Managing nausea during pregnancy

During one of my clinics, a couple walked in, desperately wanting to vent out their concern. The husband begins, “My wife has not been able to eat or drink anything for the past one month.

She has been vomiting everything that she ingests whether it’s food or even a sip of liquid. She has lost weight and as you can see we have to walk with a plastic bag everywhere for her to vomit in, she is really suffering doctor!’

’ This is a story of a pregnant woman suffering a severe form of nausea and vomiting, medically known as ‘hyperemesis gravidarum’.

What really happens?

Nausea and vomiting are common symptoms during pregnancy affecting 25 per cent and 50 per cent of pregnant women respectively.

In its severe form, hyperemesis gravidarum can be life threatening. Its symptoms are worst around nine weeks of pregnancy and typically improve by 16 to 18 weeks of pregnancy, although for some women it may persist until delivery.

Hypermeresis gravidarum is a diagnosis of exclusion, meaning only reached once all other causes of vomiting have been ruled out.What exactly causes this excessive vomiting (hypermeresis gravidarum) is not known, however, certain hormones and infection with H.pylori have been implicated.

No single hormone can accurately predict presence of this condition but oestrogen hormone and hCG hormone are being said to play a role.

It has been observed that nausea and vomiting tend to be severe in conditions associated with high hCG levels such as multiple pregnancies. Also infection with H.Pylori bacteria is said to play a role in this disease.

Its effects

Excessive nausea and vomiting of pregnancy can impair quality of life of a pregnant mother. The complications of this condition can be life threatening. This includes electrolyte imbalance, dehydration, nutritional deficiencies and kidney failure. Others include weight loss of the mother, premature birth and low birth weight.

There are other causes of excessive vomiting during pregnancy that are to be sought before diagnosis of of hypermeresis gravidarum is reached. Such causes include infection such as urinary tract infection(UTI), appendicitis, peptic ulcer disease and many others. Also some of the drugs given during pregnancy such as iron supplements may cause excessive nausea and vomiting.

How to control it?

Treatment is supportive and aims at improving quality of life of a pregnant mother. This includes dietary measures, avoiding triggers, replacing water and electrolytes lost during vomiting and also medication.

Dietary measures include taking meals and snacks slowly and in small amount atleast at an interval of every two hours, this includes figuring out the kind of food one can tolerate and that needs to be taken often. Also avoid lying down immediately after eating and avoid changing positions too quickly. This is also a useful measure in nausea and vomiting during pregnancy.

In terms of fluid, it has been noted that cold drinks and carbonated ones are tolerated and can be taken in small amount between meals. Sour fluids also such as lemonade or gingerale are useful and some studies have pointed out drinking ginger has an effect in reducing the symptoms.

Intravenous fluids is an option for those who cannot tolerate food or liquid of any amount and is done at the hospital.

Avoiding triggers is also one of the most important treatment of nausea and vomiting of pregnancy. Some of the triggers include; odours (such as perfume), noise, visual or physical motion ( such as flickering lights), excessive exercise, consuming large amounts of high-sugar foods and many others.

Consult your doctor for any further medication.

Most women with nausea and vomiting recover completely without complications once they follow the above measures and kept on some medications.