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Family Health Magazine - CHILDBIRTH

Nausea & Vomiting of Pregnancy
Practical tips for a common problem

Nausea is the most common symptom of pregnancy, and most women experience it. Though it is sometimes called ‘morning sickness’, it can occur at any time of the day or night. Most often, it happens between the first and fourth months of pregnancy, and improves after that. However, about 20 per cent of women have nausea through their entire pregnancy.

Every pregnancy is different. Some women have no nausea, or just a very mild upset stomach. A woman may be quite sick in one pregnancy, but not at all in the next one. Most pregnant women have several weeks of feeling quite nauseated. Fortunately, normal nausea of pregnancy is not harmful to the baby.

A few women get a more extreme condition called hyperemesis gravidarum, which involves severe vomiting. Some women with hyperemesis gravidarum can’t keep down any food or liquids, and must stay in the hospital for IV treatment. Hyperemesis gravidarum can sometimes be so severe that the mother loses a lot of weight. In these cases, the baby may not grow well. If you are losing weight, your midwife or doctor will monitor you closely to make sure that your baby is okay.

We don’t really understand what causes nausea and vomiting in pregnancy. It may be partly due to the hormone changes of pregnancy. Some cases of hyperemesis gravidarum happen in women with a stomach bacteria called Helicobacter pylori. If your nausea and vomiting are severe, your doctor or midwife may test you for H. pylori. If the test shows you have this bacteria, you can take medications to help get rid of it.

Nausea and vomiting in pregnancy can interfere with your ability to work or care for your family. It can cause a lot of stress and misery. It’s important for family members, friends and co-workers to be supportive and understanding.

Being tired is a major trigger for nausea in pregnancy. You may notice that if you are very busy at work or at home, your nausea becomes worse. If food smells cause nausea or vomiting, you may not be able to cook. Ask family members and friends for help during this time. One easy way they can assist is to make some meals for your freezer. This can make life much easier if you are tired or if nausea makes it hard to cook.

Finally, help yourself by resting whenever possible; even if it means leaving some work undone. Getting enough sleep is key.

Does it matter what I eat?

These foods, tastes and textures often appeal to pregnant women

(source: Tufts University Diet & Nutrition Letter 1994; 11(1): 6-7)

Women have tried many food ‘tricks’ to help with nausea. For instance, you might try taking liquids and solids at different times instead of together, or cut out fatty foods. However, when scientists studied these tricks, there was no proof that any of them really help.

Many women do notice that some foods are easier to manage, while other foods make nausea worse. These foods may be different for each person. You will quickly figure out which foods work best for you, and which ones you need to avoid. Bread, rice, crackers, and noodles are usually easy on the stomach, while meats and eggs can make nausea worse.

Some women find nausea is worse if they have an empty stomach. Try eating many small snacks, instead of big meals. Keep dry cereal or a plate of crackers by your bedside. Eat them at bedtime, during night trips to the bathroom, and before getting up in the morning. Doing this may help keep nausea away.

The same is true for liquids. Take small sips of fluid often during the day. Avoid drinks with caffeine, such as coffee, tea and cola.

Although good nutrition is important in pregnancy, women with a lot of nausea and vomiting should not worry too much about eating a perfect diet. Within reason, eat whatever makes you feel best. Stay away from foods that make your nausea worse. Usually, nausea won’t last forever. There will be plenty of time to eat a more nutritious diet later in your pregnancy, once you feel better. Studies of nutrition in pregnancy show that eating an unbalanced diet for a short time isn’t harmful to the woman or her baby.

Other possibilities

Acupuncture and acupressure might help. You can do acupressure for yourself, and it is considered very safe in pregnancy. The easiest way to use acupressure is by wearing a special acupressure wristband, such as a Sea-Band, which you can buy from a pharmacy. These elastic bands have plastic buttons on them, which apply pressure at certain spots on your wrist.

What about vitamins and herbal remedies?

Taking a prenatal vitamin every day is important for the health of you and your baby. However, some women find the vitamin makes their nausea much worse. This is usually due to the iron in the vitamin. If it is a problem, try taking the vitamin after a meal or at bedtime. If the prenatal vitamin still causes problems, switch to a regular women’s multivitamin without iron until the nausea improves. Once you feel better, start the prenatal vitamin again. It is also possible to get a prenatal vitamin with less iron in it, but you will need a prescription. Ask your doctor or midwife if you are interested in trying it. The most important vitamin early in pregnancy is folic acid, so make sure that the vitamin you use has folic acid. There is no benefit to taking very large doses of any vitamin in pregnancy.

Some natural products can help with nausea and vomiting. Small amounts of ginger may help settle your stomach. It can be found in teas, ginger ale, foods, candies and tablets. We don’t know whether it’s safe to use large amounts of ginger, so limit ginger tablets to 1000 milligrams per day or less.

Other herbal products include raspberry leaf tea, peppermint, and chamomile, but none of these have been studied to find out whether they work.

Medications

Of all the prescription medications for nausea in pregnancy, doxylamine with pyridoxine (brand name Diclectin) is the one that doctors and midwives usually try first. It has been available for years, has been studied the most, and is known to be safe and effective for moms and babies. Diclectin contains a type of medicine called an antihistamine (similar to some allergy medications) and vitamin B6. The biggest side effect is drowsiness, which is caused by the antihistamine. Each pill starts to work about eight hours after you take it, so you can’t take it as needed, but must use it regularly. Taking it two or more times a day will usually prevent nausea. Once your nausea is better, talk to your doctor about slowly lowering the number of pills you take.

If diclectin causes too much drowsiness, using plain vitamin B6 may work. The usual dose is 30 to 75 milligrams per day, and you can buy it without a prescription.

Dimenhydrinate (Gravol) is also very safe in pregnancy, but can cause drowsiness too. One of the nice things about this drug is that it works more quickly than diclectin. You can take a pill just when you start to feel sick, instead of all day long. You can buy Gravol without a prescription.

If these medications don’t work or aren’t enough, a number of other prescription medications might be helpful. Ask your doctor or midwife for more information.

There is hope!

Nausea and vomiting are very common problems in pregnancy. Often they only last a short while. You can try medications and other strategies to help. Talk to your doctor or midwife for ideas. Make sure you tell them if you are vomiting every day. Do your best to eat and drink enough, and sleep whenever you can. Don’t be afraid to ask your friends and family to help you during this difficult time. We hope you will be feeling better very soon!

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FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2015, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6    [CB_FHcd16]
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