Humza Khizer

Motion Sickness

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

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Your Morning Sickness Guide

Introduction

Morning sickness affects roughly half to two-thirds of all pregnant women, especially in the first trimester. The most common signs are nausea and vomiting. Morning sickness occurs mostly early in the day, hence the name, but it can occur at any time of day or night.

&nbsp;

Morning sickness usually starts during the 4th week of pregnancy and lasts until weeks 12-14. However, 1 in every 5 women experiences morning sickness throughout their second trimester and a small fraction of unfortunate women suffer from nausea and vomiting throughout their pregnancy. In the west, the incidence of vomiting and nausea during pregnancy is about 50-80%<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

In most situations, morning sickness doesn&rsquo;t affect the pregnant woman or the unborn child. However, severe morning sickness, which involves weight loss and dehydration, requires immediate medical care and assistance.&nbsp; 
&nbsp;

Understanding Morning Sickness in Pregnancy

Morning sickness can cause a variety of signs and symptoms, including:

<ul>
	<li>Nausea and sickness</li>
	<li>Loss of appetite, which can lead to <a href="https://merisehat.pk/disease/anorexia-nervosa">anorexia&nbsp;</a></li>
	<li>Vomiting</li>
	<li>Psychological and mental effects, which include <a href="https://merisehat.pk/disease/depression">depression </a>and <a href="https://merisehat.pk/disease/anxiety">anxiety&nbsp;</a> 
	&nbsp;</li>
</ul>

The reason for morning sickness is unknown. However, it is believed that a combination of physical and metabolic factors plays a significant role. This includes:

<ul>
	<li>Hormonal imbalance, particularly high levels of estroge</li>
	<li>Changes in blood pressure, particularly low blood pressure</li>
	<li>Changes in the metabolism of carbohydrates</li>
	<li>Physiological changes that pregnancy provokes 
	&nbsp;</li>
</ul>

Early in pregnancy, the thyroid gland is activated, perhaps by hCG (human chorionic gonadotropin) or a similar chemical that may cause gestational emesis. Increased free T4 and hCG and decreased TSH are all linked with the intensity of morning sickness, and, according to a study, these changes are more pronounced in participants who also experienced nausea and vomiting<a href="#accordion">[2]</a>.

&nbsp;

<h5>Is Morning Sickness Harmful to Baby?</h5>

Some mothers are worried that the action of vomiting may harm their unborn child. The physical mechanics of vomiting and retching do not harm the unborn child, but it may strain the abdominal muscles and cause localized pain, discomfort, and soreness. Nevertheless, the fetus remains well-cushioned and protected within its amniotic fluid sac. Several studies have found that mild morning sickness is associated with a lower chance of miscarriage.&nbsp;

&nbsp;

On the other hand, prolonged vomiting that leads to dehydration and weight loss can deprive the fetus of sufficient nourishment and increase the risk of the baby being underweight at birth. 
&nbsp;

Hyperemesis gravidarum (HG), which is also known as severe morning sickness, affects approximately 1 in every 1000 pregnant women<a href="#accordion">[3]</a>. The signs and symptoms of HG are frequent vomiting, weight loss, and dehydration. Hospitalization and the administration of intravenous fluid and nourishment is necessary to treat it.

&nbsp;

Untreated hyperemesis gravidarum may lead to the following possible complications:

<ul>
	<li>Electrolyte imbalances</li>
	<li>Severe anxiety, sadness, and despair</li>
	<li>Malnourishment of the fetus</li>
	<li>Severe stress on essential organs, such as the liver, heart, kidneys, and brain 
	&nbsp;</li>
</ul>

Doctors usually recommend vitamin B-6 supplements (pyridoxine), ginger, and over-the-counter medications, like doxylamine (Unisom), for management. If nausea and other symptoms of morning sickness persist, they may prescribe anti-nausea medicine. 
&nbsp;

<h5>Does Morning Sickness Cause Electrolyte Imbalance?</h5>

Mild to severe pregnancy related nausea and vomiting can usually cause dehydration and electrolyte (e.g., sodium or potassium) imbalance. For mild to severe morning sickness, more fluids and prescription drugs are suggested.

&nbsp;

A healthcare provider will discuss it with the expecting mother how frequently they have experienced nausea, the number of times they vomited, their ability to keep fluids down, and whether they tried any home remedies. For nausea and vomiting, there are a number of prescription drugs that are safe to take during pregnancy, but it all depends on the severity of the symptoms exhibited.

&nbsp;

It&#39;s best to consult with a doctor before taking any over-the-counter drugs or supplements during pregnancy. Especially if it&rsquo;s a case of hyperemesis gravidarum, which requires close monitoring and treatment with intravenous (IV) fluids and anti-nausea medications at a hospital. 
&nbsp;

To help ease symptoms of morning sickness:

&nbsp;

<ul>
	<li>Select Foods Carefully</li>
</ul>

Avoid oily, spicy, and fatty foods. Instead, opt for foods that are high in protein, low in fat, and easy to digest. Bananas, rice, applesauce, bread, and other bland foods are relatively easy to digest. Adding some ginger to your food can be beneficial at times. For some pregnant women, herbal ginger supplements appear to ease morning sickness. The majority of evidence suggests that ginger can be consumed safely during pregnancy, but there is some risk that ginger may interfere with fetal sex hormones.

&nbsp;

<ul>
	<li>Snack Frequently</li>
</ul>

Eat a couple of soda crackers or a piece of dry toast before getting out of bed in the morning. Instead of eating three large meals, snack throughout the day; this helps keep the stomach from becoming too full or empty, either of which may worsen nausea.

&nbsp;

<ul>
	<li>Drink Plenty Of Liquids&nbsp;</li>
</ul>

Drink some water or ginger ale. Every day, consume 6-8 glasses of non-caffeinated beverages to stay hydrated.

&nbsp;

<ul>
	<li>Steer Clear Of Nausea Triggers</li>
</ul>

Keep an eye out for foods or odors that seem to worsen nausea. Having a backup plan, like carrying snacks or essential oils (aromatherapy), is helpful in case of social gatherings to avoid nausea.&nbsp; &nbsp;

&nbsp;

<ul>
	<li>Inhale Fresh Air</li>
</ul>

If the weather permits, open the windows at home or workplace. Take a walk outside every day. It&rsquo;s soothing for the senses and can, therefore, act as a remedy for morning sickness.

&nbsp;

<ul>
	<li>Follow Prenatal Vitamins Guidelines</li>
</ul>

If the nausea hits after taking the prenatal vitamins, take them with a snack or right before bed. If these steps don&#39;t work, consult a doctor about alternate ways to get the iron and vitamins needed for a healthy pregnancy.

&nbsp;

<ul>
	<li>Rinse With Water After Vomiting</li>
</ul>

The acid from the stomach can erode tooth enamel. If possible, rinse with a cup of water mixed with a teaspoon of baking soda. This will help in the neutralization of the acid and protect teeth as well. 
&nbsp;

Several alternative therapies for morning sickness have been suggested, including:

&nbsp;

<ul>
	<li>Acupressure</li>
</ul>

Acupressure wristbands are accessible in most pharmacies without a prescription. Acupressure wristband studies have shown different results, but some women claim to find the wristbands beneficial.

&nbsp;

<ul>
	<li>Acupuncture</li>
</ul>

A qualified practitioner inserts hair-thin needles into the skin for acupuncture. Although it seems to help some women, acupuncture isn&#39;t a proven treatment for morning sickness.

&nbsp;

<ul>
	<li>Hypnosis</li>
</ul>

Despite the lack of study on the subject, some women have experienced relief from morning sickness through hypnosis.

&nbsp;

<ul>
	<li>Aromatherapy</li>
</ul>

Although there is limited study on the subject, particular aromas typically made using essential oils can help some women deal with morning sickness.

&nbsp;

NOTE:&nbsp;Some women are tempted to use marijuana as a way to relieve sickness and nausea if they reside in a place where it&#39;s legal. However, the American College of Obstetricians and Gynecologists advises pregnant women not to consume marijuana because the drug&#39;s effects on the mother and fetus have not been well researched. Additionally, chronic marijuana usage may also cause nausea and vomiting syndrome, which is also known as cannabinoid hyperemesis syndrome.

&nbsp;

Consult a doctor before taking any herbal remedies or alternative treatments to ease the symptoms of morning sickness.&nbsp; 
&nbsp;

Moderate nausea and vomiting during pregnancy are unlikely to cause any difficulties for the mother or the fetus.

&nbsp;

If left untreated, however, severe nausea and vomiting can lead to dehydration, an electrolyte imbalance, decreased urination, and hospitalization. The research on whether hyperemesis gravidarum affects poor weight gain in the fetus is unclear. 
&nbsp;

<h4>How To Prevent Morning Sickness?</h4>

Morning sickness cannot be totally prevented. However, avoiding triggers such as strong scents, severe fatigue, spicy foods, and sugary foods helps. 
&nbsp;

Morning sickness can affect any pregnant woman, although it may be more frequent if the expecting mother has:

<ul>
	<li>Experienced nausea or vomiting due to motion sickness, migraines, particular scents or tastes, or estrogen exposure (for example, in birth control pills) prior to the pregnancy</li>
	<li>Experienced morning sickness in their previous pregnancy</li>
	<li>A pregnancy with twins or other multiples 
	&nbsp;</li>
</ul>

They are more likely to develop hyperemesis gravidarum if:

<ul>
	<li>They are pregnant with a girl</li>
	<li>They have a family history of hyperemesis gravidarum</li>
	<li>They have already experienced hyperemesis gravidarum during a previous pregnancy&nbsp; 
	&nbsp;</li>
</ul>

<h5>Is A Doctor Consultation Necessary?</h5>

Always consult a doctor if the morning sickness feels really bad, if there&rsquo;s a sudden and extreme decrease in body weight, or if there&rsquo;s an unexplained sense of sadness or anxiety. They can prescribe a medication that will not harm your or your developing baby. 
&nbsp;

<h5>1.&nbsp;Morning Sickness Only Occurs in the Morning</h5>

It&rsquo;s a wrong concept. Morning sickness can occur at any time throughout the day. Morning sickness is named after the fact that most women feel nausea and vomiting in the morning. However, nothing guarantees that they won&#39;t feel sick at other times of the day or be sick all day and all night.

&nbsp;

<h5>2. Nausea and Vomiting are The Only Signs of Morning Sickness</h5>

Wrong again. While they are the most frequent signs and symptoms, other symptoms of morning sickness include dizziness, lightheadedness, motion sickness, and excessive salivation. None of these symptoms is pleasant and some of them, such as motion sickness, can cause nausea and vomiting.

&nbsp;

<h5>3. Don&rsquo;t Try to Eat Anything</h5>

This is bad advice. Contrary to belief, eating can occasionally help with morning sickness. Eating small meals throughout the day and a light snack before bed helps to control the blood sugar and keep morning sickness symptoms at bay. Simply avoid foods that can upset the stomach.

&nbsp;

<h5>4. Every Woman Experiences Morning Sickness</h5>

This is not true. Some women never suffer from morning sickness, no matter how many children they have. No signs of morning sickness should not be a matter of concern. Just breathe a sigh of relief.

&nbsp;

<h5>5. Morning Sickness Causes Malnutrition in the Developing Baby</h5>

It may appear that vomiting is depriving the unborn baby of essential nutrients, but this is not the case. They will get enough nutrition to develop and grow if the mother&rsquo;s consuming small meals throughout the day. It&#39;s best to consult your OB/GYN and nutritionist to create a meal plan suitable for you. 
&nbsp;

Conclusion

Everyone has an opinion and a solution for morning sickness. The issue is that morning sickness is not a one-size-fits-all problem with a single treatment. Every woman is unique. In fact, some women may suffer from morning sickness during one pregnancy but not in their next pregnancy! Morning sickness can be unpleasant and can have a negative impact on the daily life of the expecting mother. However, it normally clears itself by weeks 16-20 of a pregnancy and generally poses no harm to the fetus. However, in rare cases like hyperemesis gravidarum, hospitalization is a must.&nbsp;

Key Points

<ul><li>Morning sickness is characterized by nausea and vomiting during pregnancy. Even though it is known as morning sickness, it can occur at any time of the day.</li><li>Morning sickness typically begins at 6 weeks of pregnancy and ends in the second trimester.</li><li>Hormone imbalances, blood pressure irregularities, and alterations in carbohydrate metabolism are all possible causes.</li><li>Hyperemesis gravidarum is characterized by severe nausea and vomiting that demands medical attention (typically in a hospital) to help the individual recover.</li><li>The signs and symptoms of morning sickness can be eased by eating a few dry crackers before getting out of bed, avoiding foods and scents that make the person nauseous, drinking enough liquids, and eating high-carbohydrate and high-protein foods.</li></ul>

[1] STRONG Jr TH. Alternative therapies of morning sickness. Clin Obstet Gynecol. 2001;44(4):653–60.

[2] Mori M, Amino N, Tamaki H, Miyai K, Tanizawa O. Morning sickness and thyroid function in normal pregnancy. Obstet Gynecol [Internet]. 1988 Sep;72(3 Pt 1):355—359.

[3] Fejzo MS, Trovik J, Grooten IJ, Sridharan K, Roseboom TJ, Vikanes Å, et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Prim. 2019;5(1):1–17.

Neelam Asad

The first known medical description of motion sickness can be found in the writings of the Roman physician Caelius Aurelianus who lived in the 5th century. He described the symptoms of nausea, vomiting, and dizziness that were experienced by people traveling on horseback or in carriages. 
&nbsp;

Luckily, modern medicine has made things quite easy. Not only is the condition conveniently described, but even tackling it is much easier nowadays. Motion sickness occurs when the surrounding you are visualizing, is perceived differently by the inner ear. It causes vertigo, nausea, and vomiting.

Motion sickness can occur in any vehicle including a car, as well as in a train, aircraft, boat, or a ride at an amusement park. Hence, traveling is an unpleasant experience for anyone who has motion sickness. However, there are ways to prevent and manage it. 
&nbsp;

Understanding about motion sickness

Humans are exceptional species; every organ and every system has a purpose and that is the reason why you do not get motion sickness all the time.

Your inner ear controls your balancing ability. It is part of the vestibular system, which comprises three pairs of semicircular canals and two bag-like structures called the saccule and the utricle. They are responsible to send off what is happening around you, to your brain. 
&nbsp;

The fluid in the semicircular canals moves in response to your head movements. Both the saccule and the utricle respond to gravity and communicate to the brain whether you are lying down or in a standing position. Typically, it all fits together and your brain can make sense of it.

Occasionally, your brain receives muddled signals. For instance, while flying in a plane, you may feel as though you are moving, even though your eyes are telling your brain that you aren&rsquo;t. The inverse is also accurate. You can stand stationary on dry land after a lengthy ocean cruise and still feel as though you&rsquo;re moving<a href="#accordion">[1]</a>. 
&nbsp;

You can be fine one minute and then suddenly start exhibiting one or more of the following signs once the condition sets in<a href="#accordion">[2]</a>:

<ul>
	<li>Cold sweats</li>
	<li>Dizziness</li>
	<li>Tiredness</li>
	<li>Headache</li>
	<li>Agitation</li>
	<li>Unable to concentrate on matters</li>
	<li>Salivating more than usual</li>
	<li>Nausea</li>
	<li>Vomiting</li>
	<li>Increased pallor of skin i.e. skin becomes pale.</li>
	<li>Hyperventilation (fast breathing) 
	&nbsp;</li>
</ul>

Whether you are looking to treat it or prevent it, motion sickness can be easily controlled<a href="#accordion">[1][2]</a>:

<ul>
	<li>Herbs: The aroma of mint, ginger, or lavender can help you relax. You can even chew on hard ginger or peppermint candies to prevent nausea. 
	&nbsp;</li>
	<li>Diet And Drink: Consume a lot of water. Make sure you eat only low-fat, bland, and starchy foods before you travel. Additionally, to prevent stomach distress, you avoid big meals and oily, spicy, or acidic foods. Lastly, you should avoid smoking and drinking alcohol. 
	&nbsp;</li>
	<li>Fresh Air: Roll down the windows if you&rsquo;re traveling in a car. 
	&nbsp;</li>
	<li>Gaze: Lay down your phone, tablet, or book. Instead, fix your gaze on the skyline or a distant object. 
	&nbsp;</li>
	<li>Lie Back: You can try lying down to relax. 
	&nbsp;</li>
	<li>Pressure Points: You should wear acupressure wristbands as anecdotal evidence suggests that stimulating a specific point right under your wrist helps ease nausea. 
	&nbsp;</li>
</ul>

Furthermore, you should always be facing forward when you are traveling. It is crucial to be specific as to where you sit:

<ul>
	<li>Boat: Go for a seat in the middle section of the boat, that too on the upper deck.</li>
	<li>Bus: Try to find a window seat.</li>
	<li>Car: Sit in the passenger seat.</li>
	<li>Cruise Ship: Try to reserve a cabin in the front or center of the cruise ship. Staying closer to the water can help as well.</li>
	<li>Plane: The wing section is the best place to avoid motion sickness.</li>
	<li>Train: Opt for a front-facing window seat. 
	&nbsp;</li>
</ul>

However, if you are looking for a pharmaceutical treatment modality, your doctor can suggest the following<a href="#accordion">[2]</a>:

<ul>
	<li>Antihistamines: Antihistamines are commonly employed for allergy treatment, yet they can also be effective in preventing and relieving symptoms of motion sickness. They can be used prophylactically as well. However, it is worth noting that only sedating antihistamines are effective in this regard. Non-sedating antihistamines can also help control motion sickness, but they are comparatively less effective than their sedating counterparts. 
	&nbsp;</li>
	<li>Patches: Skin patches or oral pills containing scopolamine are recommended for adults to alleviate nausea and vomiting. Apply the patch behind your ear at least 4 hours before your trip. Then, after 3 days, replace the patch with a fresh one. Side effects include dry mouth. 
	&nbsp;</li>
</ul>

Technological treatments available for motion sickness include:

1. Wearable Devices: There are several wearable devices available that can help alleviate motion sickness. These devices work by using gentle electrical stimulation to target specific nerves in your body that are involved in motion sickness. One example is the ReliefBand, which is worn like a wristwatch and will deliver electrical pulses to the median nerve<a href="#accordion">[3]</a>. 
&nbsp;

2. Virtual Reality: Studies have shown that virtual reality can effectively treat motion sickness. A headset is used to simulate a different environment, such as a calm and stable room, which can help alleviate your symptoms of motion sickness<a href="#accordion">[7]</a>. 
&nbsp;

3. Transcranial Magnetic Stimulation (TMS): TMS is a non-invasive treatment that uses magnetic fields to stimulate specific areas of the brain. Studies have shown that TMS can be effective in reducing symptoms of motion sickness<a href="#accordion">[5]</a>. 
&nbsp;

4. Anti-Nausea Apps:There are several apps available that claim to reduce symptoms of motion sickness by providing visual and audio cues that help retrain the brain&rsquo;s response to the motion. One example is Sense Relief, which helps alleviate your symptoms of motion sickness<a href="#accordion">[8]</a>. 
&nbsp;

Not all of these treatments may work for everyone. It&rsquo;s always best to consult with a healthcare professional before trying any new treatment for motion sickness. 
&nbsp;

In conclusion, motion sickness is a complex condition that affects many people when traveling by any mode of transportation. While the exact causes of motion sickness are not fully understood, it is believed to be related to a mismatch between the signals received by the eyes, inner ears, and other sensory organs.

Fortunately, there are many treatments available for motion sickness, including traditional remedies, like ginger and acupressure, as well as newer technological interventions, like virtual reality and wearable devices. As our understanding of the underlying causes of motion sickness continues to improve, it is likely that even more effective treatments will be developed, making it easier for people to travel comfortably and without discomfort. 
&nbsp;

Key Takeaways

<ul>
	<li>Motion sickness, also known as kinetosis or travel sickness, has been a known phenomenon for thousands of years.</li>
	<li>Motion sickness occurs when the surrounding you are visualizing, is perceived differently by the inner ear.</li>
	<li>Motion sickness can occur in any vehicle including a car, as well as in a train, aircraft, boat, or a ride at an amusement park</li>
	<li>Symptoms of motion sickness include cold sweats, dizziness, tiredness, headache, and agitation.</li>
	<li>Whether you are looking to treat it or prevent it, motion sickness can be easily controlled.</li>
	<li>Antihistamines are frequently used to treat allergies, but they can help prevent motion sickness and alleviate its symptoms</li>
	<li>Studies have shown that virtual reality can effectively treat motion sickness. 
	&nbsp;</li>
</ul>

[1] Motion sickness: Symptoms, causes, treatment, prevention (no date) WebMD. WebMD.

[2] Motion sickness: Symptoms & treatment (no date) Cleveland Clinic.

[3] 0676 electrical stimulation for nausea, vomiting and motion ... - aetna

[4] Sea sickness could be cured by a mobile phone app (2015) The Independent. Independent Digital News and Media.

[5] Ciccone, A. (2022) Transcranial stimulation may help relieve, prevent motion sickness, Neurology Advisor.

[6] Kennedy, R. S., Lane, N. E., Berbaum, K. S., & Lilienthal, M. G. (1993). Simulator sickness questionnaire: An enhanced method for quantifying simulator sickness. The International Journal of Aviation Psychology, 3(3), 203-220