Sick of “morning” sickness
33:46 Share

After graduating from high school, Anthony needed a plan. He loves playing video games, but that doesn't cover rent. So he took a job at Amazon packing boxes. He heard about their free skills training programs to boost his pay. Now Anthony is a software developer for Amazon. With a bigger paycheck, he upgraded his computer system at home. With his new skills, he's developing a video game in his free time.

Grow your career and your pay. Learn more at aboutamazon.com. Support for this show comes from WhatsApp. The personal chat on WhatsApp is a place where you share everything, from the mundane connections to the memories that mean everything. It's a place that can truly feel like it's your own. And WhatsApp makes sure everything stays protected from outside eyes, even theirs. No one, not even WhatsApp,

I'm Julia Longoria. This is Unexplainable. And this one's going to get a little personal. That is the sound of me about to hurl.

I really don't like making things about me, but that's not the reason I'm about to barf right now. If you've watched TV sitcoms or rom-coms in the last few decades, there's only one real reason a woman like me would be unexpectedly puking for a studio audience. She's been barfing for an hour. Do you have, like, the flu? I don't know. I hope you're not pregnant. That sounds like morning sickness. Miranda?

I don't know why they call it morning sickness when it's all f***ing day long. Yep, it's morning sickness. And I can assure you, it's not just in the morning. I haven't been able to track down whoever coined that term, but I hope they have the afterlife's equivalent of diarrhea. Misery loves company. In early pregnancy, I was vomiting every day or every other day, mostly in the evenings.

At week 15, I gave my pregnancy tracker apps the middle finger as they congratulated me on the end of my nausea. For lots of people, it stops in the second trimester, but not for me. I just puked everything I'd eaten that day. Some people have helpfully told me to eat more protein, just as others told me to eat less protein. Friends have gleefully announced that it must be a girl, while other family members maintained, well, that means it's a boy.

My doctors have been just as unhelpful. Some pills prescribed to me seem to be helping some days, but other days I still retch multiple times. The question I'm left with, shouted dramatically at the heavens, why? Today on Unexplainable, you're going to have to bear with me as I, Julia Longoria, turn my pain into art, or at least into journalism.

And I'll ask why. Why do pregnant people, who are presumably eating for two, why do so many of us barf so much? Pregnancy nausea has been in the human record since about the year 2000 B.C.,

But the story of how we finally got some kind of scientific answer to why starts with a woman in the 90s. If you could think back to the Marlena before you, you know, before you ever got pregnant, when you were maybe trying not to get pregnant, what is your earliest memory of the term morning sickness? Just what I saw in television shows and movies. ♪

People saying, ha, ha, ha, she's pregnant. Like it's an aha moment. Marlena Fejzo is a geneticist. And like so many of us, she didn't think much about pregnancy nausea until she found out she herself was pregnant. When I woke up, I ran to the bathroom and I sort of laughed after thinking, this is morning sickness, aha. But within a week, realized that it was not...

Very funny. I had nonstop nausea and vomiting, so I couldn't get out of bed until around noon without vomiting. When I called the nurse, she said, this is normal in the first trimester. From the sounds of it, Marlena's nausea was significantly worse than what I've been experiencing. I ended up going to the emergency room twice for intravenous fluids.

In that pregnancy, I was able to keep something down every day. It did go away in the second trimester, and the rest of my pregnancy was really not so bad. By the time Marlena had seen a doctor, she was in her second trimester, and she was already feeling better. She never brought it up, and her doctor didn't ask about her nausea. Marlena gave birth to a healthy baby boy, and she never thought about pregnancy nausea again until two and a half years later.

I walked by a gelato store and I didn't feel like going in. I thought I must be pregnant because normally that smell would be delicious and I would have to go in, but I just did not feel like going in. And I was like, this is not normal. I must be pregnant. And I took a pregnancy test and sure enough, I was pregnant. It got bad really fast. Pretty soon I could not eat, drink or move without violently vomiting blood.

It was like that feeling that you have a few seconds before you vomit that I had all the time where I'm just constantly about to vomit. And I had to spend every waking second trying not to vomit because once I started, I couldn't stop. And it would last hours and just be very violent because there was nothing in there to vomit. So...

My body would reach further and further down my intestines to try to find something to vomit up. So it was very violent. And I had to do everything I could to try to stop that cycle from happening because it was very hard to stop. It was torture. I didn't keep any food down for over a month. This time, Marlena told her doctor about it. The OB, he gave me the diagnosis of

He said I had hyperemesis. Hyperemesis gravidarum. What was going through your mind when you heard the word hyperemesis? Did you know what that was? I don't think I knew what it was at the time. Must have been the first time that I'd heard it. Hyperemesis gravidarum, or HG, is an extreme form of pregnancy nausea that affects about 2% of pregnancies worldwide. What I personally have gone through in my pregnancy is nothing compared to this condition.

And when Marlena got sick in 1999, just like now, there weren't any proven treatments for it. My doctor, he offered that I could have home health care, tried seven different medications at once. I actually had a Zofran pump in my leg because I couldn't swallow medication without vomiting. And I lost the fat in my thigh so quickly that they had to move that pump to...

Eventually, my doctor gave me a feeding tube. A feeding tube. It goes through your vein. It's pretty dangerous because it gets inserted above your heart. And if it gets infected, you can have serious consequences. So they try not to do it if they can, which is why I think my doctor waited so long. But I really was starving to death. This was extremely scary. A small percentage of people die from HG. Yeah.

I was in bed, lying flat at home. I couldn't even sit up. I couldn't go to the bathroom. I couldn't brush my teeth. I also had something called hypersalivation. So just buckets and buckets of saliva coming out of my mouth. And it was really acidic. So I had kind of burn marks all over my face. So my doctor prescribed that suction machine that they have at the dentist office. I had to have

Pretty much 24-hour care. I mean, my husband took care of it at night. He had to wake up in the night to change my tubing and everything. We hired someone who took care of my son because I couldn't even see my two-and-a-half-year-old. My husband would just bring him in at night to say goodnight to me.

At one point in this fog, Marlena has a faint memory of getting a call from her doctor. I suppose I did at one point talk to my doctor on the phone because I know that he did tell me that

People who have this are trying to get attention. Wait, I'm sorry. What? He said this on the phone to you? Yeah. Yeah. He said I was exaggerating my symptoms to get attention. He said this directly to you? Yeah. Are you factually in your hospital bed at home talking to the doctor with a feeding tube in your... Yes. Yes.

Because I was only in one place the whole time. I couldn't even turn to my side. So I was lying flat on my back in my bed talking to my doctor. And he said that to me and starts telling me about, he's actually even done the studies, trying to be scientific with me. Like, I've done a study on this. I never saw that study. Did you look for it? Later I did. I never found it. Not at that time. But he said he had done a study that showed that

Women with hyperemesis were infantile and just wanted attention from their mothers. Wow. It's really the reverse where a lot of women with hyperemesis will end up moving in with their mothers because the mothers are the ones that will take care of them and take care of their children when they're going through this. But it's not...

because they want attention from their mothers because they don't have a choice, right? You can't cook when you're extremely nauseous. So you need someone who's willing to do that for you. Literally have a feeding tube, but like, what are you talking about? Exactly, yeah. But it's actually pretty common for doctors to say that to their patients, unfortunately, even to this day.

And I didn't have any energy to argue with him. I mean, I couldn't even barely stand up for more than a second. How did you feel in that moment? I was definitely angry because obviously it's imprinted in my brain and I remember it so well. But I was also really too sick to really, I mean, I was really struggling every second. Yeah. So, yeah. During this pregnancy, what?

She never saw the inside of her doctor's office again after her very first visit when she got diagnosed. She had gotten an ultrasound at that first visit. That was the last picture of my baby that I ever got because I lost it in the second trimester. When you lost the pregnancy, how soon was it before you kind of stopped feeling nauseous? It was immediate. It was crazy.

Literally that day I could eat again and it was so strange because I was like, it's so easy to eat and yet it had been so hard to like even just be near food. That must be like so heartbreaking and so... It was very weird because it was like I felt so good to be able to eat again physically, but I felt so bad having just suffered so much for no reason. It took me about a month to recover and

But when I did recover, I started looking into what was known about it. Marlena is a geneticist. Up until this point, she'd been so sick and weak that she hadn't taken a scientific curiosity about why she was getting sick and what she could do about it. Now, out of the haze of hyperemesis,

She put her scientist hat back on. And then I just searched PubMed for medical articles related to nausea and pregnancy and hyperemesis, but there was very little out there at the time. I just was like, okay, I have to work on this because there's nothing out there and I need the answers. So you were like, I'm going to go find the answers. Yeah, exactly. Answers after the break.

After graduating from high school, Anthony needed a plan. He loves playing video games, but that doesn't cover rent. So he took a job at Amazon packing boxes. He heard about their free skills training programs to boost his pay. Now Anthony is a software developer for Amazon. With a bigger paycheck, he upgraded his computer system at home. With his new skills, he's developing a video game in his free time.

Grow your career and your pay. Learn more at aboutamazon.com. Support for this show comes from Rinse. Here's a question. Who does your laundry? Well, you can simplify your life by having Rinse do it for you. With one touch in-app scheduling, pickup and delivery are effortless. Your clothes come back fresh, folded, and ready to wear, handled by laundry experts who get every detail right. Rinse makes laundry and dry cleaning the easiest part of your week.

Sign up at Rinse.com and save $20 on your first order. When you open a Corona, you hear the sounds of wherever you are a little differently. A little more Corona. And you think to yourself, why am I just listening? Corona. La Playa awaits. Relax responsibly. Corona Extra Beer. Imported by Crown Imports Chicago, Illinois. To be clear,

I have not been diagnosed with hyperemesis gravidarum. My symptoms come nowhere near to what Marlena went through. But it has become bad enough that I've found myself researching the long history of pregnancy puking to try to understand why we seem to know so little. Apparently the Greeks wrote about pregnancy nausea on papyrus circa 2000 B.C.,

Roman doctors, at one point, recommended a hot wine bath to combat the illness. Don't knock it till you try it, I guess? Fast forward, though, to the 1950s and 60s, and something happened that had a bit of a chilling effect on pregnancy nausea research. The thalidomide disaster, so the drug thalidomide was given in the 50s and 60s for nausea and vomiting, hyperemesis in pregnancy, and

Unfortunately, that drug led to babies being born with severe limb deformities. For decades after that, as far as I can tell, we didn't do much else to figure out why pregnancy nausea happens. But it's pretty clear, even from what little was out there when Marlena did her search, that it was not a disease.

That pregnancy nausea is not in your head, contrary to what her doctor claimed. People said to me while I was sick that it must be psychological because only humans have it, but that is just not true. So there's evidence from veterinary journals that dogs, cats, and monkeys all have an early period of appetite loss, just like humans have.

The most extreme example is the octopus. They actually lay their eggs and then starve to death and die. For humans, I read pregnancy nausea in general is associated with positive pregnancy outcomes.

leading some scientists to believe that it's evolution. We puke to protect our babies. Like, if we eat less, then we won't need to go out and hunt and gather and risk getting eaten by predators, I guess? Clearly, we don't need that anymore as humans. You know, maybe animals still need it, but for us, it's just click Uber Eats. Our food is very safe and easy to get without risking our lives. So it's...

mechanism that I think we should try to evolve away from. Leave in the past. Yeah. I could not agree more. But Marlena's doctors seemed to still be stuck in, maybe it's all in your head. She was determined to dump that hypothesis. But if you want to get rid of a bad theory, you got to come up with a better one. And that's not easy.

At this point, Marlena was very early in her career, a postdoc at UCLA, who was not focused on pregnancy nausea. She didn't have any funding to go into this. She just had a hole in her heart from her last pregnancy and a burning curiosity. And what did you do next? I wrote a survey with all the questions I could think of related to hyperextension.

Hyper-emesis. She wrote a survey intended for people who'd been diagnosed with hyperemesis gravidarum, asking a lot of questions. It was very long. It was like 30 pages. But the main things she was curious about... What is the recurrence risk?

If you have this once, what's your chance you'll have it again? I asked about medications and which ones were effective and what the side effects were. And most importantly, for her potential research... Did it run in families? I wanted to do a genetic study and so I needed evidence to show that it was genetic.

If she got anecdotal evidence that hyperemesis gravidarum ran in families, then she could go out and get some funding to try and prove it. My little brother was a statistician and he put the survey up on his website and we started getting faxes back at that time. This was around the year 2003, before things like SurveyMonkey and Google Forms were common.

So Marlena and her little brother had gotten creative. I had a lot of trouble publishing my survey results because people didn't believe the internet and who are these people that are like filling out these things and how do you know they really have what they have? But like, why would someone sit down and fill out a 30-page survey if they didn't have it? And over the course of two years, they got over 800 responses back. And what did you find?

So we found that there was a 17-fold increased risk of having it if your sister had it. Women that had it once had it again in 80% of their pregnancies, which also suggests a genetic component.

Next, Marlena set out to find biological proof that this was genetic. That meant collecting surveys wasn't enough. She had to collect DNA samples. And so people were sending in saliva samples from all over the country. This was still a sort of pet project of hers. So she got permission to store these samples in the fridge at work in one of UCLA's labs.

And when she got enough samples, she applied for official funding to try and sequence them. I applied for funding from the NIH. I applied twice and was rejected twice, unfortunately. So I had all these saliva samples sitting there. And once again, 10 years into this pet project, Marlena got creative. My brother gave me a 23andMe kit for my birthday in 2010.

23andMe, the direct-to-consumer genetic testing business. It had been named the invention of the year a few years earlier, and it had started a bit of a craze. Over 15 million people have sent the company their saliva.

Marlena approached 23andMe with a small request. I asked them to include hyperemesis in their surveys, and they were very receptive to it. They asked their customers a simple question. Do you have hyperemesis gravidarum? A few years passed, and Marlena got some data back. We found the first connection with the vomiting hormone, GDF-15.

Having at this point raised zero dollars to fund her research, Marlena had identified a gene that looked like it might play a role in HG. A gene, GDF-15, that made the vomiting hormone. A hormone that everybody has, whether you're male or female and whether you're pregnant or not.

For men and women, it's associated with stress. This hormone is why you often lose appetite when you're under some kind of physical or mental distress. It's why some people stop eating during finals week, for instance. When it gets high enough,

We think that it's a signal that's telling your body either to expel a poisonous food and not eat that again, or in our hunting and gathering days, telling you, hey, stay in your cave until you feel better. 23andMe customers who said, yes, I have HG, seem to share a similar variant of the vomiting hormone gene. It was really an aha moment.

It turned out we already knew that placenta makes a lot of this vomiting hormone. So it already had a connection with pregnancy. She didn't yet know how exactly the vomiting hormone played a role.

But it was something. So she published her findings. After my paper came out, I was contacted by a scientist from the company Regeneron. He said he was very interested in my paper and could they do anything for me? And so I said, well, actually, I have all these DNAs in my freezer that haven't been sequenced. And I had actually applied to the NIH again. And they...

denied me funding. She'd been denied funding a third time. Even though they funded a study very similar size on erectile dysfunction genetics, so I was not happy about that. But the biotech company Regeneron would help her. They sequenced those saliva samples that she'd been storing in the university fridge for years. And yet again, same gene showing up,

the vomiting hormone gene surfaced. Very strong evidence that the vomiting hormone and its corresponding gene were the stars of the morning sickness show. But how? What exactly was going on with the hormone? Why was it causing certain people to get really, really sick?

To get to the bottom of this, Marlena did another study. Again, not funded by the NIH, but this one involved researchers from around the world. Our next paper was international collaboration of many researchers where we figured out what was going on. And after years of Marlena just DIYing it, the team finally found an answer.

People with hyperemesis have lower levels before pregnancy. For people who got really sick during pregnancy, like people with HG, they were making very little vomiting hormone before they got pregnant. So when they got pregnant, the levels shot up and that change was an utter shock to the system.

So like they had a low, it had to do with like the sort of change in the level of the hormone. Exactly. Rather than how much. Exactly. How convinced are you that you have found the cause of hyperemesis? And I guess like, is it also the cause of morning sickness, quote unquote, more generally? Yeah, so it is the cause of hyperemesis.

all nausea and vomiting in pregnancy as well as other forms of nausea. I'm convinced of that. She says other factors might also contribute to it, but she's convinced this is the main cause. I was honestly kind of shocked to hear her say this. She figured this out almost single-handedly

Eventually, yeah, she had a team of researchers, but it's thanks to her curiosity about her own health that we know the cause of morning sickness. That she knows it, and I know it, and now you know it. So why does the medical establishment act like we don't know the cause of morning sickness? When I asked my doctor about the cause of nausea, he said there could be lots of contributing factors, which I guess is true, but we have a pretty good idea for the main cause.

And Marlena says she has some pretty good ideas for how we could treat the root cause of pregnancy nausea, thanks to an experiment that a colleague of hers at Cambridge did. He gave mice a high dose of vomiting hormone, and they predictably puked. But when he gave them just a little bit of the hormone before giving them a high dose, the mice seemed to be desensitized. They didn't puke.

Marlena applied for NIH funding last year to try and test this treatment on actual patients, to try and desensitize patients with a history of HG. Shocker, the NIH denied her proposal.

And another shocker, that's not stopping Marlena from trying to find an answer herself to her remaining unanswered questions. I am doing a study of women that are trying it on their own because many people are trying it on their own anyway with their doctors and are contacting me saying they're trying it. Based on your research, basically, they've decided to just give it a go? Yes. Is insurance covering it for them or they're just kind of going...

For some people, I think it is. Some people it isn't. But, you know, people want to complete their families and they want to be able to carry their pregnancies healthfully and safely. I mean, I can totally understand why these women are doing it. Yeah. And I am curious, just hearing your story and hearing about your research, if your experience with your second pregnancy affected your decision to try to get pregnant again.

Oh yeah, definitely. In my second pregnancy, my body killed my baby. So I feel like

I'm not going to take that risk again and risk my body killing another potentially healthy pregnancy. So I ended up doing surrogacy, gestational surrogacy, and I was very lucky to have twin daughters as well. So I was able to complete my family, which really allowed me to feel happy and be able to work on this and give back. So I'm very grateful. Yeah.

And I mean, you know, the experience that I guess I'm going through right now, just like even any pregnancy, and I'm sure it's on a heightened scale with folks who have HG, but like talk about unexplainable, right? Like pregnancy is like so mysterious, even to the person, especially to the person who's pregnant. Like you have so little communication or feedback or information about the fetus or the baby, right?

And to me, I guess like I've been reflecting on how like this sickness almost feels like one form of feedback in it. And it's easy to feel like, oh, am I doing something wrong? Is there like meaning in this?

I don't know, what do you say to people who are looking for meaning in the vomit? Yeah, no, I definitely think we don't need that anymore. I think that it's just a mechanism that our evolution has not evolved out of fast enough. It's like your appendix or something. Yeah, I don't think we need it anymore, that heightened sense of smell and that...

extreme nausea and vomiting. You know, maybe animals still need it, but we do not. This episode was produced by me, Julia Longoria. We had editing from Jorge Just, mixing and sound design from Christian Ayala, music from Noam Hessenfeld, and fact-checking from Esther Gimm. Meredith Hoddenant runs the show, and Bird Pinkerton backed away slowly from the platypuses as more and more kept coming out of the tall grass.

How could you? She yelled. One platypus stood up and said quietly, we had no choice. Thanks, as always, to Brian Resnick for co-creating our show. If you have thoughts about the show, send us an email. We're at unexplainableatbox.com. You can also leave us a review or a rating wherever you listen. It really helps us find new listeners.

You can also support this show and all of Vox's journalism by joining our membership program. You can go to vox.com slash members to get ad-free podcasts and a whole bunch of other good stuff. Plus, you'll be helping keep this place running and make sure journalists like me get paid. Unexplainable is part of the Vox Media Podcast Network, and we will be back next week.

To remind you that 60% of sales on Amazon come from independent sellers, here's Tracy from Lilies of Charleston. Hi, y'all. We make barbecue sauce, hot sauce, and specialty popcorn. They get help from Amazon to grow their small business faster. They handle all our shipping and logistics, which is a big help. All on it up. Have a great day, Tracy. Hot stuff, Tracy. Ooh, honey. Shop small business on Amazon.