Morning sickness: When is it a concern?

Is it normal for morning sickness to last beyond the first trimester? I am at 27 weeks, and I'm throwing up several times a day. Should I be concerned?

- Elaine / Iowa

Mayo Clinic obstetrician and gynecologist Roger Harms, M.D., and colleagues answer select questions from readers.

Answer

Morning sickness is a misnomer, since it can strike at any time of the day or night. Most women who experience morning sickness notice a dramatic improvement after the first trimester — at roughly 13 weeks. But some women have nausea and vomiting beyond the first trimester. Also, morning sickness may be more severe if this is your first pregnancy or if you're carrying multiple fetuses.

Some simple steps that may be helpful in relieving nausea and vomiting:

Eat smaller meals or snacks frequently throughout the day.
Before getting out of bed in the morning, eat a couple of soda crackers or a dry piece of toast.
Have a small snack at bedtime or when you wake up to go to the bathroom in the middle of the night.
Avoid greasy, rich, fatty and spicy foods.
Suck on hard candy.
Wear an acupressure wrist band. Some studies have shown a benefit from acupressure and acupuncture in relieving nausea.

Because you lose fluids when you throw up, it is important to stay hydrated. Try sucking on ice chips or ice pops. Take frequent small sips of water instead of drinking a whole glass of water all at once. Some women find that taking small sips of ginger ale or peppermint tea relieves their symptoms. Check with your doctor before using any natural remedies alleged to relieve nausea and vomiting during pregnancy.

Certainly, throwing up several times a day may make it more difficult for you to retain adequate fluids — which is a health concern for you and your baby. Call your doctor if:

You have not been able to keep liquids down for more than one day.
You're vomiting blood, which may appear bright red or look like black coffee grounds.
You lose more than 2 pounds.
You have vomited more than four times in one day.

Severe morning sickness (hyperemesis gravidarum) may require a stay in the hospital and treatment with intravenous (IV) fluids and medications, including anti-emetics, which control nausea. Rarely, severe or persistent nausea or vomiting may be caused by a medical condition unrelated to pregnancy, such as thyroid, liver or gallbladder disease.