant women for relief of morning sickness. The drug was withdrawn when its teratogenic effects came to light...
  37. Khalil A, Tanos R, El Hachem N, Kurban M, Bouvagnet P, Bitar F, et al. A HAND to TBX5 Explains the Link Between Thalidomide and Cardiac Diseases. Sci Rep. 2017;7:1416 pubmed publisher
    ..Thalidomide was used by pregnant women for morning sickness but was removed from the market because it caused severe malformations including CHDs...
  38. Wells C, Schwalberg R, Noonan G, Gabor V. Factors influencing inadequate and excessive weight gain in pregnancy: Colorado, 2000-2002. Matern Child Health J. 2006;10:55-62 pubmed
    ..To address these problems, a sustained approach to women's health, education, and well-being across the lifespan will be required, rather than a reliance upon targeted interventions during pregnancy. ..
  39. Smith A, Mioduszewski O, Hatchard T, Byron Alhassan A, Fall C, Fried P. Prenatal marijuana exposure impacts executive functioning into young adulthood: An fMRI study. Neurotoxicol Teratol. 2016;58:53-59 pubmed publisher
    ..marijuana exposure is important given the increase in number of pregnant women smoking marijuana to relieve morning sickness. Altered executive functioning is one area of research that has suggested negative consequences of prenatal ..
  40. Enabulele J, Ibhawoh L. Resident obstetricians' awareness of the oral health component in management of nausea and vomiting in pregnancy. BMC Pregnancy Childbirth. 2014;14:388 pubmed publisher
    ..Oral health component in the management of nausea and vomiting in pregnancy has been largely neglected in obstetric care. It is pertinent that ante-natal health care providers receive adequate education on perinatal oral health care. ..
  41. Staroselsky A, Garcia Bournissen F, Koren G. American Gastroenterological Association institute medical position statement on the use of gastrointestinal medication in pregnancy. Gastroenterology. 2007;132:824-5; author reply 825 pubmed
  42. Currie S, Gray C, Shepherd A, McInnes R. Antenatal physical activity: a qualitative study exploring women's experiences and the acceptability of antenatal walking groups. BMC Pregnancy Childbirth. 2016;16:182 pubmed publisher
    ..and experiences of PA during pregnancy were categorised into biological/physical (including tiredness and morning sickness), psychological (fear of harm to baby and self-confidence) and social/environmental issues (including access ..
  43. Einarson T, Piwko C, Koren G. Quantifying the global rates of nausea and vomiting of pregnancy: a meta analysis. J Popul Ther Clin Pharmacol. 2013;20:e171-83 pubmed
    ..The prevalence of HG was 1.1% (CI95%:0.8%-1.3%), with a range of 0.3%-3.6%. Almost 70% of women worldwide experience NVP, but reported rates vary widely. HG, the most severe form, affects 1.1%. ..
  44. Law R, Maltepe C, Bozzo P, Einarson A. Treatment of heartburn and acid reflux associated with nausea and vomiting during pregnancy. Can Fam Physician. 2010;56:143-4 pubmed
    ..Antacids, histamine-2 receptor antagonists, and proton pump inhibitors can be used safely during pregnancy, as large studies have been published with no evidence of adverse fetal effects. ..
  45. Koren G, Maltepe C. Preventing recurrence of severe morning sickness. Can Fam Physician. 2006;52:1545-6 pubmed
    ..article showed that initiating antinauseants even before symptoms start could prevent recurrence of severe morning sickness. In the study described, however, different physicians used different drugs...
  46. Khresheh R. How women manage nausea and vomiting during pregnancy: a Jordanian study. Midwifery. 2011;27:42-5 pubmed publisher
  47. Orbán L, Dastur F. Shifts in color discrimination during early pregnancy. Evol Psychol. 2012;10:238-52 pubmed
    ..These results are the first indication that changes to color discrimination may occur during early pregnancy, and is consistent with the view that pregnancy sickness may function as an adaptive defense mechanism. ..
  48. Helmreich R, Shiao S, Dune L. Meta-analysis of acustimulation effects on nausea and vomiting in pregnant women. Explore (NY). 2006;2:412-21 pubmed
    ..However, the number of acupuncture trials was limited for pregnant women, perhaps because it is impossible to self-administer the acupuncture and thus inconvenient for women experiencing NVP as chronic symptoms. ..
  49. Mason M. Pain relief to a point. Nurs Stand. 2008;22:22-3 pubmed
    ..Acupuncture can help to relieve some of the discomfort and pain associated with pregnancy. Midwife Sarah Budd has been practising the technique for 20 years. ..
  50. Lindner S, Krönke J. The molecular mechanism of thalidomide analogs in hematologic malignancies. J Mol Med (Berl). 2016;94:1327-1334 pubmed
    Thalidomide was sold in the 1950s as a sedative and was also used by pregnant women to treat morning sickness. It became notorious for causing severe birth defects and was removed from the market...
  51. Shrim A, Weisz B, Gindes L, Dulitzki M, Almog B. Preferences of caregiver when experiencing nausea and vomiting during pregnancy. J Perinat Med. 2010;38:157-60 pubmed publisher
    ..According to our online survey, women perceive medically- and nutritionally-based care as most useful, whereas psychosocial factors are perceived to be less useful despite playing a central role in NVP. ..
  52. Mahony C, McMenemy S, Rafipay A, Beedie S, Fraga L, Gutschow M, et al. CPS49-induced neurotoxicity does not cause limb patterning anomalies in developing chicken embryos. J Anat. 2017;: pubmed publisher
    ..defects, particularly to the limbs, in those exposed in utero following maternal use of the drug to treat morning sickness. How the drug caused these birth defects remains unclear...
  53. Slaughter S, Hearns Stokes R, van der Vlugt T, Joffe H. FDA approval of doxylamine-pyridoxine therapy for use in pregnancy. N Engl J Med. 2014;370:1081-3 pubmed publisher