Pregnancy Health: On Morning Sickness and Hyperemesis Gravidarum

Part 2 of an Ongoing Series on Pregnancy Health

This is the second installment of an ongoing series on pregnancy health. The first installment, on nutrition, can be found linked below.

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Morning sickness - and less commonly, its extreme version, Hyperemesis Gravidarum (HG) - affects the majority of women during pregnancy.

There are likely biological reasons for morning sickness, and there are several theories as to what the benefits are to the developing fetus:

1. The Embryo Protection Hypothesis - morning sickness discourages mothers from eating potentially harmful foods

2. Hormonal Impacts - not necessarily a benefit but nausea and vomiting are a byproduct of the hormones estrogen and human chorionic gonadotropin (hCG), which are necessary for healthy fetal development, so nausea can be an indication of good hormonal levels in pregnancy

3. Behavioral Adaptation - morning sickness encourages rest, and reduced food intake supports energy diversion to embryonic development

More severe morning sickness can be linked to MCAS and histamine issues, nutritional deficiencies, and mitochondrial dysfunction.

While morning sickness is very normal, depending on the severity it can range from a simple nuisance to completely debilitating - either way, it is frustrating to deal with at the outset of pregnancy.

Keep reading to learn more about my experiences with morning sickness and HG, how my symptoms have become more tolerable with each pregnancy (I’m currently nearing the end of my third), the pitfalls of using various medications and supplements, and strategies I’ve used for reducing nausea and vomiting in pregnancy.

Mistakes I Didn’t Know I Was Making

The symptoms in pregnancy with my first child hit me like a truck.

Within a week of seeing a positive pregnancy test, I immediately had dizziness, fainting, nausea, and vomiting so severe that I could barely stand. I had to crawl along the wall or on the floor from the couch to the bathroom. It was like a bad episode of Arrested Development with Lucille 2 - and it turns out extreme vertigo is not as funny when not buffered by the Bluth family antics.

I looked online and saw the common recommendation to take B6 and Unisom. It did almost nothing to help. I was losing hope - I had been desperate to get pregnant and start our family, but how could I survive 9 months like this? How could I work? We were also going to multiple open houses every weekend trying to buy our first home.

How could I buy a house when I couldn’t even stand up?

When I called my OB, she told me it was too early for these symptoms to be pregnancy related. They started at 5 weeks. She told me they wouldn’t be able to see me until 10 weeks, and to call my Primary Care Physician (PCP).

When I called my PCP, she told me these were absolutely pregnancy related symptoms, since obviously they started when I became pregnant. She also said that there wasn’t much she could do because I was pregnant, and I couldn’t undergo typical testing for conditions related to dizziness and vertigo - and for the first time in my life, a medical practitioner recognized my symptoms of dizziness and fainting and said, “You know, it sounds like you may have POTS.” But I couldn’t do the diagnostic testing. It would be another 3 years before I received that official diagnosis.

I finally got help by way of an OB on an advice nurse phone line - who recognized that, yes, dizziness is a rare but possible symptom of early pregnancy, and recommended that I take 24-hour Dramamine. Interestingly, Dramamine is an antihistamine, and I also had undiagnosed Mast Cell Activation Syndrome (MCAS). He also prescribed Zofran - a medication commonly prescribed for morning sickness, which also has some effects on histamine levels - but has actually never been studied or approved for use in pregnant women.

I was never officially diagnosed with Hyperemesis Gravidarum (HG), because my symptoms reduced once the placenta took over in my second trimester, and I was somewhat able to manage once I began Dramamine - however, I borderline met the diagnostic criteria for HG because I lost more than 5% of my pre-pregnancy weight and I was severely dehydrated, suffered nausea and vomiting throughout my pregnancy, regularly needed IV fluids, and took Dramamine and Zofran for my entire pregnancy.

And the cause? Extreme malnutrition, POTS, and MCAS.

The appropriate solution would have been nourishing myself well, ideally having started in preconception - but again, it would take me years to learn that. I still had no idea how depleted I even was.

Here are the things I took in my first pregnancy and why they ultimately caused much more harm than good:

• Standard Prenatal - with synthetic vitamins and folic acid instead of folate. My body could not properly process, absorb, or utilize these nutrients, leaving them to build up in my body interfering with proper absorption - ultimately leaving me more malnourished than I would have been if I had taken no prenatal at all.
  Risks: This can increase the risk of complications like neural tube defects, miscarriage, or preeclampsia - and might be why I had recurrent miscarriages while trying to conceive in the first place.

• Zofran - The most commonly prescribed medication for morning sickness in the US, which has never been studied in pregnant women and is known to carry a risk of birth defects. It was initially developed to treat chemotherapy-related nausea. Zofran can mask the root causes of morning sickness by depleting you of nutrients as it increases gastric emptying contributing to malabsorption, which is one of the causes of morning sickness in the first place.

  Risks: GlaxoSmithKline has faced multiple lawsuits as Zofran has been proven to cause birth defects including cleft palate and cleft lip, heart defects, and kidney malformations. Interestingly, these are all birth defects associated with MTHFR gene mutations as well - so while it has never been studied, it’s possible Zofran is exacerbating illness in those with MTHFR mutations.

• Unisom & B6 - These are commonly recommended for morning sickness - likely because Unisom is an antihistamine, and morning sickness is significantly associated with histamine. As well, B6 supports DAO enzymatic function, which is responsible for processing and clearing histamine. In many cases, severe morning sickness is a function of MCAS, resulting from depletion, and Unisom and B6 are again masking the root cause (though B vitamin levels, including B6, are a critical nutrient for resolving these symptoms - which is discussed further on in this article).
  Risks: As a first generation antihistamine, Unisom can cross the blood brain barrier and block acetylcholine and carries a risk of dementia. As it crosses the placenta as well, potentially blocking acetylcholine which plays a critical role in fetal brain development (including formation of neural pathways, synaptic signaling, memory and attention systems), there are potential long term neurological and cognitive effects for the baby which have never been studied.

• 24-hour Dramamine - Recommended for severe and persistent dizziness and fainting in pregnancy as Unisom and B6 weren’t cutting it; sometimes recommended to patients with HG. While the risk of fainting while pregnant is certainly bad, dramamine does pose issues to the fetus that are not well studied and should be considered.

  Risks: Dramamine is also a first generation antihistamine that crosses the placenta and the blood brain barrier, blocks acetylcholine, carries a risk of cognitive issues and dementia in the person taking it, and likely poses a risk to the cognitive development of the baby - all of which has never been studied.

• Levothyroxine - About halfway through my pregnancy, I was diagnosed with hypothyroidism. Years later I would learn that I actually had a gluten intolerance that was hindering my thyroid function and showing up on labs as hypothyroidism. But of course, conventional doctors don’t check for that, so I was prescribed levothyroxine. There is also a connection between thyroid function and histamine as the thyroid regulates enzymes responsible for breaking down histamine.

As you can see, many of my health and pregnancy issues stem from MCAS and histamine issues. Anecdotally, based on conversations I have had with hundreds of followers as I share health information on my Instagram page - it appears that taking antihistamines in pregnancy can increase the rate of histamine issues in those babies. My first child has dealt with more significant histamine issues, emotional lability, and prominent MTHFR symptoms and (minor) related birth defects - very likely due to the cocktail of medications I was taking described above, none of which I have taken in subsequent pregnancies.

My body knew I shouldn’t be taking any of these things, but I didn’t know how to listen to my body and my brain hadn’t gotten the message about the risks of these medications. In fact, one night when taking these medications, I choked so hard on the pills that I ripped my uvula in half. You know - the hangy thing in the back of your throat. It’s still torn and there’s basically nothing I can do to fix it short of surgery to remove it.

It’s sometimes hard to look back at photos of myself pregnant with my daughter and postpartum because I was tremendously inflamed. I have truly never been so inflamed in my life. I was incredibly nutrient deficient, struggling with histamine overload from MCAS, and exacerbating everything with ill advised medications.

35 weeks pregnant with my first baby

One evening, during my babymoon at 6 months pregnant at a beautiful cabin in Big Sur, my heart started racing and skipping beats and my husband and I panicked - so he drove an hour and a half round trip along the rural coast of California to a 24-hour pharmacy in Monterey to buy a blood pressure cuff. We immediately called my doctor, who saw me two days later when I got home and ended up diagnosing me with hypothyroidism. The truth is that this was likely some sort of mast cell mediated cardiac allergic reaction, possibly to gluten. The thyroid issue was a byproduct. Alas, I was put on levothyroxine and took it for the remainder of my pregnancy - and periodically for two years until I received a proper diagnosis of gluten sensitivity, later ultimately completely resolving hypothyroidism with dietary changes alone.

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As I detailed in my first post on pregnancy health, and have discussed at length elsewhere, I got very sick in 2020 just before my daughter turned 2. I actually had a very early miscarriage/chemical pregnancy in February of 2020, and was just getting a referral to a fertility specialist when the world shut down due to Covid. I then became too sick with a plethora of other conditions to even think about having another child.

Just 2 years later, in early 2022 as I was climbing out of my health crisis, my husband and I were shocked to learn that I was pregnant. We were in the process of moving to another state and it was one of the most stressful times in our lives. I truly did not think it was possible for me to get pregnant at that time. I will discuss infertility and how we overcame it in a future post - but the bottom line is that, despite being incredibly stressed, specific nutritional supports and finally understanding and appropriately addressing MCAS - in BOTH partners - allowed us to get pregnant with ease.

And now I was terrified of backsliding, of being nauseous and undernourished for the next 3-9 months, of passing along all my health issues to my second baby. Now I knew better, I knew about preconception nutrition and how to prepare, but I hadn’t been doing it as long as I had hoped.

I’d begun healing and reversing over a dozen diagnosed conditions.

Would I be able to resolve morning sickness?

Tips and Tricks

Here are the specific things I did in my second pregnancy and fine-tuned in my third pregnancy that helped me reduce the symptoms of morning sickness by about 50%, from suffering with Hyperemesis Gravidarum to a managing a more regular level of morning sickness and exhaustion (which again, is somewhat typical in first trimester pregnancy, and is not necessarily indicative that something is “wrong”).

Preconception

• Because the severity of morning sickness can be driven by histamine, stabilizing mast cells and getting MCAS under control was a critical factor of preconception for me. While I wasn’t trying to get pregnant in 2022, I had spent 18 months treating and stabilizing MCAS - which likely contributed significantly to me getting pregnant with ease, and having a reduction in morning sickness symptoms of about 25%. I sometimes used mast cell stabilizers in my second pregnancy, but I did not need them at all by the time of my third pregnancy - and have not regularly used them in years.

• Increasing B vitamins, improving my Copper and Zinc ratio (further discussed here), and optimizing intake of other vitamins and minerals that support histamine regulation, digestive function, and reduce nausea helped tremendously

• Improving my overall nutrition and limiting inflammatory foods that were making me sick was also critical, as discussed in my first article on pregnancy health - and in particular optimizing my gut health and my stomach acid/digestive enzymes in order to properly digest and absorb nutrients

Morning Sickness Supports

• Water and electrolytes - Staying hydrated is critical for keeping morning sickness at bay. I have found that the best, most hydrating water is natural spring water. I actually collect it from a spring near my house, at the recommendation of my midwife during my second pregnancy. Filtered water removes all the minerals needed to actually hydrate your cells. While many people add minerals back in to filtered water, I have found that my body knows the difference and doesn’t utilize re-mineralized water nearly as well as water that never had the minerals stripped out in the first place. When I feel particularly dehydrated, I drink mineral water like Gerolsteiner. I went from needing IV fluids at least weekly in my first two pregnancies to not needing them at all in my third.

• Eating every 2-3 hours - Having an empty stomach can worsen nausea, so making sure I eat regularly to keep something in my stomach is critical. This can be difficult but I always make sure to have something easy on hand and next to my bed - rice crackers, nuts, toast.

• Protein and fat - Many people have aversions to protein and fat, especially in the first trimester, but they tend to be the most satiating macronutrients that will keep you full the longest. If I could start my day with some breakfast meats - bacon, sausage, ham - I felt a lot better. Cheese was a go to for protein and fat, as I was often able to eat various cheeses with little to no problem - cream cheese and cucumber sandwiches, caprese salads, even chips and cheese, or just slices of raw cheese. Peanut butter on toast or a rice cracker has also been a very useful protein/fat rich snack. Soups and broths are also easy to eat, and my favorite gluten-free ramen has been a go-to for a filling and hydrating snack throughout pregnancy.

• Bedside table snacks - the hunger would come on strong for me throughout my first trimester, and if I didn’t eat something within 5-10 minutes, it would quickly shift to nausea. Keeping snacks on me at all time - on my bedside table, in my purse - was crucial to not quickly tipping from hunger into nausea.

• An apple a day keeps the nausea at bay - Apples, especially those more on the tart/sour side, were a literal Godsend in my second and third pregnancy. My favorite apples are honeycrisp. Apples contain quercetin, which is a natural mast cell stabilizer (quercetin is found in red/orange foods and red/orange apples have the highest amount), as well as malic acid, which plays a role in the Krebs cycle and helps produce cellular energy (mitochondrial dysfunction is another contributor to the severity of morning sickness). I would eat 2-3 sliced apples a day, typically starting my day with them and carrying them with me to have a few slices throughout the day to support nausea. Dipping apple slices in peanut butter was also a very helpful snack.

• Lemons and sour candies - Both of these can stimulate digestive enzymes, so food doesn’t just sit in the stomach contributing to nausea and indigestion. I drank lemon water regularly and on really hard days I quite enjoyed the Yum Earth Sour Littles - a dye free version of Sour Patch Kids made with natural and organic ingredients.

• Teas - Teas were particularly helpful for staying hydrated and quelling nausea. Many people like ginger and ginger tea, but I personally can’t stand it. For digestive support I prefer peppermint, chamomile, lemon balm, licorice, and a popular Ayurvedic digestive blend of fennel, cumin, and coriander.

• Digestive enzymes - Digestive enzymes (including papaya pills and other supplement blends) can provide some support when nausea is contributed to by gastroparesis, or food simply taking longer to digest and exit the stomach. Digestive enzymes are also particularly helpful later in pregnancy when indigestion and heartburn increase due to slower digestion and physical pressure from the uterus growing and pushing the digestive system up. I have been liking Hilma’s digestive enzyme lately.

• Alex eats outside - This is a rule that started in my first pregnancy, when my husband decided to eat a tuna sandwich when I was 8 weeks pregnant, and I lost it. We greatly reduce pungent foods in the house when I’m early in pregnancy, and when my husband eats some of his favorite foods - like tuna and hot sauce - he does so outside. We live in a beautiful place, it’s nice for him to eat outside.

Final Thoughts

In my first and second pregnancy, I often needed IV fluids, particularly in the first trimester. In my third pregnancy, I didn’t get an IV of fluids even once. While I attribute this mostly to drinking spring water, I think that holistically everything I have done nutritionally and for my immune system over the last 5 years contributed to this improvement, and the fact that my symptoms and level of morning sickness repeatedly improved with each pregnancy.

I also didn’t take any medications or prenatals in my first trimester with my third pregnancy. I am far too sensitive to supplements and they are a huge trigger when I am pregnant. Nutritionally, what you have consumed and stored before pregnancy matters much more to an early developing fetus than what you eat day to day during the first trimester. That isn’t to say eating and nutrition isn’t important - it is, of course, the most important - but your body will take whatever you have stored from approximately 6 months leading up to conception and ensure your baby gets everything you already have. Your baby is the priority.

Another factor to mention - carrying a boy results in lower levels of morning sickness than a girl due to the excess testosterone and lower levels of estrogen, which contributes to nausea. While not a predictable indicator of sex, I have found this to be a minor factor in the severity of morning sickness in my pregnancies.

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The great news is that most women find that their nausea resolves and their energy levels return around weeks 10-12, when the placenta takes over hormone production. For most women, morning sickness is a somewhat annoying 6 week reminder to slow down and rest - and then in your second trimester you start to feel much better.

How has pregnancy nausea impacted you? Drop your tips and tricks in the comments below to share with others!

Explore related articles in our Pregnancy Health series at the links below:

Pregnancy Health: On Nutrition, Prenatals, and Learning Along the Way

Pregnancy Health: On Supporting Fertility

Pregnancy Health: On Prenatals