‘The smell of human breath made me vomit’: Could this be the end of morning sickness for women?
It is difficult to pinpoint the lowest moment of my first trimester. It might have been the day of the coronation, when I was hunched over a sick bag on a rammed tube platform listening to a loud Australian voice drift towards me. “It’s sad to see a young woman drunk on such an important occasion,” the voice opined. “She should be ashamed.”
Professionally, it was probably the time I flew to an idyllic Italian country estate to interview a famous fashion designer. Midway through asking about her latest collection, I felt a telltale rising nausea – although worse than retching in her pristine downstairs loo was having to later play the transcript and hear myself bark, “I’m going to be sick”, followed by five minutes of faintly appalled Italian murmurs.
My husband would probably argue that the most depressing development was my sudden revulsion for the smell of all human breath – no matter how minty fresh. He was under strict instructions to never try and kiss me (to be fair, who would want to?) and after a few days was relegated to the sofa as I could no longer bear to share our bed.
While I suffered more than most, I am not an extreme outlier: 80 percent of women experience some queasiness in early pregnancy; 15 to 20 percent have severe nausea and vomiting, 5 percent throw up every day, and a further 1 in 50, including the poor Princess of Wales, get hyperemesis gravidarum. This is pregnancy sickness at its most chronic, leading to extreme weight-loss, dehydration and sometimes hospitalisation – I was diagnosed with it by one doctor, but I think my case was borderline.
All I know is that had I felt this constant, all-consuming nausea in normal life, I would have retreated under a duvet until whatever hell was being rained upon me passed. But nobody can go to bed for two and a half months, and so the only alternative was to just keep going.
And yet, the thinner and sicker I got, the more perplexed I became about the dearth of information or help.
“There is a general lack of attention to many issues which arise in women’s health, in pregnancy and in other areas,” agrees Emily Oster, the economist and best-selling author of Expecting Better. “One issue may be funding – these just are not topics which get enough money to study them. In the case of pregnancy nausea in particular I think many people dismiss the possible severity, which makes it harder to get the attention you need for people to look for solutions.”
On the NHS website, advice included eating ginger (doesn’t help), trying acupressure (doesn’t work) and asking your employer if you can come to the office during the hours you feel better (never?). Nobody seemed to know what caused the nausea, and while a few websites suggested it might be the hormone hCG or an excess of progesterone and oestrogen, they didn’t seem sure.
So I was fascinated to read a study by Cambridge University and the University of Southern California, which came out a few weeks ago and which argues that a little-known hormone called GDF15 is to blame. Some women have less of it in their bloodstream prior to conception, and are therefore more sensitive to its tyrannical effects.
The authors suggest that GDF15 is produced by the placenta as a way of making pregnant women alter the way they eat. In the prehistoric era, our diets would have contained a wide array of plants, some of which contain chemicals that might damage a developing foetus, and a lot of uncooked meat or fish, which could introduce parasites into the body. Nausea would have made them all entirely unpalatable throughout the first trimester, which is when a baby’s organs, spine and brain are being developed.
This is, of course, unnecessary in our new hygienic era, which is why the study scientists believe that blocking GDF15 would have no impact on carrying a healthy baby to term. Any medication designed to do so would need to pass clinical trials, which are more complicated on pregnant women, and labs would have to find an agent that cannot cross the placenta, but the authors believe a targeted drug might be available within the next five years.
Alongside these findings, Cambridge have debunked other myths. HCG, the hormone measured by pregnancy tests, has apparently been blameless all along, and the impact of progesterone is negligible. The authors also argue that against the long-held idea that the worse the nausea, the healthier the pregnancy – explaining that, yes, women are more likely to miscarry if they don’t feel at all sick, but that’s because if a foetus is failing, its placenta will shrink and atrophy, and will therefore produce less GDF15. The hormone itself does not have any protective effect.
This feels like the first major development in early pregnancy sickness since the thalidomide tragedy of the 1950s. Invented by a German company and initially developed as a tranquiliser, thalidomide was soon used as an antidote to morning sickness. In the mid-20th century, nobody was aware that certain chemicals could cross the placenta, and that when taken in early pregnancy thalidomide causes shortened limbs, sight loss, hearing loss and facial paralysis. It took five years for the drug to be taken off the market and in that period it damaged countless lives.
“Our safety protocols now are much, much better than they were at that time so a tragedy of this magnitude is extremely unlikely today,” says Oster. “But the memory of this absolutely haunts a lot of our feelings around pregnancy medications, and around anti-nausea medications in particular.”
I have first-hand experience of this. After failing twice to get a prescription, I was finally given a course of anti-sickness pills called Cyclizine when my weight-loss became severe. I’m 5 foot 9 and was 59 kg when I fell pregnant; after six weeks of consuming little more than Marmite toast, my weight had dropped to a skeletal 53 kg. A doctor dipped my urine and confirmed that I was officially starving.
As she gave me the pills, she advised that they should only be taken under ‘severe circumstances’ as no clinical trials had been done on pregnant women; understandably, this worried me and it was only after speaking to Dr Caitlin Dean – a GP who works with the charity Pregnancy Sickness – that I concluded they were absolutely safe to use.
“Unfortunately the healthcare professional who told you this was ill-formed,” says Dean. “The medications have been around for decades – there may not have been any clinical trials but there are studies of hundreds of thousands of women who have taken them over the last few decades and there is no evidence whatsoever that they cause any harm to the baby.”
What can cause problems for both the mother and child is malnutrition. “Severe weight loss in the mother is associated with increased autism and cardiovascular disease later in life for the baby,” says Dean, “so when a doctor says we don’t know if these medications are safe, when they absolutely are, it shows a real lack of understanding around pregnancy sickness.”
Oster agrees, adding that there is a tendency to frame the choice to take medication as something you should only do ‘if you really need it’, which leaves women in the position of feeling that taking anything is selfish. “In the case of severe nausea (or even moderate nausea and vomiting) this is tremendously misplaced,” she says.
On days where I managed to keep the pills down, I was able to eat more, but I still felt very sick and rarely consumed more than 800 calories a day. It is only now that I realise that I could have opted for much stronger – and equally safe, according to Dean – drugs like domperidone. I wish one of the many doctors I spoke to had mentioned this.
Equally, until the hallowed time when GDF15 ends its reign of terror, I believe we need to be more open to the idea that not everyone experiences early pregnancy in the same way. Spain is now offering paid leave during menstruation, but the majority of women would never need it; most women continue with their daily lives during the menopause – the proposed legislation is for those who cannot. Morning sickness, surely, is no different, and I would have found a clear set of guidelines on how to take time off very helpful.
Now, I am in my second trimester and am thankfully no longer a vessel for misery – my husband is off the sofa, I’m eating more than someone on double-dose Ozempic and we are finally able to enjoy this hugely wanted pregnancy. I know I am very lucky that thus far the baby seems healthy, but I will also always remember the spring of this year as the most difficult physical period of my life to date. And I hope that – whether through drugs or a better understanding of morning sickness – I will be one of the last generations of women to suffer through it.