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Nausea or Morning Sickness
Nausea and vomiting of pregnancy is generally a mild, self-limited condition that may be controlled with conservative measures. A small percentage of pregnant women have a more profound course, with the most severe form being hyperemesis gravidarum. Unlike morning sickness, hyperemesis gravidarum may have negative implications for maternal and fetal health. Hyperemesis gravidarum, a severe form of nausea and vomiting, affects one in 200 pregnant women. Although the definition of this condition has not been standardized, accepted clinical features include persistent vomiting, dehydration, ketosis, electrolyte disturbances, and weight loss (more than 5 percent of body weight). Pregnant women who have severe vomiting may require hospitalization, orally or intravenously administered corticosteroid therapy, and total parenteral nutrition. Nausea is not an easy thing to deal with and no one should downplay the discomfort involved. Try as many approaches to managing nausea as you can but be realistic - no suggestion is going to 'cure' you. Sometimes, all you can do is endure. For most women, it does go away with time, and often it is worst in the first 3-4 months. You may or may not experience it again in subsequent pregnancies; each pregnancy is different and you must be prepared for the possibilities. It will end eventually! Minimizing Nausea Remember, all of these are just ideas that have worked for some people. There are no guarantees! Not all of these suggestions will work for you, and sometimes nothing works. Keep your blood sugar levels even by eating small, frequent meals high in protein and complex carbohydrates. Simple carbohydrates (foods high in sugar and even unsweetened fruit juice) are turned quickly into blood sugar in your system. Complex carbohydrates take longer to turn into blood sugar, so they will keep your blood sugars from spiking quickly and then dropping, and will provide longer-term energy. High fiber foods, fats, and proteins also slow down the carbohydrate conversion, which will keep your blood sugar more even. Eat before you are hungry. If you wait until your body tells you it is hungry, you may already have lowered your blood sugar too much and the acid production in your stomach may also worsen nausea. Strike first by eating frequent small snacks (a carbohydrate and a protein are best) before your blood sugar has a chance to dip. Eat a substantial bedtime snack, including protein. It's a long time between your last meal of the day and your breakfast the next morning, so it's very easy for blood sugar to become too low during this time, causing nausea upon rising. Shortly before bedtime, try eating a fairly significant snack of complex carbohydrates and protein. The protein will help slow down the release of the complex carbohydrates, enabling you to have more steady blood sugar levels through the night. Sometimes, some women even need to get up in the middle of the night and get a little extra snack, like a glass of milk, in order to help their morning nausea. It's worth a try! Try eating before getting out of bed in the morning, then take it slowly. Before getting out of bed in the morning (like 20-30 minutes ahead of time), have a high-carbohydrate snack. Common suggestions are crackers, but some women find other foods work better. Experiment till you find your best choice (some like salty foods, others do not). Once you are up, ease yourself into the day as gradually as your schedule allows; rushing and quick movements at first tend to aggravate nausea. Give the morning snack a chance to take effect and raise your blood sugar. Be sure to get enough fluids. Dehydration is a danger to those with nausea, so it is important to stay hydrated. Some women find they tolerate fluids best with meals; others find it better to take them only between meals. Small sips, taken frequently, may also help. Be sure to take your prenatal vitamin, but try switching brands or times. Some women note a sensitivity to certain prenatal vitamin brands, especially the prescription type. Try switching for a week to an over-the-counter brand (be sure it has enough folic acid), or try asking your doctor for a different prescription type. Avoid trigger foods and substitute alternatives as needed; get enough protein. Some foods seem to act as triggers to nausea. Try to keep a variety of foods as much as possible, and be creative in your choices so that the essential nutrients are covered. Don't forget the importance of significant amounts of protein in your diet as well. Rinse or brush after throwing up. Having the smell or taste of vomit in your mouth after one bout can lead to another. Try brushing your teeth afterwards, but if you are one of the people for who brushing can induce nausea, try a gentle rinsing instead. Over time you will find your physical triggers (such as brushing, strong smells, or moving too fast) and you will learn to avoid them or adapt to them. But finding a way to refresh yourself after a bout of nausea is important - do whatever works for you. Try Sea Bands. These small bands worn on each wrist put pressure on the inner wrist and often help nausea. They have no side effects and can be found at many pharmacies or marine shops. Treatment The management of nausea and vomiting of pregnancy depends on the severity of the symptoms. Treatment measures range from dietary changes to more aggressive approaches involving antiemetic medications, hospitalization, or even total parenteral nutrition. NONPHARMACOLOGIC THERAPY Dietary Measures. Initial treatment of women with mild nausea and vomiting of pregnancy (i.e., morning sickness) should include dietary changes. Affected pregnant women should be instructed to eat frequent, small meals and to avoid smells and food textures that cause nausea. Solid foods should be bland tasting, high in carbohydrates, and low in fat. Salty foods (e.g., salted crackers, potato chips) usually can be tolerated early in the morning and sour and tart liquids (e.g., lemonade) often are tolerated better than water. Emotional Support. Although nausea and vomiting of pregnancy and hyperemesis gravidarum are not strongly associated with psychologic illness, some women may become depressed or exhibit other affective changes. It is important that these women receive appropriate support from family members and medical and nursing staff. Ginger. A popular alternative treatment for morning sickness, ginger has been used in teas, preserves, ginger ale, and capsule form. PHARMACOLOGIC THERAPY Pyridoxine (Vitamin B6) and Doxylamine. Pyridoxine can be used as a single agent or in conjunction with doxylamine. Antiemetics. If the previously discussed therapies are unsuccessful, a trial of antiemetics is warranted. The phenothiazines prochlorperazine (Compazine) and chlorpromazine (Thorazine) have been shown to reduce nausea and vomiting of pregnancy compared with placebo. Antihistamines and Anticholinergics. Meclizine (Antivert), dimenhydrinate (Dramamine), and diphenhydramine have been used to control nausea and vomiting during pregnancy. All have been shown to be more effective than placebo. Motility Drugs. Metoclopramide (Reglan) acts by increasing pressure at the lower esophageal sphincter, as well as speeding transit through the stomach. This drug has been shown to be more effective than placebo in the treatment of hyperemesis gravidarum. Metoclopramide has not been associated with an increased incidence of congenital malformations.
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