NAUSEA AND VOMITING OF PREGNANCY AND MY 4PM QUEASIES

My first pregnancy I had the “4pm queasies” – every day at 4pm, no matter what i had eaten, not eaten, exercised or not, I was on the couch like a cat, lying there curled up to try to feel better. Water, sips of ginger ale, Cheerios – nothing helped. But by 7pm I was better and ready for dinner. 

My second pregnancy was better and I just felt a general sense of queasiness all day every day for a few weeks. My best friend from college told me “you’re used to hangovers so you should be able to get through this”. But let me tell you, by that point I hadn’t had a proper hangover in a decade!

I was certainly not alone –  nausea and vomiting of pregnancy affects up to 85% of all women in early pregnancy. 

It starts around 6 weeks, peaks between 7 to 12 weeks, and resolves by 18 weeks for most women. Most literature says the peak is closer to 9 to 11 weeks for most women. 

However, it continues into the 3rd trimester for 15% of women, and in an unlucky 5% it will continue until delivery. The severest form of nausea and vomiting of pregnancy, Hyperemesis gravidarum, affects less than 3%.

Remember when my friend Kate Middleton was in the news everywhere because she had Hyperem? I was even interviewed for an NBC article about it! (LINK HERE). Like so much else with the royal family, the invasion of their personal space and lives can actually be beneficial for the public. 

THEORIES

There are a few theories behind why women get these symptoms: 

1. Hormonal basis: there are two likely hormonal culprits: beta-hCG and estradiol. 

• The pregnancy hormone, beta-hCG, peaks when symptoms peak. When beta-hCG is higher, such as in twin pregnancies, nausea and vomiting is usually worse. 
• Estradiol is a form of estrogen. Nausea and vomiting is more common when estradiol levels are increased, and less common when levels are decreased. Women who experience nausea after estrogen exposure not pregnant (such as with high dose birth control pills) are more likely to have nausea and vomiting of pregnancy than women who never had that sensitivity in the first place. 

2) evolutionary adaptation – it may have helped women avoid potentially dangerous food. 

3) psychologic predisposition – This theory stinks of patriarchy. It puts the blame on women and may hinder progress toward treatment options. I write it here to acknowledge it exists and refute it strongly.

RISK FACTORS

There are some risk factors that increase the chances of developing nausea and vomiting of pregnancy. You can’t do anything about these, but may help explain why you’re suffering and your co-worker didn’t:

1. genetic disposition – if your sister or mom had it, you’re more likely to have it to
2. Personal history of hyperemesis in previous pregnancy
3. Pregnancy with a female fetus
4. If you’re prone to motion sickness 
5. Suffer from migraines

Next week we’ll talk about ways to feel better – both little lifestyle adjustments and medications.