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If Morning Sickness Is Associated With Fewer Miscarriages and Higher IQ Babies - Should It Be Treated?

Posted: 05/12/2012 00:00

The many myths surrounding morning sickness are being wheeled out yet again, given the news that a royal is suffering from it.

First of all 'morning sickness' is misnamed as it only occurs in the morning in less than 20% of women. Despite reassurances currently being published that the Duchess's torment is going to be very temporary, in fact only half of women with nausea and vomiting during pregnancy are completely relieved by 14 weeks' gestation. Plus it can be extremely debilitating with up to a quarter of women in one study with symptoms requiring time off work as a result.

Miserable though it may be to experience as a condition, in fact 'morning sickness' (if it's not of the rarer more severe kind), oddly enough, can be good news for a pregnancy. It's associated with lowered risk for miscarriage, pre-term birth, low birth weight, and perinatal death. However it can also be associated with serious medical conditions which need to be screened for and treated, but most often it occurs in medically normal pregnancies.

In 2009 a study published in 'The Journal of Pediatrics' from the Hospital for Sick Children, Toronto, provoked controversy when it found nausea and vomiting during pregnancy was significantly associated with better IQ test results in children aged three to seven years after delivery. A battery of psychological tests were involved including measures of intelligence, neurocognitive abilities and behavior problems.

The study entitled 'Long-term Neurodevelopment of Children Exposed to Maternal Nausea and Vomiting of Pregnancy and Diclectin' - by Irena Nulman, Gideon Koren and colleagues, found the more severe the nausea and vomiting during pregnancy, the better the child's eventual scores across the range of tests.

No one knows exactly why nausea and vomiting during pregnancy is generally good for the foetus, but this has led to a 'Maternal and Embryo Protection Hypothesis', which argues its purpose may be to shield the mother from contaminated food, so protecting the developing foetus against potentially threatening toxins and bugs.

Some have hypothesised that raised hormone levels during pregnancy, such as oestrogen and Human Chorionic Gonadotropin levels make the smell or olfactory system in the female brain hyper-sensitive. One theory is that it's smells which might be the primary driver of nausea and vomiting during pregnancy, and extra-sensitivity to odours protects mothers from imbibing hazards. It is also established that Asian women have more troublesome vomiting and this seems to be due to the structure of Human Chorionic Gonadotropin.

Many features of nausea and vomiting during pregnancy suggest an evolutionary adaptive design. For example, Samuel Flaxman and Paul Sherman from the Dept of Neurobiology and Behavior, Cornell University, contend it's therefore no accident it tends to occur during the most sensitive period of embryogenesis (weeks five-18). They also point out in their commentary in the academic journal 'Trends in Ecology & Evolution', it causes physical expulsion of and subsequent aversions to the foods that are most likely to be hazardous including meats, caffeinated beverages and pungent vegetables. They also note the intriguing absence of nausea and vomiting during pregnancy in seven societies on four continents lacking such dietary triggers.

Another theory is that the food aversion is a completely incidental and an unwanted side-effect, as it's a direct effect on the foetal brain or the placenta of high levels of hormones of pregnancy which cause nausea, which is why there appears to be an association with baby benefits.

Whether nausea and vomiting has a natural protective or positive purpose during pregnancy raises a conflict for doctors as to whether women should be treated to suppress symptoms, or encouraged instead to 'ride them out'. This is made all the more difficult given the long history of some anti-nausea treatments when ingested, causing congenital problems. Severe nausea and vomiting in pregnancy, otherwise known as hyperemesis gravidarum, should definitely be treated as it can result in life-threatening malnutrition and liver damage, but it's rare, and affects less than 1% of pregnant women. The most dangerous consequence is for the woman to suffer vitamin deficiencies and this can cause maternal brain damage.

Women suffering from so-called normal nausea and vomiting are often desperate, and any treatment which doesn't involve taking something, given the risks to the foetus, should be welcomed.

This condition also responds to vitamin supplementation, acupuncture and acupressure. These treatments can also improve mood during pregnancy and the emotional impact of nausea and vomiting during pregnancy is extremely important.

 
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The many myths surrounding morning sickness are being wheeled out yet again, given the news that a royal is suffering from it. First of all 'morning sickness' is misnamed as it only occurs in the mo...
The many myths surrounding morning sickness are being wheeled out yet again, given the news that a royal is suffering from it. First of all 'morning sickness' is misnamed as it only occurs in the mo...
 
 
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02:29 PM on 12/18/2012
With my first pregnancy, I spent weekends in bed, I got home from work and went to bed, and I occasionally had a nap at work. Napping was the only thing that stopped me being sick, if I was awake I was sick. Luckily I was able to keep down some food, and drink so I was never sick enough to warrant drugs although 20 weeks in I’d have taken anything just to feel normal again.
This time round I’m 13 weeks in and feeling just as bad, but I have an 18 month to run round after. No time for napping, and as she is currently ill no time for actual sleep. All I can do it eat, and keep my fingers crossed it keeps away the nausea. At least when I’m being sick I know the nausea will go for a short while and I’ll feel human.
Everyone handles illness in different ways, what some women can cope with, others can’t.
I don’t judge the Duchess of Cambridge in fact I rather envy her, yes she has media scrutiny but she doesn’t have to cook and clean for her husband, she can lounge around in a tracksuit and wallow if she wants.
My daughter is worth all the sickness in the world, and I know I’m incredibly lucky to be blessed with a second chance at another healthy baby, but some days I just want to ask, why am I being punished???
07:42 PM on 12/05/2012
I had terrible morning sickness with my 2, however after the Thalidomide disaster I would NEVER touch any drugs in pregnancy except from standered things like paracetamol and antibiotics
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Dr Raj Persaud
10:05 AM on 12/06/2012
Many thanks for your comment - experiences vary but some women endure such a terrible time, they are driven in desperation to consider anything that might help.

In a study entitled 'Understanding the Stigma of Hyperemesis Gravidarum: Qualitative Findings from an Action Research Study', Zoe¨Power, Ann Thomson, and Heather Waterman from the University of Manchester point out the treatment of women with this serious condition varies from hospital to hospital, particularly as in the UK, it seems there remain no national guidelines.

The most common experience described by women with hyperemesis gravidarum in this study, published in the academic journal 'Birth', was constant nausea and very frequent vomiting, with an inability to tolerate almost any diet or fluids without throwing up. Duration of symptoms could extend from days to weeks and months. Extreme hunger and thirst impossible to alleviate, weakness and general distress were commonly reported. Often it seems nothing much helped except perhaps rehydration by intravenous infusion. Feeling defeated was common. The symptoms frequently ended up having a strong emotional impact - but it seems health professionals often took the opposite, unhelpful and even stigmatising view, and seemed to assume that the vomiting was caused by psychological problems.

At its most extreme, historically, nausea and vomiting during pregnancy were stigmatised as psychological manifestations of an unwanted pregnancy. The more modern scientific view, which is that there are most likely biological and even genetic causes, seems to be taking a long time to percolate to the front line of clinical
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25sammy25
We just wanna be togever !!!!
07:38 PM on 12/05/2012
Morning sickness in pregnancy is common, but not to the extent of vomiting. However, due to prescription drugs, I suffered continual nausea. My doctor said there was nothing he could do about it. I went to the chemist and asked if there was anything to counteract this nausea. She recommended Sea Bands, which are pressure point wrist bands. I put them on immediately I came home and it was like a miracle, my nausea completely disappeared. I now wear one on each wrist all the time. They are also used for car/plane travel sickness and after anaesthetic used in an operation. I would recommend them through my own experience.
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Dr Raj Persaud
09:57 AM on 12/06/2012
Many thanks for your useful comment - when we referred in our article to acupressure - wrist bands was one manifestation we were thinking of - but didn't have enough space to emphasise this does look like a promising approach. Elisabeth Hyde has published an interesting clinical trial showing the benefits of acupressure in this condition in the Journal of Nurse-Midwifery, but there appears not enough follow up of this kind of research. You can find a link to the abstract for the research paper here: http://onlinelibrary.wiley.com/doi/10.1016/0091-2182(89)90077-3/abstract
Best wishes Raj Persaud
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25sammy25
We just wanna be togever !!!!
09:17 PM on 12/07/2012
Dr Raj Persaud - Thank you for you interest in my comment.  I have read the link which is very interesting .  It was amazing that I had a consultation with my doctor about my nausea and he could do nothing for me but my chemist could.  I told my doctor about them whether he listened or not is a different story.  I honestly think these Sea Bands are beneficial for so many different ailments, I don't know if more research is required but more publicity about the benefits, starting with hospitals and GPs.  Thank you again for your response.
03:23 PM on 12/05/2012
I've had this condition and it is debilitating and you feel terrible but it is not so serious that you have to be in hospital for an extended period/
I spent 2 days in each pregnancy in hospital for treatment for dehydration.
Then I had to get on with life as best I could, still not feeling well but not receiving the amount of attention Kate is receiving. Ordinary women have jobs, families and lives to get on with we don't get to spend weeks or even days being pampered.
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03:40 PM on 12/05/2012
The Duches of Cambridge has things to do, even if they don't appear to some people to be a "job". She wouldn't be in hospital if the didn't need to be and the fact that she is tells us that it is serious enough to be there, for however long it takes.
04:11 PM on 12/05/2012
What things does she have to do?
The palace have cancelled all her 'engagements'
A band of flunkies will be doing their headless chicken act covering for her....how many people have that.
She doesn't have to be in hospital, her condition is not that serious.
06:34 PM on 12/05/2012
My wife spent a total of 3 weeks worth of time in hospital with our second son due to the extreme vomiting she suffered, she actually lost weight by the end of the pregnancy it had become so bad.
02:49 PM on 12/06/2012
She was clearly nowhere near as ill as your wife.....she's out today.
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ToniChicago
02:12 PM on 12/05/2012
Even "normal" morning sickness is debilitating as many women can't function with it. If, as the writer says, it can be treated with non-hormonal treatment, it should definitely be treated. It's hard to describe how bad it is if you haven't experienced it, but think of trying to function with the world's worst hangover - which goes on all day for about four months.
12:31 PM on 12/06/2012
I'd say the hangover comment is a pretty good way to describe it. I had 'morning' sickness until I was 17 weeks pregnant and it was from the moment I got out of bed until I fell asleep again at night. I tried every home remedy going from the ginger biscuits to preggie pops and nothing worked. The heightened sense of smell didn't help as I could smell the dogs breath from the other side of the room which wasn't pleasant :/ I did have medication in the end but even this didn't completely stop it.