Alahan Mengandung (Morning Sickness): Bila Bermula, Cara Atasi & Bila Bahaya

Alahan mengandung (morning sickness) is nausea and vomiting in pregnancy. It affects around 8 out of 10 pregnant women, can happen at any time of the day, usually starts between weeks 4 and 7, and for most women clears up by weeks 16 to 20. It does not put your baby at increased risk. Small, frequent plain meals, rest and sipping fluids often help, and a doctor can prescribe safe medicine. If you cannot keep food or fluids down for 24 hours, see a doctor quickly, as this may be hyperemesis gravidarum. This guide explains what is normal, what helps, and the warning signs.

Apa itu alahan mengandung?

Alahan mengandung, or morning sickness, is feeling sick (nausea), being sick (vomiting), or both, during pregnancy. Around 8 out of every 10 pregnant women have it (NHS), and the Royal College of Obstetricians and Gynaecologists (RCOG) says it affects up to 90% of pregnant women. Despite the name, it can happen at any time of the day or night.

The cause is thought to be hormones produced in pregnancy (RCOG). Research suggests that a hormone called GDF-15, made by the placenta, plays a major part: it causes loss of appetite and nausea, and genetic differences may explain why some women are much sicker than others (RCOG; MedlinePlus).

You may be more likely to have morning sickness if (NHS):

• you are having twins or more;
• you had severe sickness and vomiting in a previous pregnancy;
• you tend to get motion sickness, for example car sickness;
• you have a history of migraine;
• morning sickness runs in your family;
• you used to feel sick when taking contraceptive pills containing oestrogen;
• it is your first pregnancy;
• you have a BMI of 30 or more.

Nausea is one of the early signs of pregnancy. For the other signs and when to do a test, see our guide to tanda-tanda mengandung (early pregnancy signs).

Bila alahan bermula dan berakhir?

How much sickness you have in one pregnancy does not predict how you will feel in future pregnancies (MedlinePlus), but if you have had severe sickness or hyperemesis gravidarum before, it is likely to happen again (NHS).

Tiba-tiba alahan hilang: normal ke?

Many women worry when their sickness suddenly gets better, especially in the first trimester. Here is what the evidence says:

• Sickness usually eases with time. For most women it clears up by weeks 16 to 20 (NHS). It can also vary from day to day.
• Losing sickness is not on its own a sign of miscarriage. The main symptom of miscarriage is vaginal bleeding before 24 weeks, which may come with pain and cramping in your lower tummy or fluid or tissue coming from your vagina (NHS).
• Nausea is linked with a lower risk of loss, but that is an average. A study of 797 women with 1 or 2 previous pregnancy losses found that women with nausea, or nausea with vomiting, had a lower risk of pregnancy loss (Hinkle et al., JAMA Internal Medicine, 2016). This does not mean that women with little or no sickness are going to miscarry.

Sometimes a miscarriage causes no symptoms and is only found at a scan (NHS). If you are worried, it is always fine to contact your doctor or klinik kesihatan. Get help urgently if you have bleeding, tummy pain or fluid leaking from your vagina. For more, see our guide to keguguran (miscarriage).

Cara atasi alahan mengandung di rumah

Most women can manage their symptoms themselves (RCOG). Things that may help:

• Rest. Tiredness can make nausea worse (NHS).
• Eat before you get up. Have something plain, like dry toast, crackers or a plain biscuit, in the morning before getting out of bed (NHS; ACOG).
• Eat small and often. Choose small, frequent meals of plain foods that are high in carbohydrate and low in fat, such as bread, rice, crackers and pasta (NHS). Five or six mini meals a day helps keep your stomach from being empty (ACOG).
• Add some protein. Milk, yoghurt, nuts, seeds and nut butters are easy sources (ACOG).
• Eat cold food if the smell of hot meals makes you feel sick (NHS).
• Avoid your triggers. Stay away from foods or smells that make you feel sick (NHS). Open a window or use a fan when cooking, and ask someone else to take out the rubbish (ACOG).
• Sip fluids little and often. Drinking plenty of fluids, a little at a time, may help prevent vomiting (NHS). Dehydration can make nausea worse (ACOG).
• Try ginger. There is some evidence that foods or drinks containing ginger may help reduce nausea and vomiting. Check with your pharmacist before taking ginger supplements in pregnancy (NHS).
• Try acupressure. There is some evidence that pressing on your wrist, with a special band or with your fingers, may help (NHS).
• Protect your teeth. Stomach acid from frequent vomiting can wear away tooth enamel. Rinsing your mouth with a teaspoon of baking soda in a cup of water helps neutralise the acid (ACOG).

Vitamins and iron tablets

Keep taking folic acid in the first 12 weeks (NHS; see our guide to folic acid for pregnancy). ACOG says taking a vitamin supplement before and during pregnancy reduces the risk of severe nausea and vomiting, and MedlinePlus suggests taking prenatal vitamins at night. Iron tablets can make sickness worse, and RCOG says they can be stopped for a while when sickness is severe. In Malaysia, iron and folic acid are given free at government klinik kesihatan (MyGOV), so ask the nurse or doctor there before you stop or change them. For more on iron, see our guide to kurang darah (anaemia).

Drann does not recommend any "ubat alahan" product, herb or supplement brand. Ask your doctor or pharmacist before taking anything for sickness in pregnancy.

Ubat alahan mengandung

If self-help does not work, or your sickness is severe, a doctor can prescribe anti-sickness medicine (an antiemetic) that is safe in pregnancy (NHS). Your doctor will first check that your sickness is not caused by something else (ACOG). Medicines that may be used include:

You may need to try different medicines, or a combination, to find what works (NHS; RCOG). Do not buy anti-sickness medicine or herbal remedies on your own without advice, and tell your doctor about everything you take.

Hyperemesis gravidarum: bila alahan jadi bahaya

Hyperemesis gravidarum (HG) is a severe form of pregnancy sickness. It is thought to affect around 1 to 3 in 100 pregnant women (NHS). RCOG describes it as sickness so severe that it stops you from doing your daily activities and you are unable to eat and drink normally. ACOG says it may be diagnosed when a woman has lost 5% of her pre-pregnancy weight and has other problems from dehydration.

You are more likely to get HG if you are carrying twins or more, you had HG in a previous pregnancy, or your mother or sister had it (NHS; ACOG). It is not caused by anything you have or have not done (NHS).

Treatment for HG

Most women can be treated at home or as outpatients, but about 1 in 5 women with HG may need to stay in hospital (RCOG). Treatment can include:

• checks of your weight, pulse, blood pressure, urine and blood to see whether you are dehydrated;
• fluids through a drip in your arm, sometimes given over a short time (rapid rehydration);
• anti-sickness medicine by mouth, injection or drip;
• a B vitamin called thiamine;
• stockings or heparin injections to prevent blood clots, because dehydration and staying in bed raise the risk (RCOG; NHS).

If you still cannot eat enough, nutrients may be given through a drip or a feeding tube (ACOG; MedlinePlus). If you had HG before, talk to your doctor early in your next pregnancy about starting medicine early (NHS).

Bila perlu ke klinik atau hospital

Contact your doctor, klinik kesihatan or hospital quickly if you are vomiting and you (NHS):

• have very dark urine or have not passed urine in more than 8 hours;
• are unable to keep food or fluids down for 24 hours;
• feel very weak, dizzy or faint when standing up (see our guide to pening kepala (dizziness));
• have tummy pain;
• have a high temperature;
• vomit blood;
• have lost weight.

ACOG also lists a racing or pounding heartbeat as a sign of dehydration. MedlinePlus advises contacting your provider if you vomit more than 3 times a day, or if sickness does not improve despite home remedies.

When sickness may have another cause

Nausea and vomiting in pregnancy can also come from other conditions, such as a urine infection, a stomach ulcer, food-related illness, or thyroid or gallbladder disease (NHS; ACOG). Your doctor may look for another cause if:

• sickness starts for the first time after 9 weeks (ACOG), or vomiting only starts after 16 weeks (RCOG);
• you have tummy pain or tenderness, a fever or a headache;
• you have pain when passing urine (see our guide to UTI symptoms);
• you have swelling at the front of your neck, which can be a sign of a thyroid problem;
• you have had a stomach ulcer or gallstones before (RCOG; see our guide to ulser perut).

In Malaysia, KKM advises registering your pregnancy at a government klinik kesihatan before 12 weeks (MyGOV). This gives you a place to go for regular checks, and you can tell the nurse or doctor there if your sickness is getting worse.

Kesan pada emosi dan mendapatkan sokongan

Pregnancy sickness can be hard to cope with. It can affect your mood, your work, your home life and your social life (RCOG). Women with HG may feel anxious about going out, isolated, or unsure how to cope (NHS), and some become depressed and need extra support such as counselling (RCOG). Anxiety and depression can sometimes continue after the pregnancy (MedlinePlus).

Support from family and friends can help (RCOG). Your husband or family can help, for example by cooking or taking out the rubbish so you avoid strong smells (ACOG), and by arranging childcare so you can rest (NHS). If you feel low most of the day or cannot enjoy things, tell your doctor or the nurse at your klinik kesihatan. See also our guide to kemurungan (depression).

Frequently asked questions (FAQ)

Bila alahan mengandung bermula dan berakhir (when does morning sickness start and end)?

Morning sickness usually starts between the 4th and 7th week of pregnancy (RCOG). For most women it clears up by weeks 16 to 20 (NHS), and it settles by 20 weeks in 9 out of 10 women (RCOG). For some women it lasts longer, and a few have nausea throughout the pregnancy (ACOG). Despite the name, it can happen at any time of the day or night.

Tiba-tiba alahan hilang, adakah tanda keguguran (is it a miscarriage sign if morning sickness suddenly stops)?

Not on its own. Sickness often eases as pregnancy goes on, and for most women it clears up by weeks 16 to 20 (NHS). The main symptom of miscarriage is vaginal bleeding before 24 weeks, sometimes with pain and cramping in the lower tummy (NHS). A study of women with 1 or 2 previous losses found that those with nausea had a lower risk of pregnancy loss (Hinkle et al., JAMA Internal Medicine, 2016), but this does not mean that a pregnancy without sickness is in danger. If you have bleeding or tummy pain, or you are worried, contact your doctor or klinik kesihatan.

Alahan teruk tanda anak perempuan ke (does severe morning sickness mean a baby girl)?

Not reliably. ACOG lists being pregnant with a girl as one of several risk factors for severe nausea and vomiting, together with twins, sickness in a previous pregnancy, a mother or sister with severe sickness, and a history of motion sickness or migraines. A risk factor is not a test, so the amount of sickness cannot tell you whether you are having a boy or a girl.

Makan apa bila alahan mengandung (what to eat with morning sickness)?

Eat small, frequent meals of plain foods that are high in carbohydrate and low in fat, such as bread, rice, crackers and pasta (NHS). Eat something plain, like dry toast or a plain biscuit, before you get up in the morning (NHS; ACOG). Cold food may be easier if the smell of hot food makes you feel sick. Adding protein, such as milk, yoghurt, nuts or peanut butter, may help (ACOG). Sip water little and often, and eat whatever you can keep down.

Ubat alahan mengandung apa yang selamat (what medicine is safe for morning sickness)?

If self-help does not work, a doctor can prescribe anti-sickness medicine that is safe in pregnancy (NHS). Options include vitamin B6 (pyridoxine), with doxylamine added if needed, and antihistamines such as cyclizine or promethazine; other medicines are used if these do not work (ACOG; RCOG). Do not take any medicine, herb or supplement for sickness without asking your doctor or pharmacist first, and do not stop prescribed medicine on your own.

Alahan teruk boleh bahayakan bayi (can severe morning sickness harm the baby)?

Normal morning sickness does not put your baby at any increased risk (NHS). Hyperemesis gravidarum is unlikely to harm your baby if it is treated effectively, but if it causes you to lose weight, there is an increased risk that your baby may be born smaller than expected (NHS). Untreated hyperemesis gravidarum may cause more harm to the baby than any possible effects of a medicine recommended by your doctor (RCOG). That is why it is important to get help early.

Bila perlu ke hospital kerana muntah semasa mengandung (when should I go to hospital for vomiting in pregnancy)?

Get medical help quickly if you are vomiting and cannot keep food or fluids down for 24 hours, have very dark urine or have not passed urine in more than 8 hours, feel very weak, dizzy or faint when standing up, have tummy pain or a high temperature, vomit blood, or are losing weight (NHS). These can be signs of dehydration or hyperemesis gravidarum, which may need fluids through a drip in hospital (RCOG).

Disclaimer

This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. If you are pregnant and worried about sickness, vomiting or any other symptom, contact your doctor, klinik kesihatan or hospital.

References

• Vomiting and morning sickness — NHS
• Severe vomiting in pregnancy (hyperemesis gravidarum) — NHS
• Miscarriage: symptoms — NHS
• Pregnancy sickness (nausea and vomiting of pregnancy and hyperemesis gravidarum) — Royal College of Obstetricians and Gynaecologists (RCOG)
• The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69) — RCOG
• Morning sickness: nausea and vomiting of pregnancy — American College of Obstetricians and Gynecologists (ACOG)
• Morning sickness — MedlinePlus Medical Encyclopedia
• Hyperemesis gravidarum — MedlinePlus Medical Encyclopedia
• Hinkle SN, et al. Association of nausea and vomiting during pregnancy with pregnancy loss: a secondary analysis of a randomized clinical trial. JAMA Intern Med. 2016;176(11):1621-1627
• Kesihatan ibu hamil — Portal Rasmi Kerajaan Malaysia (MyGOV)