Q: I just found out I am pregnant. Both of my sisters were really sick during their pregnancies so I am wondering if there is anything I can take to prevent this from happening to me?
Nausea and vomiting in pregnancy are often referred to as morning sickness, although it can occur at any time of day. Mild nausea with or without vomiting are very common pregnancy symptoms and are reported in up to 90 per cent of pregnancies. Symptoms typically start during the first trimester around week 5 and resolve in the second trimester by week 20. For a small percentage of people these symptoms will persist throughout the entire pregnancy.
The exact cause of these symptoms is not fully understood but it is believed that hormonal changes and genetic predisposition play a key role. A hormone called hCG (human chorionic gonadotropin) rises to its highest level in the first trimester around the time when symptoms start. Another hormone called estrogen increases in the first trimester and decreases later in pregnancy often around the time when symptoms begin to subside. These two hormones are identified as the most likely culprits, but your genes also come into play. If your mother or sister experienced morning sickness, it increases the likelihood of you having these symptoms as well. Being pregnant with more than one child at a time is also a risk factor for nausea and vomiting.
To reduce the frequency and severity of your symptoms dietary changes are often necessary. Try eating smaller meals more often and opt for foods that are high in protein and high in carbohydrates to give your body the energy it needs and to keep you feeling full for longer. Since your stomach is more sensitive eat only foods that appeal to you and avoid foods that are fatty, fried or spicy. Keeping a box of crackers beside your bed and having a few 15 minutes before you slowly get out of bed in the morning can be helpful to reduce nausea. Also, avoid eating right before going to bed or lying down right after a meal. If your prenatal multivitamin seems to be worsening your nausea, try taking it in the evening with your supper meal.
If your symptoms start to become bothersome, speak to you doctor or your pharmacist, as pharmacists in New Brunswick can assess and prescribe for nausea, about a prescription medication called doxylamine/pyridoxine (Dicletin). It is the first line choice for treating morning sickness and it needs to be taken on a regular basis to be effective. The dose you take in the evening helps with your morning symptoms, the dose you take in the morning helps with your afternoon symptoms, and the dose you take in the afternoon helps with your evening symptoms. You can also try dimenhydrinate (Gravol) over-the-counter as a second line choice, if you find a full tablet makes you too drowsy try taking just half a tablet. Many natural options to treat your symptoms exist as well and results can vary from person to person. Ginger tablets and acupuncture or acupuncture wristbands tend to be the ones that are most commonly recommended.
Acid reflux is another common condition that occurs during pregnancy and one of its symptoms can be nausea. Over-the-counter calcium carbonate (Tums) is often the first product chosen to treat acid reflux. If you are not experiencing sufficient relief, ranitidine (Zantac) is a step up from calcium carbonate but can be difficult to find in some pharmacies in recent years. You can speak to your doctor about getting a prescription for a proton pump inhibitor to reduce acid production such as omeprazole (Losec).
In some cases, severe nausea and vomiting can lead to dehydration and weight loss, a condition known as hyperemesis gravidarum. It is important to seek medical attention if you are experiencing symptoms of dehydration such as dry mouth, increased thirst, sunken eyes, decreased urination or dark coloured urine or if you are losing weight as you may require intravenous fluids, electrolyte or vitamin replenishment and other prescription medications to treat your symptoms.
You should also consult your doctor if your nausea and vomiting is severe, persistent and impedes your daily activities without signs of dehydration or weight loss as this can also warrant additional prescription anti-nauseants such as metoclopramide or ondansetron. A trip to the doctor is also needed if your nausea begins after the ninth week of pregnancy or if you see blood or small black particles in your vomit.
Erin Thompson (BSc, BScPharm) is a graduate of Dalhousie University and a community pharmacist practicing at Shoppers Drug Mart in Quispamsis N.B. Her opinions expressed in this column are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment.