Morning Sickness
Q: I'm pregnant and have been throwing up occasionally, but not always in the morning. How do I know if it's morning sickness or something else?
Dr. Donnica: Morning sickness may be accompanied by a mild headache, dizziness, or abdominal discomfort. It is NOT characterized by abdominal pain, cramping, or fever; if these symptoms are present, you should contact your physician. Remember that just because you're pregnant and have nausea and/or vomiting, it's not necessarily due to morning sickness. You could have the flu, food poisoning, appendicitis or anything else that causes nausea or vomiting in a non-pregnant woman. In fact, acute appendicitis is the most common non-obstetric surgical condition in pregnancy; gallbladder surgery is second. The risk of gallstones and other gallbladder problems actually increases in pregnancy as well.
Levels of HCG peak in the 8th - 9th week of pregnancy; generally morning sickness diminishes by the 12th - 14th week of pregnancy and concludes by the 16th week of pregnancy. For a minority of patients, morning sickness continues daily for nine months with fluctuations in severity.
Severe, persistent vomiting during pregnancy is generally not morning sickness: this is a condition called hyperemesis gravidarum, which occurs in about one in 200 pregnancies. Hyperemesis refers to continual or profuse vomiting that begins before 20 weeks of pregnancy, is not associated with other medical problems, and causes weight loss, dehydration, disturbed nutrition, or electrolyte imbalance. It requires hospitalization and intravenous fluids along with psychological counseling and other support. Risk factors for hyperemesis include having a first pregnancy, having had previous hyperemesis, or having twins or other multiple gestations. This was once thought to be a psychological condition in women who did not want to be pregnant; this has been disproven. A very rare risk factor for hyperemesis is a condition called "molar pregnancy" (or hyatidiform mole). This is a tumor of fetal tissue origin that is not developing into a baby. Patients with hyperemesis will have an ultrasound as soon as possible to rule out these possibilities.
Call your doctor if:
If you have any severe abdominal pain or lower abdominal cramping.
You can't keep any food down at all for 2 consecutive mealtimes.
You can't keep fluids down for 4 hours.
If you vomit up any blood or anything resembling coffee grounds
If you lose more than 2 pounds.
If you have not been able to urinate for 6 hrs.
If you have signs of appendicitis: nausea and/or vomiting along with pain in the belly-button area or the lower right side of the abdomen, with or without a slightly elevated fever.
If you have a fever greater than 101.5 degrees.
It you have signs of gallbladder problems: nausea and/or vomiting along with right upper abdominal pain, especially after eating.
If morning sickness persists past 16 weeks of pregnancy
If you do not gain any weight in the first 14 weeks of pregnancy.
Created: 9/24/2000 - Donnica Moore, M.D.
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 Severe, persistent vomiting during pregnancy is generally not morning sickness: this is a condition called hyperemesis gravidarum, which occurs in about one in 200 pregnancies. 
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