Nausea and vomiting during pregnancy: Part 1

A small number of women experience NVP during the entire 9 months, says DietDoc.

Nausea and vomiting during pregnancy are probably among the most negative aspects of expecting a baby, that women have to endure. Prince William's wife Catherine was rushed to the hospital with extreme nausea (hyperemesis gravidarum) in the early stages of her pregnancy.

Mild or severe

Nausea and vomiting of pregnancy (NVP) usually occurs during the first trimester and most women experience some degree of nausea on waking in the morning, which is why the less serious manifestation is colloquially called morning sickness. A smaller number of moms-to-be develop nausea at other times of the day like in the late afternoon and sometimes in response to certain trigger stimuli such as specific smells or fatty foods.

There are, however, a small number of women who suffer severe nausea and vomiting 5 or more times a day, which is know as "hyperemesis gravidarum", for the entire 9 months of their pregnancy, a prospect that is daunting to say the least. In addition to making the mother’s life a nightmare, such persistent nausea and vomiting can have serious consequences for the normal development of the baby because of the mother’s inability to eat an adequate diet or to keep food down. Hyperemesis gravidarum can also seriously affect a woman’s quality of life and her physical and psychological health.

A disturbing lack of information

To determine what can be done to alleviate both types of NVP, I did a search of the scientific literature and was amazed to find that despite the fact that 75-80% of pregnant women develop NVP, researchers such as Badell and coworkers (2006), admit that “The exact etiology and pathogenesis of NVP are poorly understood and are most likely multifactorial”. Furthermore Coad and coworkers (2002) state: “Although NVP has been documented for thousands of years , its cause has not yet been satisfactorily elucidated.”

The latter authors also mention the startling fact that NVP caused the death of Charlotte Brontë due to “starvation and dehydration after suffering very severe NVP 4 months into her first pregnancy”.(Coad et al, 2002). Charlotte Brontë and her baby died in April 1855, more than 155 years ago, and yet we still don’t really know what causes NVP and what treatments can improve the quality of pregnant women’s lives and the health and nutrition of their babies.

Research into diseases and conditions that only affect women has a disturbing tendency to lag behind research that addresses illnesses that affect men or both sexes. Prime examples are how long it took for scientists to give attention to osteoporosis and female risk factors for heart disease. I sincerely hope that researchers will pay more attention to NVP and come up with some solutions for a condition that affects the welfare of so many women and their unborn babies.

Current theories

The current theories that have been put forward to explain both mild and severe NVP include: 

• Endocrinological or hormone changes
• Psychological predisposition
• Evolutionary adaptation
• Infection with Helicobacter pylori (the organism that has been identified in patients with ulcers that do not respond to standard therapy but require eradication of the organism with antibiotics and treatment to reduce acid production)
• A high BMI (overweight or obesity)
• Previous history of NVP
• Young age
• First pregnancy (primiparity)

(Coad et al, 2002; Badell et al, 2006; Latva-Pukkila et al, 2010)

It can, however, not yet be said with certainty which of these possible causes or combination of causes is responsible for the phenomenon of mild NVP or hyperemesis gravidarum. Statistics show that hyperemesis gravidarum occurs in approximately 0,5% of pregnancies and can be so severe that it leads to dehydration and electrolyte imbalances. In severe cases, the mother has to be hospitalised (Latva-Pukkila et al, 2010).

Treatment of NVP

The treatments suggested for NVP are varied ranging from the use of anti-emetic medication in countries like Canada, where such medications are available, to dietary and lifestyle changes. The latter advice includes plenty of rest and avoidance of stress and smells that may trigger NVP.

Dietary advice includes the following:

(Latva-Pukkila et al, 2010)
 

• Eat regular small meals (6 or more a day)
• Drinking cool, bland fluids like low-fat milk, yoghurt, smoothies, or fruit juice
• Only eat those foods that are tolerated (although this may result in an unbalanced diet)
• Avoid foods or drinks that trigger NVP (common trigger foods are coffee, meat, poultry, fish, eggs, spicy and fatty foods)
• Use of a liquid meal supplement such as Nutren or Ensure (buy at chemist). You may need to experiment to determine which liquid meal supplement and flavour agrees best with you and does not trigger NVP.
• Take things easy when you wake in the morning. Lie in bed and first have a dry biscuit and a cup of tea (rooibos or standard tea - drink it black with a squeeze of lemon if this is less nauseating for you).
• Suck a slice of lemon or an ice cube when you feel the nausea coming on.
• If you suffer from hyperemesis gravidarum see your doctor because you may require hospitalisation to restore your fluid and electrolyte balance and as a last resort, you may need to ask the doctor to prescribe an antinausea medication if he/she regards your situation as an emergency.

 - (Dr IV van Heerden, registered dietician)

References:

(Badell ML et al, 2006. Treatment options for nausea and vomiting during pregnancy. Pharmacotherapy, Vol 26(9):1273-87; Coad J et al, 2002. Nutrient insult in early pregnancy. Proc Nutr Soc, Vol 61(1):51-9; Latva-Pukkila U et al, 2010. Dietary and clinical impacts of nausea and vomiting during pregnancy. J of Human Nutr & Dietetics, Vol 23, Issue 1:69-77