Nausea in Pregnancy: When Does It Start and What Helps?

Nausea in pregnancy usually starts before week 9 and in most women eases noticeably between weeks 14 and 20. Eating a few crackers before getting out of bed in the morning, small and frequent meals so that the stomach is never empty, plain foods that are low in fat, sipping fluids and foods with ginger are the steps that help most to ease nausea.

Although it is called "morning sickness", nausea can appear at any time of day, and some pregnant women go about all day with a mild queasy feeling. Annoying as it is, mild to moderate nausea does not harm the baby. What matters is being able to keep up your fluid and energy intake and recognising the warning signs.

When Does Nausea Start and End in Pregnancy?

In most pregnant women, nausea starts soon after a missed period, usually before week 9, and begins to ease towards the end of the first trimester. The American College of Obstetricians and Gynecologists (ACOG) says it passes by week 14 in most women, while the NHS says it usually improves between weeks 16 and 20.

Every pregnancy is different. Twin pregnancy, severe nausea in a previous pregnancy, a history of motion sickness or migraine, and similar complaints in the family may make nausea more likely to be pronounced.

What Causes Nausea?

Although the exact cause of nausea is not known, the rapid hormonal changes in the early weeks are thought to be the most important factor. Your sense of smell and taste also change in this period; even the smell of a dish you used to like can make you feel sick.

Tiredness and long gaps without food noticeably increase nausea. For this reason, most eating suggestions aim to keep blood sugar and stomach fullness more even. Other conditions, such as a urinary tract infection, can also cause nausea and vomiting, so tell your doctor if your complaint changes in an unusual way.

What Helps with Morning Sickness?

The habit that helps most with morning sickness is to eat a few crackers or a slice of toast before getting out of bed and then to get up slowly. Moving around without anything in a stomach that has been empty overnight can make nausea worse.

• Keep crackers, rusks or a handful of nuts ready on the bedside table.
• You do not have to have breakfast as soon as you get up; it is enough to eat something small within half an hour.
• Build your breakfast from plain options such as cheese, eggs, bread and fruit rather than strong-smelling foods.
• Instead of hot tea, you can try warm water or a light tea made with freshly grated ginger.

Which Foods Are Easier to Tolerate with Nausea?

Plain, low-fat, mild-smelling foods based on carbohydrate are easier for most pregnant women to tolerate. The aim is not an ideal menu, but to find the foods that stay down.

• Plain carbohydrates: Crackers, toast, rice pilaf, pasta, boiled potatoes.
• Cold foods: If the smell of hot meals bothers you, cold options such as yoghurt, cold pasta salad or a cheese sandwich give off less smell.
• Protein: Adding a small source of protein to each meal (yoghurt, milk, cheese, eggs, peanut butter or almond butter) eases nausea for some pregnant women.
• Fruit: Juicy fruits such as banana, apple, watermelon and melon provide both energy and fluid.
• Ginger: Fresh ginger tea or using ginger in cooking helps some pregnant women. If you are thinking of using ginger supplements (capsules and so on), ask your doctor or pharmacist first.

Fatty, fried and very spicy foods usually make nausea worse. The foods you really should avoid in this period are about food safety rather than nausea; I have covered them in my article on what not to eat in pregnancy.

How Do Smells and Kitchen Habits Affect Nausea?

In the early weeks, sensitivity to smell is one of the strongest triggers of nausea, so small changes to how your kitchen works can make eating directly easier.

• Open the window or run the extractor fan when you cook; if possible, leave the cooking of strong-smelling dishes to another family member for a while.
• Cut back on cooking methods that give off strong smells, such as frying, kavurma (slow-cooked fried meat) and sautéing onion and garlic, in this period.
• Preparing plain meals (boiled chicken, rice, pasta) one day a week and keeping them in small containers in the fridge gives you a quick option when you get hungry.
• Make time to rest; tiredness can noticeably increase nausea.

How Can You Prevent Fluid Loss If You Are Vomiting?

If you are vomiting, the safest way is to take fluids not in large amounts at once, but in small sips through the day. Instead of drinking a glass of water in one go, taking a few sips every 10 to 15 minutes makes it easier for your stomach to hold the fluid.

If drinking water is hard, sucking ice chips, diluted fruit juice, ayran (a salted yoghurt drink), a lightly brewed herbal tea or the broth from soup are good alternatives. Taking fluids between meals rather than with food also reduces vomiting in some pregnant women. Chewing gum or sucking a sugar-free sweet to take away a bad taste in the mouth can make it easier to drink.

Does Nausea Harm the Baby, and When Should You See a Doctor?

Mild to moderate nausea and vomiting do not pose a risk to the baby. However, not being able to keep anything down, weight loss and fluid loss change the picture; this is called hyperemesis gravidarum and needs treatment.

If any of the following applies, see your doctor or the nearest healthcare facility without delay:

• If you cannot keep any food or fluid down for 24 hours
• If your urine is very dark, or you have not passed urine for more than 8 hours
• If you feel dizzy when you stand up, feel faint or notice marked weakness
• If you have abdominal pain, a fever or blood in your vomit
• If you are losing weight

If lifestyle changes are not enough, your doctor can assess the medication options that can be used in pregnancy. Do not use any medicine, herbal product or supplement for nausea on your own.

How Can You Rebuild Your Eating After the Nausea Passes?

When nausea eases, the aim is to slowly widen the menu that was necessarily narrowed in the early weeks. Adding vegetables, pulses, fish and wholegrains back one at a time, and not moving to large portions before your appetite has fully returned, is easier on the stomach.

If you were not able to eat enough for a few weeks in the first trimester, do not see this as something to blame yourself for; this period is hard for most pregnant women. It is important to keep taking the vitamins your obstetrician has recommended and to build a balanced routine once the nausea has passed. You can also take a look at my article on what helps with heartburn in pregnancy, which is common in the second trimester.

If you would like to plan together what you can eat during the nausea period and set up a balanced routine for the rest of your pregnancy, we can work together in line with your obstetrician's advice through nutrition counselling in pregnancy.

Sources

• NHS – Vomiting and morning sickness
• NHS – Severe vomiting in pregnancy (hyperemesis gravidarum)
• ACOG – Morning Sickness: Nausea and Vomiting of Pregnancy
• ACOG Practice Bulletin No. 189: Nausea and Vomiting of Pregnancy. Obstet Gynecol, 2018 (PubMed)

This article is for general information only; please consult your doctor and dietitian about your own situation.