6 causes of nausea during pregnancy and how to avoid them

Nausea is one of the most common complaints of early pregnancy, and for many women it comes with vomiting too. It usually starts before nine weeks and, according to the NHS, settles for most women by around weeks 16 to 20. It is unpleasant but rarely harmful. The exceptions are covered at the end.

1. Hormones

The main driver is the hormone surge of the first trimester. Human chorionic gonadotropin (hCG) rises steeply after implantation, and oestrogen climbs with it. Progesterone relaxes smooth muscle, which slows digestion, so food sits in your stomach for longer. Heartburn and a sour taste often arrive at the same time.

What helps:

• Eat small amounts often instead of large meals.
• Choose plain starch and protein, which tend to sit better than fatty food.
• Rest when you can. Tiredness makes nausea worse.

2. Strong smells

Your sense of smell sharpens in early pregnancy. A wok of sambal frying at the mamak, the fish section at the pasar, a perfume in a lift or petrol fumes at the station can turn a good morning.

What helps:

• Ask whoever cooks to use the hood fan and keep the kitchen door shut.
• Carry a sliced lemon or lime, or something citrus-scented, to breathe through when a smell hits.
• Travel off-peak if you can, and stand near the door of the train or bus.

3. An empty stomach in the morning

Your stomach is emptiest after a night's sleep. That is why the first hour after waking is often the worst, and why "morning" sickness is misnamed for women who feel it all day.

What helps:

• Keep plain crackers or dry bread beside the bed and eat a little before you sit up.
• Get up slowly.
• Avoid strong coffee or teh tarik on an empty stomach.

4. Heat and dehydration

Malaysian heat and humidity mean you lose fluid all day without noticing. Add vomiting and you can become dehydrated fast. Watch for dark urine, a dull headache, dizziness when you stand and a dry mouth.

What helps:

• Sip through the day instead of gulping a big glass, which often comes straight back.
• Try cold water, ice chips or frozen fruit when nothing else stays down.
• If you are vomiting repeatedly, oral rehydration salts from a pharmacy replace more than plain water does.

Ginger tea or ginger sweets are worth a try. A Cochrane review found the evidence for every remedy thin, with some sign that ginger helps milder nausea. It costs little, so try it and see.

5. Brushing your teeth

A heightened gag reflex plus a strong, foamy toothpaste can set off retching at the sink. Brush a little later in the morning, use a small brush head, and keep the paste off the back of your tongue.

Do not stop brushing. Pregnancy makes gums react more to plaque, and stomach acid from vomiting softens enamel. After being sick, rinse with plain water and wait about half an hour before you brush.

A paste you like makes this easier. Our Non-Fluoride Toothpaste is formulated for pregnancy and breastfeeding, made without SLS, with a gentle natural mint. In a Mama's Choice satisfaction survey of 62 mothers (2022), 93% felt comfortable using it with no nausea. It is halal certified by BPJPH, Indonesia, and you can buy it on Shopee. Read more in our guide to toothpaste in pregnancy.

6. Something else going on

Sometimes nausea has another cause. A urinary tract infection often brings nausea with it, along with pain or burning when you pass urine, and needs antibiotics. Stress and poor sleep also make nausea feel worse, though they do not cause it on their own. If you have had travel sickness or migraines before, you may be more prone to pregnancy nausea too.

Our round-up of pregnancy nausea remedies has more ideas to try.

When to see a doctor

Ordinary morning sickness needs no treatment. See a doctor at your klinik kesihatan or your obstetrician if you:

• Have kept nothing down, food or drink, for 24 hours.
• Are losing weight or passing very little urine.
• Have pain or burning when you urinate, or blood in your urine.
• Have a fever, blood in your vomit, or severe tummy pain.
• Start feeling sick for the first time after the first trimester, especially with a headache, swelling or pain under your right ribs.

Severe, relentless vomiting is called hyperemesis gravidarum. It needs treatment with anti-sickness medicine and sometimes a drip in hospital, so do not wait it out. Anti-sickness medicines are prescribed in pregnancy when diet changes are not enough; ask your doctor rather than buying something over the counter. In an emergency, call 999 or go to the nearest hospital.