What is Third Trimester Nausea?

When you are pregnant, your body is bound to undergo many changes and experience many symptoms as the baby continues to grow during the next nine months. One of the most common symptoms of pregnancy is morning sickness, a term commonly used to describe nausea and vomiting that pregnant women experience, especially during the first trimester.[1,2] Nausea is usually the first sign of pregnancy. Unlike the name, though, morning sickness can strike during the day and commonly affects women during the first three to four months of their pregnancy.[3] However, in some rare cases, nausea and vomiting can continue beyond an initial couple of months.[4] In some cases, nausea can continue right into your third trimester, and even last as far as the actual delivery. Here are some key points you need to know about third-trimester nausea.

Third-trimester nausea does not feel any different from what you experienced in your first trimester.[5] You can simply say that it is a continuous phase of the morning sickness you experienced during the start of the pregnancy. The only difference between first trimester morning sickness and nausea towards the end of the pregnancy is that it occurs towards the very end of your pregnancy. After finishing the first trimester of their pregnancy, many women heave a sigh of relief that they are past the morning sickness stage.[6] However, nausea during the later stages of pregnancy can affect many pregnant women and is more common than one might think.

See: Anxiety & stress in pregnancy natural remedies

Third Trimester Nausea vs. Hyperemesis Gravidarum

Is Third Trimester Nausea the same as Hyperemesis Gravidarum?

No, third-trimester nausea is not the same as hyperemesis gravidarum, a medical condition characterized by extremely severe nausea.[7] While nausea in the last months is actually quite common, hyperemesis gravidarum is a rare pregnancy complication that also includes symptoms such as dehydration, weight loss, nausea, and severe vomiting. In most cases, women who experience hyperemesis gravidarum need to be hospitalized so that the mother and baby can remain safe and healthy.[8] 

Nausea can either suddenly begin again in the third trimester, or continue from the first trimester itself. On the other hand, hyperemesis gravidarum tends to start in the first trimester itself and affects the mother throughout the pregnancy. Sometimes, hyperemesis gravidarum can even last until the delivery happens.[9]

See: Ayurveda for Nausea in Pregnancy

Causes of Third Trimester Nausea

What are the Causes of Third Trimester Nausea?

There are many causes of nausea at the end of pregnancy, including changing hormones, overeating, and sometimes a more serious cause. Here are some of the commonly observed causes of such nausea.

1. Growing Baby

A common cause of nausea is the growing fetus. As your baby continues to grow, there is more pressure placed on the stomach. This pressure makes the food move back up to your esophagus, which can lead to acid reflux. Acid reflux is a major reason for nausea during pregnancy.[10] 

Another reason why nausea will occur this late is due to the size of your growing baby bump. At this time, your child is nearly large enough to leave the uterus, so your uterus is expanding bigger than it ever has before. The added pressure on your stomach could result in that uncomfortable feeling of heartburn as the stomach acids are forced into your lower esophagus. 

Many women feel third-trimester nausea after eating, particularly since there's less space on your gut to maintain what you ingest. That's why it is a fantastic idea to keep the size of your meals little in this period, picking several little meals rather than a few large ones. It may mean you need to forgo that big dinner, but you will get to snack on lots of nutritious foods during the day, which will keep your energy levels up. Maintaining your portions relatively small will make certain your stomach doesn't need to try dealing with more than it can handle.

A morning sickness-like nausea and vomiting sometimes make an appearance during the 3rd trimester. Nausea can result if the uterus compresses the stomach or when the normal contractions slow down. Eating a few crackers or restricting yourself to tiny portions at each meal helps.

2. Fluctuating Levels of Hormones

Hormone fluctuations are mostly to blame for your morning sickness and nausea experienced during the first trimester, and it is the same for an illness that occurs as your due date approaches. Believe it or not, even at the conclusion of your pregnancy, your body is still struggling to find balance. When a woman becomes pregnant, there are various hormonal changes also that take place in the body. The key amongst these hormones is human chorionic gonadotropin (hCG), commonly referred to as the pregnancy hormone.[11,12]

When you experience nausea during the first trimester of your pregnancy, it is usually due to the elevated levels of hCG in the body. The body starts producing hCG immediately after the fertilized egg implants into the uterine lining.[13] While the hCG levels tend to taper off after the first trimester, in some cases, they may continue to remain high throughout the pregnancy.

While most people usually hold hCG responsible for third-trimester nausea, studies have found that even the fluctuating levels of estrogen through the pregnancy could also be linked to the onset of third-trimester nausea.[14] Some experts also believe that the increased estrogen levels in the body during pregnancy might cause third-trimester nausea or cause your morning sickness to worsen. 

See: Pregnancy Diet & Nutrition

Third Trimester Nausea Prevention Tips & Remedies

Prevention Tips and Remedies for Third Trimester Nausea

Taking certain prevention tips can help you minimize, if not prevent, third-trimester nausea. Here are some ways to avoid nausea:[15]

- Get plenty of rest. It is essential to get adequate sleep during pregnancy as your body is working overtime to keep you and the growing fetus nourished. 

- Avoid having caffeinated drinks such as tea and coffee. Such beverages may increase your symptoms. If you cannot start your day without your morning cup of coffee, then at least try to reduce your intake and stick to decaf coffee. 

- Drink plenty of water as it is very important to keep yourself hydrated at this time. Hydration is all the more important if you are frequently vomiting. 

- Avoid having three big meals when you are pregnant. It is better to eat smaller meals spaced out at regular intervals throughout the day. Smaller meals will help avoid acid reflux. 

- Avoid going to bed immediately after eating. It is best to have your dinner at least two or three hours before your usual bedtime. 

See: Tailbone or Coccyx Pain During Pregnancy

Consult a doctor for nausea

Do you need to consult a doctor for third-trimester nausea?

If you are feeling fine overall, then in most cases, such type of nausea is nothing to worry about. However, if you find that your nausea is becoming severe or experiencing other symptoms accompanying nausea, you should let your doctor know at the earliest. Some of the accompanying warning signs to watch out for include:[16]

- Loss of appetite

- Dizziness

- Weight loss

- Decreased fetal movement

- Regular cramping or contractions

- High fever

- Frequent and severe vomiting


The following summarizes some changes and symptoms you may encounter during the third trimester:

- Your fetus radiates body heat, causing one to feel hot from higher skin temperature.

- Increase in urinary frequency due to increased pressure being placed on the bladder.

- Blood pressure may lower as the fetus presses on the vein that returns blood to the heart.

- Constipation, heartburn, and indigestion may continue.

- You'll have increased white-colored vaginal discharge (leukorrhea), which might contain more mucus.

- Swelling of the ankles, face, and hands may happen (called edema), as you continue to keep fluids.

- Hair may begin to grow in your arms, face, and legs because of increased hormone stimulation of hair follicles. Hair may also feel coarser.

- Leg cramps may happen more frequently.

- Braxton-Hicks contractions (false labor) may begin to take place at irregular intervals.

- Stretch marks may appear on the breast, stomach, buttocks, and thighs.

- Colostrum (fluid in the breasts until the breast milk becomes available) may begin to flow from your nipples.

- Backaches may persist and increase in strength.

- Hemorrhoids may persist and increase in severity.

- Varicose veins in the legs may persist and increase in severity.

- Dry, itchy skin may persist, especially on the stomach.

- Your libido may decrease.

- Skin pigmentation may become more apparent, especially dark patches of skin on the face.

See: Pregnancy Massage Benefits

Summary

It is normal to experience nausea and vomiting during any part of your pregnancy. While most women experience nausea primarily during the first trimester of their pregnancy, some women may continue to experience third-trimester nausea. If you feel you are otherwise healthy and fetal movement is normal, then nausea is not a cause of concern. However, it is always better to let your gynecologist know about any sudden change in your symptoms when you are pregnant to rule out any other serious cause of such nausea. 

See: Shrimp During Pregnancy Benefits & Risks

References

1. Wilkinson, J.M., 2000. What do we know about herbal morning sickness treatments? A literature survey. Midwifery, 16(3), pp.224-228.

2. Flaxman, S.M., and Sherman, P.W., 2000. Morning sickness: a mechanism for protecting mother & embryo. The Quarterly review of biology, 75(2), pp.113-148.

3. Gadsby, R.O.G.E.R., Barnie-Adshead, A.M. and Jagger, C.A.R.O.L., 1993. A prospective study of nausea & vomiting during pregnancy. Br J Gen Pract, 43(371), pp.245-248.

4. Järnfelt-Samsioe, A., Samsioe, G., and Velinder, G.M., 1983. Nausea & vomiting in pregnancy–a contribution to its epidemiology. Gynecologic and obstetric investigation, 16(4), pp.221-229.

5. Petitti, D.B., 1986. Nausea & pregnancy outcome. Birth, 13(4), pp.223-226.

6. Arsenault, M., Lane, C.A., MacKinnon, C.J., Bartellas, E., Cargill, Y.M., Klein, M.C., Martel, M.J., Sprague, A.E., and Wilson, A.K., 2002. The management of nausea and vomiting of pregnancy. Journal of Obstetrics & gynecology Canada: JOGC= Journal d'obstetrique et gynecologie du Canada: JOGC, 24(10), pp.817-31.

7. Abell, T.L., and Riely, C.A., 1992. Hyperemesis gravidarum. Gastroenterology Clinics of North America, 21(4), pp.835-849.

8. Verberg, M.F.G., Gillott, D.J., Al-Fardan, N., and Grudzinskas, J.G., 2005. Hyperemesis gravidarum, a literature review. Human reproduction update, 11(5), pp.527-539.

9. Eliakim, R., Abulafia, O., and Sherer, D.M., 2000. Hyperemesis gravidarum: a current review. American journal of perinatology, 17(04), pp.207-218.

10. Law, R., Maltepe, C., Bozzo, P., and Einarson, A., 2010. Treatment of heartburn & acid reflux associated with nausea and vomiting during pregnancy. Canadian Family Physician, 56(2), pp.143-144.

11. Braunstein, G.D., Rasor, J., Adler, D., Danzer, H., and Wade, M.E., 1976. Serum human chorionic gonadotropin levels throughout normal pregnancy. American journal of obstetrics and gynecology, 126(6), pp.678-681.

12. Lenton, E.A., Neal, L.M., and Sulaiman, R., 1982. Plasma concentrations of human chorionic gonadotropin from the time of implantation until the second week of pregnancy. Fertility and sterility, 37(6), pp.773-778. 

13. Masson, G.M., Anthony, F., and Chau, E., 1985. Serum chorionic gonadotrophin (hCG), schwangerschaftsprotein 1 (SP1), progesterone, and oestradiol levels in patients with nausea and vomiting in early pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology, 92(3), pp.211-215.

14. Lagiou, P., Tamimi, R., Mucci, L.A., Trichopoulos, D., Adami, H.O., and Hsieh, C.C., 2003. Nausea and vomiting in pregnancy in relation to prolactin, estrogens, and progesterone: a prospective study. Obstetrics & Gynecology, 101(4), pp.639-644. 

15. Profet, M., 1992. Pregnancy sickness as adaptation: A deterrent to maternal ingestion of. The adapted mind: Evolutionary psychology and the generation of culture, p.327.

16. Mahalingam, G., and Venkateasan, M., 2014. Mother's knowledge of warning signs of pregnancy, labor, and puerperium. International Journal of Medical Science and Public Health, 3(6), pp.720-723.

See: Lemongrass safety during pregnancy

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