Acupuncture for morning sickness

Nausea during pregnancy: Dietary & lifestyle advice

What will be covered in this article?

  • An overlook of pregnancy related nausea and vomiting, including more severe cases seen in Hyperemeresis Gravidarum
  • Current western medicine treatments
  • The Chinese medicine diagnosis and treatment for pregnancy related nausea and vomiting
  • Pericardium 6 acupressure point to reduce nausea in pregnancy
  • Dietary lifestyle tips: Timing of meals, dietary suggestions, and temperature of foods or beverages according to Chinese medicine body constitution.

Morning sickness, both mild and severe:

Pregnancy nausea and vomiting (PNV), sometimes referred to as “morning sickness,” impacts approximately 70% of women during the first trimester of pregnancy. Hyperemesis gravidarum (HG) is considered a more serious form of PNV and is categorised by severe nausea and vomiting which strongly limits daily activities and causes an inability to eat or drink normally. HG is deemed more problematic during pregnancy due to increased risk of dehydration, weight loss, electrolyte deficiency or malnutrition [1].

Although the exact cause of PNV and HG are unknown, some studies indicate that genetics and hormonal changes are potential causes for both conditions. In particular, fluctuations in Human chorionic gonadotropin (hCG), often termed the ‘pregnancy hormone’, has long been considered as a factor, due to PNV and HG occurring when hCG levels are also peaking during the first trimester. Other potential causes include fluctuations in thyroid hormone (T4), estrodiol and progesterone, or due to upper gut motility issues and gut infections like heliobacter pylori (HP) [2].

Current western treatments:

Western medicine offers various treatment options to manage PNV and HG. The severity of symptoms often dictates the treatment approach, which ranges from dietary and lifestyle changes to pharmacological interventions.

  1. Antihistamines are often combined with pyridoxine (vitamin B6) to manage mild to moderate nausea and vomiting during pregnancy. This combination is generally considered safe and is among the first-line treatments.
  2. For more chronic and severe cases of PNV and HG, stronger anti-nausea medications like ondansetron may be prescribed. However, these medications may cause side effects such as headaches, fatigue, constipation issues, QT prolongation (rapid heart rate and arrhythmias), and serotonin disorder in rare cases [3].
  3. In severe cases of HG, hospitalisation may be required for intravenous fluid replacement to correct dehydration and electrolyte imbalances. Nutritional supplements may also be administered intravenously if required.

Chinese medicine perspective:

Chinese medicine considers multiple internal patterns which can lead to recurring or prolonged causes of nausea during pregnancy. The most common pattern associated with PNV or HG is a conflict between the Liver, Spleen and Stomach organs, also called Wood-Earth disharmony in Chinese medicine.

The role of the Stomach is to move Qi downwards, aiding digestion and moving food through the digestive tract. However, during pregnancy the Liver can become too strong and interfere or control the function of the Spleen and Stomach, leading to reversal of Stomach Qi. The most common resulting symptoms in Wood-Earth disharmony include nausea, vomiting, reflux, constipation and stool changes. 

Chinese herbs

A Wood-Earth disharmony can be further complicated by various internal patterns such as:

  1. Damp-Water accumulation: Postural dizziness/light-headedness, heart palpitations, anxiety, brain fog, lack of thirst, frequent urination, nausea and vomiting soon after ingesting fluids.
  2. Internal Cold: Cold hands and feet, aversion to cold and preference for warmth, nausea, epigastric pains, reflux and loose stools.
  3. Internal heat: Warm limbs, aversion to heat, frequent thirst and preference for cold fluids, feeling hot and flushes, irritability, insomnia, constipation and darker urine. Nausea can feel worse after warm fluids or spicy and greasy foods.

It is important to note that the above examples are only a handful of Chinese medicine patterns in pregnancy induced nausea or vomiting. A proper diagnosis and treatment plan should be given by a qualified practitioner of Traditional Chinese Medicine who can diagnose the cause of PNV or HG, based on the individuals signs and symptoms.

Acupuncture for nausea:

Pericardium 6 (PC6) is by far the most commonly used point for nausea or vomiting and has also shown in numerous clinical trials to be effective for PNV [4]. PC6 has a dual function as it connects with the Stomach channel and also directly treats the chest and upper epigastric region. This makes PC6 an ideal point for addressing nausea, vomiting, hiccups, bloating and reflux. As PC6 enters the chest and Heart region, it is often used for sleep and mood symptoms, such as anxiety, heart palpitations and insomnia.

Pericardium 6. Acupuncture for nausea in pregnancy.

PC6 can be easily located and stimulated at home using gentle acupressure. The point itself is located approximately 3 centimetres from the middle wrist crease between the two tendons of the inner forearm. Press around this area until you find a dull-achey spot and then stimulate this point for 5-10 minutes using gentle-to-moderate pressure. You can either press down and hold this point, or more effectively stimulate using an intermittent pulsing rhythm.

Chinese medicine dietary lifestyle tips:

The following Chinese medicine dietary and lifestyle tips serve as a general guide to managing nausea and vomiting during pregnancy, and in clinic have demonstrated to help reduce the intensity and frequency of PNV for most patients. If the nausea is moderate to severe, it is advisable to manage the condition with both western treatment and Chinese medicine in combination with dietary lifestyle changes.

General dietary focus:

In TCM, supporting the Spleen and Stomach is crucial, particularly during pregnancy when the body is in a state of constant change. Baked vegetables can provide a beneficial and gentle way to nourish these organs without overwhelming the digestive system. Vegetables like sweet potatoes, carrots, and pumpkins are particularly beneficial as they are not overly sweet and can strengthen the Spleen and Stomach Qi.

Acupuncture for nausea. TCM foods for nausea. Pumpkin. Sweet potato, root vegetables.

Start the day with something small and bland:

In Chinese medicine, each of the six flavours bitter, sweet, bland, sour, aromatic and salty have effects on the organs and movement of Qi. Many patients suffering from PNV or HG often have difficulties with strong tastes and smells, especially sweet, spicy and heavy flavours, as these flavours tend to generate Dampness and Heat in the Spleen and Stomach (Earth Element). The ‘bland’ flavour belongs to the Earth Element but is light and neutral, and therefore does not contribute to Dampness. Based on this idea, it is advisable to consume a small bland snack upon waking.

Example foods:

  1. Dry crackers
  2. A piece of plain toast
  3. A small handful of dried plain nuts
  4. Dried raisins
  5. Miso soup
  6. A small bowl of congee/rice porridge with ginger

Small frequent meals:

Another strategy for managing nausea in pregnancy is consuming small frequent meals every 2-3 hours or prior to feeling hungry. The focus on small regular meals is to reduce the burden on the Spleen and Stomach and maintain stable blood sugar levels, which in turn can alleviate nausea [6].

Consume protein rich meals:

Incorporating protein-rich foods into one’s diet can also assist in managing nausea during pregnancy. Proteins are broken down into amino acids, which help to stabilise blood sugar levels and in turn, alleviate or prevent nausea. According to a previous study, higher protein intake in pregnant women was associated with a reduced risk of gestational nausea and vomiting.

Cooked salmon. Healthy eating.

Protein may help to slow the stomach’s emptying process, thus stabilising digestion and reducing the occurrence of nausea [5]. As its advisable to avoid highly fatty or strong tasting foods for PNV, instead focus on eating plain lean meats like chicken, turkey and firm cooked tofu.

Adequate hydration:

It is highly important to maintain adequate hydration during pregnancy. This is essential to reduce the intensity and frequency of PNV and to prevent electrolyte imbalances. A dry mouth, dry lips and concentrated urine are frequent signs which could indicate that the body is not adequately hydrated or absorbing fluids efficiently. In Chinese medicine, the optimal colour for urine should be a mild hay-coloured yellow. Completely clear urine means overconsumption of fluids, and yellow concentrated urine means under-hydration.

During pregnancy many mums may notice they find it difficult to consume water. The key focus should be having small frequent sips rather than big gulps all at once. Miso soups, warm herbal teas (ginger, chamomile, peppermint) and sparkling mineral water with a small amount of lemon or lime may also be helpful alternatives to increase fluid intake.

Warm or Cool fluids?

According to Chinese medicine, all fluids should be predominately consumed either warm or hot. However, in clinic it has been found that some consideration should be given based on the patient’s overall presenting symptoms.

Heat-type person:

Some women may find that consuming room temperature to slightly cooler water reduces nausea if their predominate symptoms are ‘heating’ in nature. Example symptoms include feeling hot and restless, aversion to warm or warm-humid environments, recurring headaches, strong hunger, constant dry mouth or thirst, proneness to constipation, dry stools or yellow urination.

Cool-type person:

If on the other hand the predominate symptoms are cold limbs, aversion to cold environments, fatigue, bloating, loose stools, lack of thirst and clear urination, then warmer beverages will be more beneficial for women suffering from PNV.

Ginger tea:

Ginger is often used in Chinese herbal formulas to disperse stagnant Damp-Water from the Spleen, harmonise the Stomach Qi and reduce digestive symptoms such as nausea, vomiting, reflux, gurgling intestines and loose stools.

Ginger tea for nausea in pregnancy

Ginger has also been widely researched for its anti-nausea effects and is considered safe during pregnancy. Ginger contains compounds like gingerol and shogaol, which are believed to exert its anti-nausea effects. These compounds may also influence gastrointestinal motility and gastric emptying rates, assisting with digestion. A systematic review in the journal Integrative Medical Insights, concluded that that ginger can be an effective treatment for nausea and vomiting during pregnancy and poses minimal risk [7]. Aside from ginger tea, many mums will report that chamomile, peppermint or lemon tea also help to reduce nausea and settle their digestion.

Closing thoughts

The suggestions in this article are commonly used in clinic for mild to moderate pregnancy related nausea or vomiting. Many times these dietary adjustments are enough to reduce the intensity and frequency of nausea or vomiting. However, if symptoms persist it may be necessary to see a trusted GP and/or Chinese medicine practitioner to support the body and reduce the symptoms, especially if the symptoms become severe or debilitating.

Liu, C., Zhao, G., Qiao, D., Wang, L., He, Y., Zhao, M., Fan, Y., & Jiang, E. (2022). Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities. Frontiers in medicine8, 809270.

Lee, N. M., & Saha, S. (2011). Nausea and vomiting of pregnancy. Gastroenterology clinics of North America40(2), 309–vii.

Abramowitz, A., Miller, E. S., & Wisner, K. L. (2017). Treatment options for hyperemesis gravidarum. Archives of women’s mental health20(3), 363–372.

Mohd Nafiah, N. A., Chieng, W. K., Zainuddin, A. A., Chew, K. T., Kalok, A., Abu, M. A., Ng, B. K., Mohamed Ismail, N. A., & Nur Azurah, A. G. (2022). Effect of Acupressure at P6 on Nausea and Vomiting in Women with Hyperemesis Gravidarum: A Randomized Controlled Trial. International journal of environmental research and public health, 19(17), 10886.

Jednak, M. A., Shadigian, E. M., Kim, M. S., Woods, M. L., Hooper, F. G., Owyang, C., & Hasler, W. L. (1999). Protein meals reduce nausea and gastric slow wave dysrhythmic activity in first trimester pregnancy. The American journal of physiology, 277(4), G855–G861.

Crozier, S. R., Inskip, H. M., Godfrey, K. M., Cooper, C., Robinson, S. M., & SWS Study Group (2017). Nausea and vomiting in early pregnancy: Effects on food intake and diet quality. Maternal & child nutrition13(4), e12389.

Lete, I., & Allué, J. (2016). The Effectiveness of Ginger in the Prevention of Nausea and Vomiting during Pregnancy and Chemotherapy. Integrative medicine insights11, 11–17.

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