Is Absence of Morning Sickness a Sign of Miscarriage?

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Morning sickness during pregnancy is very common, but it's not the rule. While most people do have nausea and even vomiting at some point in their pregnancy (that is not necessarily limited to the morning hours), there are also people who do not have these symptoms who have healthy, uncomplicated pregnancies.

Some research has claimed that pregnant people who experience morning sickness have a statistically lower risk of miscarriage. Another study found that in people who had experienced a prior miscarriage, the symptoms of morning sickness were associated with reduced risk for pregnancy loss in subsequent pregnancies.

However, if you do not have morning sickness, that doesn't mean it's a cause for concern. Just as research has not found that having morning sickness is a sign of a healthy pregnancy, not having morning sickness doesn't necessarily mean there is something wrong with your pregnancy.

Here's what is known about morning sickness, pregnancy, and miscarriage risk, as well as when you should talk to your healthcare provider about your symptoms.

What Is "Morning Sickness?"

Experiencing nausea and vomiting in the first three to four months of pregnancy is often referred to as having "morning sickness"—despite the fact that it can happen at any time of day, not just in the morning.

Morning sickness usually resolves on its own in a few months. However, it is still normal for morning sickness to occur at any point during pregnancy.

While the symptoms can be uncomfortable and disruptive, they generally do not pose a risk to a pregnant person or the fetus.

How Common Is Morning Sickness?

As many as 80% of people experience nausea (with or without vomiting) at some point in their pregnancy. That means as many as 20% have no morning sickness, and many of these people go on to have a healthy, uncomplicated pregnancy.

Of the people who do experience symptoms of morning sickness, most report that the symptoms resolve by week 22 of pregnancy. However, about 10% of pregnant people have morning sickness that lasts up until they give birth.

Hyperemesis Gravidarum

Severe morning sickness is known as hyperemesis gravidarum. It occurs in only about 3% of pregnancies, but it can be serious. There's no single reason why some people get the condition and others do not, but genetics are thought to play a role in an individual's risk.

A person with hyperemesis gravidarum experiences severe vomiting on a daily basis, which leads to dehydration and weight loss. While a little weight loss during the first trimester can be normal, losing 5% of your body weight or more is not.

Lack of Morning Sickness

About one-third of pregnant people in Western society do not report any symptoms associated with morning sickness. In several non-Western societies, morning sickness is less common—in some places, morning sickness has never been documented.

In at least seven traditional societies, there is a known lack of morning sickness in pregnant people. While the research is not definitive, it's been theorized that the plant-based, whole-food diets these cultures follow might contribute to their lower rates of morning sickness.

Fluctuations in pregnancy symptoms are normal and there can be a wide variation between pregnant people. While it can be hard not to worry and you do want to pay attention to how you are feeling, try not to overanalyze your pregnancy symptoms.

A lack of morning sickness is not a symptom of miscarriage or a sign of increased risk. However, if morning sickness and other symptoms of pregnancy suddenly go away, this could be a sign of pregnancy loss.

Causes

Several factors are believed to contribute to morning sickness, including the hormonal changes of pregnancy and genetics.

While many pregnant people have morning sickness, there are also people who do not experience any nausea and have completely healthy pregnancies.

The possible causes of morning sickness symptoms that have been the most well-studied are biological factors such as levels of pregnancy-specific hormones (beta hCG, estrogen, and progesterone) and genetic influences.

During the first trimester of pregnancy (when morning sickness symptoms tend to be worst), several major hormonal shifts take place. Pregnant people who have higher levels of hCG (such as those carrying multiples or a female fetus) often have worse symptoms of morning sickness.

For example, a study in Japan in 2018 found that pregnant people who were carrying a female fetus had more severe morning sickness than people carrying a male fetus. Morning sickness was also noted to be worse in people who were carrying multiples—especially if one or more fetuses were female. However, the link is not definitive, and several other studies have found no association between the severity and duration of morning sickness symptoms and hormone levels.

Your genetics likely also plays a role in whether you'll experience morning sickness. Research has shown that the tendency for nausea and vomiting during pregnancy seems to run in families.

Does Morning Sickness Have a Purpose?

If you've experienced morning sickness, you might wonder if there is a reason for all the discomfort. While the exact purpose of morning sickness is unknown, there are several proposed theories.

For example, it's been suggested that nausea and vomiting in early pregnancy could be an evolutionary "trick" to ensure a pregnant person is paying enough attention to their diet and nutrition.

Another theory is that vomiting, in particular, might be a safeguard against toxic substances that could harm a pregnant person or fetus.

Treatment

As mentioned previously, your diet might be a protective factor. If you are pregnant and do not have any symptoms of morning sickness, consider whether what you eat could partially explain your lack of symptoms.

If you have morning sickness, you might find that making some changes to your diet can help ease or prevent symptoms.

Dietary changes you might want to try include:

  • Drinking plenty of fluids
  • Eating five or six small meals a day rather than three big meals
  • Following the BRAT (bananas, rice, applesauce, and toast) diet and bland foods (broth or Saltine crackers) when you feel sick
  • Having a small snack when you first wake up and before you go to bed
  • Trying ginger candy, capsules, or tea to reduce nausea
  • Talking to your provider about taking a vitamin B6 supplement
  • Using motion sickness wristbands or acupressure points

Prescription Medications

If your morning sickness is severe or gets worse and you are losing weight, your provider might give you a prescription anti-nausea medication such as Zofran (ondansetron) or Unisom (doxylamine succinate).

They might also recommend that you try a newer anti-nausea drug (Diclegis and Bonjesta) that is combined with vitamin B6 and doxylamine succinate.

When to Call Your Provider

Morning sickness is more common than not, but if you don't develop the symptoms, it does not necessarily mean you need to be concerned. It's not a definitive sign that something is wrong with your pregnancy.

Severe Symptoms

A bigger concern related to morning sickness is at the other end of the spectrum—severe symptoms. While it's not common, hyperemesis gravidarum can make you very sick and requires treatment and careful monitoring.

If your symptoms are not resolved with remedies, do not seem to be improving or are getting worse as your pregnancy progresses, and/or you're losing weight, it's important that you talk to your provider.

Signs of Miscarriage

Not having morning sickness is not necessarily a sign of miscarriage. However, there are signs and symptoms that could indicate pregnancy loss is impending or has already happened.

While you do not want to become overly concerned about a possible miscarriage, it's important that you know the signs or symptoms.

Miscarriage signs and symptoms can include:

  • Vaginal bleeding
  • Pelvic pain or lower back pain (can be constant or might come and go)
  • Pregnancy symptoms that suddenly disappear (this could include morning sickness, fatigue, and breast tenderness that rapidly gets better)
  • Other possible symptoms that are less common include increased vaginal discharge, leaking amniotic fluid, or passage of tissue

If you experience any signs or symptoms of a miscarriage, call your provider right away or go to the nearest emergency room.

A Word From Verywell

Symptoms of nausea and vomiting are common in early pregnancy. Even though it's called "morning sickness" these symptoms can occur at any time of day. They can also appear at other points in pregnancy—not just at the very beginning.

Some people do not experience any symptoms of morning sickness during their pregnancy. While some research has theorized that morning sickness has a protective effect against miscarriage, this does not mean that you should be worried if you don't have symptoms. Many people do not experience morning sickness and have a completely healthy, uncomplicated pregnancy.

You don't want to become overly preoccupied with pregnancy symptoms, including those of morning sickness. That said, it's important to pay attention to how you are feeling. While morning sickness symptoms might not necessarily correspond to your risk of a miscarriage, they can still present other health problems.

Most of the time, morning sickness is uncomfortable and disruptive, but not serious and gets better with time (especially with dietary changes and remedies).

However, if you develop severe morning sickness (hyperemesis gravidarum), it's important that you talk to your provider. You might need more treatment, such as prescription medication, to manage your symptoms and prevent weight loss.

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