Morning sickness is one of the most common symptoms of pregnancy, affecting up to 80% of expectant mothers. Despite the name, it can occur at any time of day and range from mild nausea to severe vomiting. This episode provides a thorough deep dive into morning sickness during pregnancy. Explore the science behind its causes, including groundbreaking new research on the hormone GDF15. Review a full range of evidence-based remedies, from dietary changes and supplements to acupressure and prescription medications. Plus, this episode discusses hyperemesis gravidarum, how morning sickness impacts your quality of life, what research suggests about a possible protective effect, and how partners can assist. Whether you’re struggling with nausea, seeking relief, or simply want to understand why this happens, this episode has you covered.

Listen Now

This episode is made possible with support from our sponsors. I appreciate your support for the brands that help power this podcast.

Article and Resources

What Morning Sickness Is

Morning sickness is the common term for nausea and vomiting of pregnancy. It affects 70 to 80% of expectant mothers. Despite the name, morning sickness does not just happen in the morning. It can occur at any time of day and, for some women, it lasts all day. The medical term you may see in research is nausea and vomiting of pregnancy, or NVP.

Morning sickness is most common in the first trimester and can start as early as one to two weeks after conception. If you do experience morning sickness, symptoms typically begin before nine weeks. For most women, morning sickness resolves by about 14 weeks or at the start of the second trimester. However, for some women, symptoms persist well into the second trimester or, in rare cases, throughout the entire pregnancy. While figures vary slightly across studies, up to 15% of women experience nausea beyond 20 weeks.

The severity of morning sickness varies widely. Some women feel mildly nauseous for a short period each day. Others experience persistent nausea, frequent vomiting, and difficulty eating or drinking. Understanding where you fall on this spectrum can help you and your care provider decide on the best approach to managing symptoms.

What Causes Morning Sickness

We like to blame hormones for nearly everything that happens during pregnancy. For decades, researchers suspected that hormones play a role in morning sickness, but the exact mechanism was not well understood. That changed significantly with a landmark study published in Nature in 2023, which identified a hormone called GDF15 (Growth Differentiation Factor 15) as a major driver of nausea and vomiting during pregnancy.

GDF15 is a hormone that acts on the brainstem to cause nausea and vomiting. During pregnancy, the placenta produces GDF15 at very high levels. The study found that the vast majority of GDF15 in a pregnant woman’s blood comes from the feto-placental unit, meaning the baby and the placenta are the primary source. Higher levels of GDF15 in maternal blood are associated with more severe nausea and vomiting.

Here is where things get really interesting. The severity of morning sickness depends not just on how much GDF15 is produced during pregnancy, but also on how much exposure a woman had to GDF15 before pregnancy. Women who have naturally lower levels of GDF15 before becoming pregnant appear to be more sensitive to the dramatic rise that occurs in early pregnancy. This means the sudden increase from a low baseline to a high level during pregnancy may be what triggers the nausea. There is actually a blood condition called β-thalassemia that causes chronically high GDF15 levels. Women with this condition are already accustomed to elevated GDF15 levels. As a result, the increase during pregnancy is less of a shock, and they report very low levels of morning sickness.

This research is significant because it opens the door to potential future treatments. In the study, mice that were pre-treated with GDF15 became desensitized to it and showed fewer signs of nausea when exposed to high levels. Researchers are now exploring whether building up a woman’s tolerance to GDF15 before pregnancy could help prevent morning sickness. Several drugs that block the GDF15 pathway are currently in clinical trials for cancer patients with nausea and vomiting. Researchers hope these may eventually be tested for use during pregnancy.

In addition to GDF15, other hormones likely contribute. Human chorionic gonadotropin, known as hCG, is the hormone that gives you a positive pregnancy test. Morning sickness tends to peak around the same time hCG levels are highest, around 12 weeks. Estrogen, progesterone, and prostaglandin E2 have also been linked to nausea during pregnancy. A heightened sense of smell, which is very common in the first trimester, can also trigger or worsen nausea.

Risk Factors for Morning Sickness

There is no guaranteed way to predict whether you will experience morning sickness, but several factors make it more likely. Genetics plays a significant role. If your mother experienced morning sickness, you are more likely to as well. If you had morning sickness in a previous pregnancy, you have a higher chance of experiencing it again. Women who are prone to motion sickness or migraines are also at increased risk. If you have a history of nausea when taking birth control pills, which tend to be high in estrogen, you may be more susceptible. Expecting twins or multiples also increases the likelihood, because hCG levels tend to be higher in multiple pregnancies. Because the placenta produces GDF15, it is plausible that multiple pregnancies could also result in higher GDF15 levels, although this has not been specifically studied.

How Morning Sickness Affects Your Quality of Life

The effects of morning sickness extend well beyond physical discomfort. There is a mental and emotional component to morning sickness that is often not discussed. Having morning sickness can significantly affect your quality of life, especially in the first trimester when many women have not yet shared their pregnancy news. You may miss work, cancel plans, or struggle with everyday activities.

Research shows that morning sickness can significantly impact family life, the ability to perform usual daily activities, social functioning, stress levels, and even the intention to have more children. This study found that exercise was associated with a higher quality of life and better mental health. That is worth noting as a potential strategy to counteract the emotional side of morning sickness.

There is also an unspoken expectation that you should feel nothing but gratitude for being pregnant. While the opportunity to carry a baby is something to appreciate, that does not negate the real physical and emotional challenges of pregnancy. Feeling miserable does not make you any less grateful, nor does it diminish the value of your experience. It is completely valid to acknowledge that pregnancy is hard. You may have moments where you do not enjoy being pregnant, and that is not only okay, it is normal.

It is also worth remembering that most of what we see from expecting mothers online is the polished version of pregnancy: the weekly countdowns, cute outfits, and nursery photos. Most women are not posting about how terrible they feel. If you are struggling, know that you are far from alone.

The Protective Theory and Miscarriage Research

Many studies have explored whether morning sickness serves a protective purpose. One hypothesis is that nausea and aversion to certain foods may protect you and your baby from potentially harmful substances during a critical period of development. Nausea in early pregnancy can also alert you to the fact that you are pregnant, sometimes before a test would show a positive result. Because nausea and vomiting are linked to hormone production, experiencing these symptoms could also be a sign that your body and placenta are producing hormones needed for a healthy pregnancy.

A widely cited study made headlines when it found that morning sickness was associated with a reduced risk of miscarriage. However, there is nuance to this. This study specifically enrolled women who had already experienced one or two prior pregnancy losses, which could have been a higher-risk group to begin with. For this group, nausea and vomiting were common very early in pregnancy and were associated with a lower risk of pregnancy loss. According to this research, morning sickness is a positive sign of a healthy pregnancy.

The flip side of these findings can create unnecessary anxiety. If you are not experiencing morning sickness, it does not mean something is wrong. One study did not show an association between the absence of nausea and vomiting and an increase in the overall rates of major malformations. This conversation is still evolving, and there is much we do not yet know. If it helps to think that nausea may be a positive sign for your pregnancy, that is great. However, do not stress if you are symptom-free. Plenty of healthy pregnancies occur without a single day of nausea.

Hyperemesis Gravidarum

On the severe end of the spectrum is hyperemesis gravidarum, often abbreviated as HG. This is more than just severe morning sickness. Hyperemesis gravidarum is a serious medical condition characterized by persistent nausea and vomiting that leads to significant weight loss, typically more than 5% of pre-pregnancy weight, along with dehydration and metabolic disturbances. It affects approximately 0.3 to 3% of pregnancies and is a leading cause of hospitalization in the first half of pregnancy.

The symptoms of hyperemesis gravidarum typically begin between four and six weeks and can persist well beyond the first trimester. In some cases, symptoms continue throughout the entire pregnancy. Common clinical signs include dehydration, ketonuria (high levels of ketones), electrolyte imbalances, and orthostatic hypotension (sudden drop in blood pressure). If left untreated, complications can include Wernicke encephalopathy, a rare but serious neurological condition caused by thiamine (B1) deficiency, as well as other nutritional deficiencies.

The GDF15 research discussed earlier has provided major insight into why some women develop hyperemesis gravidarum. Women with HG tend to have significantly higher circulating levels of GDF15 during pregnancy. Those with a genetic predisposition to lower GDF15 levels before pregnancy appear to be hypersensitive to the rapid rise that occurs when the placenta begins producing it.

If you are experiencing severe nausea and vomiting, are unable to keep food or fluids down, are losing weight, or feel dizzy or faint, please get in touch with your doctor or midwife as soon as possible. Do not wait for your next scheduled prenatal appointment. Hyperemesis gravidarum can require medical intervention, and there are treatments like IV fluids, electrolyte replacement, and medications.

Early treatment matters because morning sickness can escalate if left untreated. When nausea goes unmanaged, it can lead to not eating, which drops your blood sugar, which makes the nausea worse. That cycle can lead to dehydration, which makes everything harder to manage and can eventually result in hospitalization. ACOG emphasizes that treating symptoms early, even with simple dietary changes or vitamin B6, can help prevent that cycle from taking hold. If you wait until symptoms are severe, they can be much harder to bring under control. The takeaway is that you do not need to tough it out. Addressing symptoms early, even mild ones, gives you the best chance of keeping them manageable.

Navigating Morning Sickness: Practical Strategies

Now that we have covered the science behind why morning sickness happens, let’s get into practical strategies to help you find relief. Everyone is different, and what works for one expecting mother may not work for you. Finding the right approach often involves trial and error. One helpful strategy is to keep a journal to track your symptoms, what you eat, and what seems to help or worsen your nausea. Over time, you may identify patterns that make it easier to manage your nausea.

Dietary Strategies

What and how you eat can make a real difference in managing morning sickness. One of the most important strategies is eating small, frequent meals throughout the day. An empty stomach can make nausea significantly worse, so avoiding long gaps between meals is key. Instead of three large meals, try eating five or six smaller meals or snacks spaced throughout the day.

You may want to eat something first thing in the morning, even before getting out of bed. Your blood sugar levels drop during the night, and waking up with low blood sugar can contribute to nausea. Keeping crackers or a small dry snack within reach so you can eat a few bites before you even sit up is a widely recommended strategy. This is one of the most commonly cited tips in clinical guidelines, including those from ACOG.

Including protein in every meal or snack can also help. Protein is digested more slowly than carbohydrates, which helps stabilize blood sugar and may reduce the likelihood of feeling weak, lightheaded, or hungry, all of which can trigger nausea. Good protein-rich options include nuts, cheese, yogurt, eggs, and nut butters. Even adding a small amount of protein to a carbohydrate-heavy snack, like pairing crackers with cheese or toast with nut butter, may help.

When it comes to what to eat, easy-to-digest foods are usually best tolerated. ACOG suggests the BRATT diet as a starting point: bananas, rice, applesauce, toast, and tea. These foods are low in fat, bland, and gentle on the stomach.

Cold or room-temperature foods may be easier to manage than hot foods because strong food odors can be a major trigger for nausea, especially with the heightened sense of smell that is common in early pregnancy. If cooking smells are a problem, consider asking your partner or someone else to handle food preparation, relying on meals that require minimal cooking, or opening windows and using a fan while food is being prepared.

Staying Hydrated

Staying hydrated is crucial, especially if you are vomiting. Dehydration can make nausea worse and lead to additional complications. If drinking water is difficult, there are alternatives worth trying. Sparkling water can be helpful because the carbonation may settle your stomach. Sucking on ice chips, frozen fruit popsicles, or slowly sipping cold liquids can make hydration more manageable. Some women find that drinking through a straw helps them consume more fluids. The key is to drink in small amounts throughout the day rather than trying to drink a large volume all at once.

Supplements

If your prenatal vitamin is making your nausea worse, try taking it with a meal or a snack, or switch to taking it at night before bed. Interestingly, research shows that taking a prenatal vitamin before and during pregnancy may reduce the severity of morning sickness.

There is evidence that vitamin B6, also known as pyridoxine, may reduce nausea in pregnant women. ACOG recommends vitamin B6 as a safe, over-the-counter first-line treatment for nausea and vomiting of pregnancy. Please consult with your doctor or midwife before starting any new supplement, including B6, so that they can advise on the right dosage and factor in any specifics of your pregnancy.

Ginger

Ginger is another option with research to support it. A systematic review and meta-analysis found that ginger significantly reduced nausea symptoms compared with a placebo. You can consume ginger in many forms, including ginger tea, ginger candies, ginger supplements, or ginger ale.

If you drink ginger ale hoping to get the anti-nausea benefits of ginger, you should know that most commercial ginger ale brands contain very little actual ginger. Major brands like Canada Dry and Schweppes list less than 2% ginger extract in their ingredients. The parent company of both brands paid over $11 million in legal settlements for misleading marketing about their ginger content. In addition to containing minimal ginger, most commercial ginger ale is high in sugar or high fructose corn syrup.

Ginger beer typically contains more real ginger than ginger ale, which is why it has a stronger, spicier flavor. However, it can also be high in sugar. If you want the actual therapeutic benefit of ginger, your best options are ginger tea brewed from fresh ginger root, ginger supplements, or ginger candies that list real ginger as a primary ingredient. These are more likely to provide the active compounds that research has shown to be effective. As with any supplement, talk to your doctor or midwife about the right approach for you.

Lemons

Lemons are one of the most widely used natural remedies for pregnancy nausea, and research supports their effectiveness. One study found that 40% of women used lemon scent to relieve nausea and vomiting during pregnancy, and about 27% reported it was effective.

The exact mechanism behind why lemon helps with nausea is not fully understood, but there are a few theories. The strong, clean citrus scent may help override the unpleasant odors that often trigger nausea during pregnancy, effectively distracting the brain from nausea signals. Citric acid, one of the main compounds in lemon, may also have a calming effect on the stomach by stimulating areas of the brainstem involved in regulating nausea and vomiting. For many women with a heightened sense of smell during pregnancy, the sharp, fresh aroma of lemon appears to cut through environmental smells that worsen nausea.

You can try smelling a fresh lemon, squeezing a wedge into a glass of water, inhaling lemon essential oil, or using lemon in foods and drinks. Because lemon is widely available, inexpensive, and has no known risks in normal amounts, this is an easy remedy to try.

Essential Oils and Aromatherapy

While certain smells can trigger nausea, some scents may actually help relieve it. The essential oils most commonly recommended for morning sickness are lavender, ginger, peppermint, spearmint, and citrus oils like lemon, grapefruit, lime, and orange.

One study examined the effects of inhaling lemon essential oil when participants first felt nauseous. Researchers found a greater decrease in morning sickness with lemon oil inhalation than with a placebo on the second and fourth days of the study. Another study that combined lemon and peppermint essential oils found that nausea and vomiting intensity decreased significantly in the treatment group compared to the placebo on days two, three, and four. In both studies, the differences between the treatment and control groups were not significant on the first day but became significant on subsequent days. This suggests that essential oils may be more effective with consistent, repeated use rather than a single application. A complete episode examines the safety and evidence behind essential oils during pregnancy.

Movement, Fresh Air, and Positioning

Simple changes in your environment and position can help reduce nausea. Stuffiness indoors may worsen symptoms, so opening a window or stepping outside for fresh air can help. Gentle movement, like a short walk, may help you feel better. Avoid lying down immediately after eating, as this can slow digestion and contribute to acid reflux, which can make nausea worse. Sitting upright or slightly reclined after meals is generally better.

Acupressure and Acupuncture

Acupressure and acupuncture are both traditional practices that involve stimulating specific points on the body to relieve symptoms. Acupressure uses physical pressure, typically from your fingers or a wearable device, while acupuncture uses thin needles inserted by a trained practitioner. Both have been studied as treatments for nausea during pregnancy.

The most commonly studied point for nausea relief is called P6. It is located on the inside of your wrist, about three finger-widths below the base of your palm, between the two tendons. You may have seen wristbands marketed as sea bands or anti-nausea bands. These are the same wristbands people wear for motion sickness, and they work by applying constant, gentle pressure to the P6 point. They are widely available at pharmacies and drugstores, are inexpensive, and have no known side effects. One study found a statistically significant effect of acupressure at the P6 point in reducing the degree of nausea and vomiting in women with hyperemesis gravidarum. Because these wristbands are low-risk and easy to use, they are worth trying, even if they provide only modest relief.

Acupuncture takes a different approach. Rather than applying pressure, a trained acupuncturist inserts very thin needles at specific points on the body to stimulate those areas. There is some evidence that acupuncture can improve symptoms of nausea and vomiting during pregnancy. The main considerations with acupuncture are the time and cost of seeing a professional. However, if other remedies are not providing enough relief, it may be worth exploring as an additional option.

Prescription Medications

If lifestyle changes and over-the-counter remedies are not providing enough relief, prescription options are available. Many women do not seek treatment for morning sickness because of concerns about medication safety during pregnancy. It is important to know that well-studied options exist, and that untreated morning sickness that progresses can become harder to manage. When nausea goes unaddressed, it can start a cycle where not eating drops your blood sugar, which worsens the nausea, which leads to dehydration, which makes everything harder to bring under control. Addressing symptoms early gives you the best chance of keeping them manageable and can help prevent more serious complications, including hospitalization.

ACOG provides a stepwise treatment algorithm for morning sickness. The first step is dietary and lifestyle changes. If those are not sufficient, vitamin B6 is recommended as a first-line treatment. If B6 alone is not enough, doxylamine, an antihistamine found in some over-the-counter sleep aids, can be added.

Understanding how these medications work can help you feel more confident about discussing them with your care provider. Vitamin B6 is involved in the production of neurotransmitters, including serotonin and dopamine, which play a role in how your brain processes nausea. While the exact mechanism is not fully understood, supplementing with B6 appears to help regulate these signals and reduce nausea for many women.

Doxylamine is an antihistamine that works by blocking histamine receptors. By blocking those receptors, doxylamine helps reduce the nausea signal. This is the same reason antihistamines are used for motion sickness. A common side effect of doxylamine is drowsiness, which is why it is also the active ingredient in certain over-the-counter sleep aids. When B6 and doxylamine are used together, they act through two distinct pathways to reduce nausea, which is why the combination is often more effective than either alone.

The combination of doxylamine and B6 has been used to treat morning sickness since the 1950s. A prescription medication called Diclegis combines doxylamine and pyridoxine (vitamin B6) in a delayed-release tablet. It is currently the only FDA-approved medication specifically indicated for nausea and vomiting of pregnancy. Diclegis is the most extensively studied medication for nausea and vomiting of pregnancy, with safety data from more than 200,000 pregnancies. The most common side effect is drowsiness.

It is worth noting that both doxylamine and vitamin B6 are available individually over the counter. However, the prescription delayed-release formulation is specifically designed to provide sustained relief throughout the day and night, whereas the individual over-the-counter versions do not offer this. If you and your care provider decide to try the over-the-counter route, ensure you purchase the correct product. Doxylamine is the active ingredient in Unisom SleepTabs specifically. Other Unisom products contain a different antihistamine called diphenhydramine, which is not the same medication.

If the doxylamine-pyridoxine combination does not provide adequate relief, your care provider can discuss additional options. Ondansetron, which you may know by the brand name Zofran, is an anti-nausea medication originally developed to treat nausea and vomiting caused by chemotherapy. It works by blocking serotonin receptors in the brain and gut. Serotonin is one of the key chemical signals involved in triggering the nausea and vomiting reflex. By blocking those receptors, ondansetron can significantly reduce symptoms. It is not FDA-approved for use in pregnancy specifically, but it is commonly prescribed off-label for cases of morning sickness that do not respond to B6 and doxylamine. If your care provider recommends ondansetron, they can discuss the evidence and help you weigh the benefits and risks for your situation.

The key takeaway is that safe treatments exist, and you do not have to suffer through morning sickness without help. Talk to your doctor or midwife if you are struggling. Starting treatment early, even with something as simple as vitamin B6, can help prevent symptoms from escalating.

Protecting Your Oral Health

One often-overlooked consequence of morning sickness is its effect on your teeth. If you are vomiting frequently, your tooth enamel is repeatedly exposed to stomach acid. Over time, this can erode the enamel and increase your risk of cavities.

Here is a tip that might seem counterintuitive. Do not brush your teeth immediately after vomiting. Brushing while stomach acid is still on your enamel can actually scratch and further damage it. Instead, rinse your mouth with a mixture of about one teaspoon of baking soda in a cup of water. The baking soda helps neutralize the acid. Wait at least 30 minutes after vomiting before you brush. This small adjustment can make a real difference in protecting your teeth during pregnancy.

Cannabis During Pregnancy

As cannabis becomes more widely legal and accessible, some expecting mothers wonder whether it could help with morning sickness. Cannabis has long been used to treat nausea in other medical contexts, such as chemotherapy, which makes this a natural question. Let’s look at what the research and current medical guidelines say.

In 2025, the American College of Obstetricians and Gynecologists published a comprehensive clinical consensus on cannabis use during pregnancy and lactation. ACOG’s recommendation is clear that there is no medical indication for cannabis use during pregnancy. They advise that clinicians should counsel patients to discontinue cannabis use during pregnancy and lactation and work with them to find alternative methods to address health concerns. This goes for consuming cannabis in any form.

The research behind this recommendation shows that cannabis use during pregnancy has been associated with adverse outcomes, including spontaneous preterm birth, low birth weight, NICU admissions, and postnatal neurocognitive and behavioral effects in children. To understand why, it helps to know a little about how cannabis interacts with the body. Cannabinoid receptors are proteins found throughout your body, including in the brain, gut, and reproductive tissues. These receptors respond to compounds found in cannabis, known as cannabinoids, the most well-known being THC. When THC enters your body, it binds to these receptors and produces its effects, including changes in mood, appetite, and nausea.

The reason this matters during pregnancy is that THC crosses the placenta, meaning it reaches your baby. The fetus begins developing cannabinoid receptors very early, as early as five weeks of gestation, which is before most women even know they are pregnant. This means THC reaching the fetus could interact with these developing receptors during a critical period of brain and organ development. THC is also transferred through breast milk, which is why ACOG recommends against cannabis use during both pregnancy and lactation.

It is important to know that medical marijuana is not safer than recreational cannabis. Both contain the same active compounds. CBD products are also not recommended during pregnancy. The FDA does not regulate CBD, and many products have been found to contain THC and other contaminants.

If you are using cannabis to manage nausea, anxiety, pain, or other symptoms, please talk to your care provider. This is a topic I would like to explore in more detail in a future episode, but the current evidence supports avoiding cannabis during pregnancy.

How Partners Can Help

Your partner can play an important role in helping you navigate morning sickness. Even small gestures can make a big difference when you are dealing with constant nausea, and letting your partner know what you need is a good place to start.

One of the most practical things your partner can do is take over cooking and food preparation, especially if food smells are triggering your nausea. Opening windows, running a fan while cooking, or preparing cold meals with less odor can all help. Having your partner keep the kitchen stocked with snacks you can tolerate, like crackers, ginger tea, or whatever is working for you, means you always have something available. Keeping water, sparkling water, or ice chips readily available is another simple way they can support you.

Beyond the practical side, emotional support matters just as much. It can be really helpful when your partner acknowledges that what you are going through is real and difficult, rather than minimizing it by saying it will pass or that it is normal. While both of those things may be true, they can feel dismissive when you are in the thick of it. What tends to help more is when your partner asks what you need, takes on extra responsibilities around the house without being asked, and is patient on the hard days. If you are struggling significantly, your partner can also encourage you to talk to your care provider or offer to come with you to a prenatal appointment. Attending appointments together is a great way for both of you to stay informed and for your partner to hear directly from your doctor or midwife about how they can help support you.

Talking to Your Doctor or Midwife

Most morning sickness is a normal, temporary part of pregnancy and does not require medical intervention beyond lifestyle changes. However, there are situations where you should contact your care provider. These include being unable to keep fluids down for 24 hours, losing weight, dark-colored urine, feeling dizzy or faint, or a rapid heartbeat. These can be signs of dehydration or hyperemesis gravidarum and should not be ignored.

You should also talk to your provider if nausea is making it difficult to eat enough to meet your basic nutritional needs over time. If you are craving non-food items, this can indicate an underlying nutritional deficiency and may be a condition called pica, which you should discuss with your care provider. In the vast majority of cases, morning sickness is temporary, but your provider is there to help if things feel unmanageable. Do not hesitate to reach out between appointments if you need support.

Even if your morning sickness feels manageable, it is worth discussing your symptoms with your doctor or midwife. They may have suggestions you have not considered, and it is always helpful for your care provider to know what you are experiencing. Keeping them informed about your symptoms is part of good prenatal care.

Thank you to the brands that help power this podcast.