It was impossible to blithely dismiss as "a minor complication" the severe nausea that accompanied each of my pregnancies. I became unable to accomplish many routine tasks and was especially anxious about providing enough nourishment to my unborn baby. Eager to find reasons and remedies, I pored over the available information. I found that although nausea has affected as many as 80 percent of pregnant women for over 4,000 years, no clear consensus exists on its cause or successful treatment. What does exist, however, is a host of promising explanations and remedial options.

Causes . Hormonal release is the reason most commonly cited for nausea in early pregnancy. These months are marked by a rapid increase in estrogen activity and rising levels of human chorionic gonadotropin (HCG), the hormone that maintains estrogen levels. In fact, a pregnant woman produces as much estrogen during the course of her pregnancy as a nonpregnant women would produce in 150 years! The hormone theory is supported by the high correlation between women who experience nausea while taking oral contraceptives (which raise estrogen levels) and women who experience nausea while pregnant. What accounts for the eventual disappearance of symptoms is a gradual adjustment to the high hormonal levels. In most cases, this occurs by the second trimester.

Because a high level of estrogen activity is considered healthy during the early stages of a normal pregnancy, nausea is often considered a positive prognostic sign. In fact, some researchers advise health practitioners to carefully observe the pregnancies of women who experience no nausea. Many studies further indicate a significantly lower risk of miscarriage before the 20th week if nausea or vomiting is present in early pregnancy. In addition, proportionately fewer low-birthweight babies are born to women who experience nausea.

Viewing nausea as a sign of a healthy pregnancy did not keep me from seeking remedies, but it certainly did help my morale! . Digestive difficulties are common throughout pregnancy--a time when the muscles and valves of the digestive tract slow the journey of food through the stomach and intestines, allowing for greater absorption of nutrients but also contributing to stomach upsets. A reduced production of hydrochloric acid and some digestive enzymes adds to the difficulties. . Low blood sugar levels and high basal metabolic rates (amounts of energy utilized during complete rest) are typical of pregnancy and are often associated with "morning sickness." After a night without food, a pregnant woman's blood sugar level undergoes a severe drop, resulting in dizziness, shakiness, nausea, and fatigue. During the day, periods without nourishment may cause similar symptoms. . Vitamin B-6 deficiencies in pregnancy have been linked to nausea, vomiting, anemia, headaches, nervousness, foot and leg cramps, hemorrhoids, and edema (retention of water). Both stress and consumption of overcooked and overprocessed foods increase one's need for B-6. . The question of sidedness is a new and interesting concern. One researcher suggests that the severity of nausea in pregnancy is directly related to whether the egg was provided by the right or the left ovary. According to studies conducted in Sweden in 1986, women who conceived from an ovum released from the right ovary were more likely to experience nausea and vomiting in early pregnancy than were those who conceived from a leftsided ovary. The anatomical differences between the left and right sides of the body are said to subject the liver to distinct hormonal influences and thus account for this phenomenon. . Psychological factors contributing to nausea are currently under investigation. Pregnant women are sometimes told that their nausea is symptomatic of an "emotional rejection" of the baby. Research does not support this theory, however. A 1985 study by Colleen Dilorio, published in Nursing Research, shows that many women who experience nausea during pregnancy joyfully receive the news of conception and eagerly await their babies. The erroneous conclusion that nausea is a psychological attempt to "expel an unwanted child" may simply be related to society's current obsession with assigning personal responsibility to physical problems. By viewing nausea as an element of a positive, healthy pregnancy, we can stop engendering unnecessary blame. . Stress, fatigue, and change have also been implicated. In several studies, pregnant women report that nausea and vomiting are aggravated by stress and fatigue, particularly in the evening hours. Change--even positive change--creates both added stress and an increased need for special care during pregnancy.

Remedies

The most common advice I received in the early months of pregnancy was "it will soon pass," along with a suggestion to eat crackers before my feet hit the floor in the morning. While three months of nausea felt like an eternity, it did pass, and the boxcar or so of crackers I consumed seemed to help. Indeed, a number of remedies can safely and effectively overcome the nausea of early pregnancy. Although no single recommendation is guaranteed to help everyone, through trial and error you may discover several that are just right for you. . Diet. Most dietary recommendations for pregnant women experiencing nausea are based on an effort to maintain blood sugar levels. Quick drops in blood sugar during the day may be avoided by abstaining from refined starches and sugars, alcohol, and caffeine. Try small, frequent, high-carbohydrate meals and high-protein snacks. Never leave the house without a snack in hand! To minimize early morning nausea, eat something high in protein along with a little natural sugar before going to sleep or upon awakening at night; yogurt and fruit is a helpful combination, as is cottage cheese and juice. Nibble before getting up in the morning (the cracker remedy!), and continue to eat often throughout the day.

One key to eating frequently and nutritiously is to keep your cupboards and refrigerator stocked with healthful and easy-to-prepare foods. Nuts and seeds (cashews, walnuts, peanuts, and pumpkin and sunflower seeds), fresh and dried fruits (raisins, dates, and figs), yogurt, cottage cheese, cheese slices, granola, and fresh raw vegetables all offer excellent nutrition without preparation. Easily prepared foods include blender drinks (perhaps fortified with brewer's yeast, wheat germ, or blackstrap molasses for iron), whole grain toast or crackers with toppings (peanut butter or tahini), and muesli (a nourishing combination of oats, fruit, nuts, and a liquid such as milk or juice). Dishes prepared in advance can provide several days' worth of delicious alternatives requiring no further cooking. Try rice pudding, hummus, bean salads, veggie dips, and pasta salads, for example.

Think about your favorite foods, and stock up on the most nutritious ones. But be prepared for some surprises. You may find, for instance, that a once-favorite food is now unpalatable or that you suddenly acquire a taste for an item you've never liked before. Food likes and dislikes during this time are unpredictable and quite individualized. Some women find dry foods (toast, pasta, crackers) easier to tolerate, while others find relief from sipping water, herbal teas, juices, or carbonated drinks. Milk settles some stomaches but aggravates others. Most women avoid spicy, hot, or greasy foods that are hard to digest.

Women who experience nausea during pregnancy often have no desire to eat at all. I found that by forcing myself to eat small, high-protein snacks very frequently--every 30 minutes or so--I was able to keep the nausea at a manageable level for longer periods of time.

Specific foods help solve specific problems. Eating half a grapefruit with meals, or taking papaya enzyme tablets before eating, helps produce digestive enzymes. Acidophilus-containing foods, such as yogurt and kefir, contribute to beneficial intestinal flora. Drinking a tea made of umeboshi plum helps balance the acid/alkaline content of foods. Umeboshi is sold in health food stores as a thick paste extract and can be eaten directly from the bottle. To make the tea, simply stir a kidney-bean-sized bit of the extract into a cup of very hot water, and add a little honey to lessen the bitter taste. In addition, drinking liquids between meals (rather than with them) sustains high concentrations of hydrochloric acid to ease digestion.