Ease the Quease

Motherhood Magazine

July 2015

Ease the Quease

Nausea and mild vomiting are common symptoms in early pregnancy but you don’t have to suffer any longer!
It’s time you try these morning sickness treatments.

Women experience different degrees of morning sickness. While some go through the 40 weeks without a hint or nausea, some experience nearly constant nausea and vomiting. Don’t worry, morning sickness won’t last forever.

Morning sickness in pregnancy (also known as hyperemesis gravidarum) is a set of symptoms related to nausea, vomiting and poor appitite. There is a spectrum which ranges from minimal symptoms to very severe vomiting and nausea with poor oral intake. These symptoms usually appear to be worst in the morning and gradually improve as the day progresses. However, they can last the whole day for some pregnant mothers, explains Dr Jason Lim, consultant, Department of Obstetrics and Gynaecology, SGH.

Morning sickness is caused mainly by the presence and gradual rise of two female hormones, namely human chorionic gonadotrophin (hCG) hormone and progesterone hormone. It is unclear how hCG causes these symptoms which progesterone can slow down the digestion transit in the stomach and intestines, resulting in nausea, vomiting and in some cases, reflux of gastric contents.

The Deal with Morning Sickness

It is estimated that morning sickness affects between 50 to 90 percent of pregnancies.

However, a small proportion of pregnant mothers may still continue to experience nausea and vomiting after the first 12 weeks. If this persists with worsening severity, it is important to consult your gynaecologist as some of these symptoms may be a manifestation of other underlying medical conditions, advises Dr Lim. It is unclear why some mothers may experience these symptoms during one pregnancy and not during the next.

Morning sickness usually happens in the first trimester of the pregnancy
and this may last up to 12 weeks. This is due to the rapid elevation of
the hCG levels.

Risks and Complications

Mothers with mild symptoms of morning sickness usually do not need any medical therapy. However, in severe cases of vomiting and poor oral intake (including food and fluids), this can result in dehydration, electrolytes imbalance and poor nutritional status. The pregnant mother may experience lethargy, low mood, giddiness and even ‘fainting spells’. She may hurt herself in the process. Fortunately, morning sickness, says Dr Lim, often does not have any adverse effect on the developing foetus. But, caution must be exercised in severe cases especially if left untreated; this may have potential harmful effects on both the mother and baby.

A WORD OF ADVICE
For mothers with severe morning sickness associated with persistent vomiting and/or very poor oral intake
of food and fluids, it is important to seek medical attention as potential complications may result

Relieving Morning Sickness

If the pregnant mother experiences nausea without vomiting, taking several small portion meals may be helpful in slowly building up the appetite, says Dr Lim.

Avoid “spicy foods”, chilli or “carbonated” drinks as these
might trigger gastric reflux which may worsen the vomiting.

Dr Cynthia Kew, obstetrician and gynaecologist, Mount Elizabeth Novena agrees. She says you can start with managing your diet and fluids intake. Avoid oily foods or foods with smells that make you feel sick. Going for frequent small amounts of food intake rather than the usual three full meals a day will help. Drink fluids frequently, again in small amounts to keep hydrated. You can drink a variety of fluids like juices or barley. Avoid gaseous drinks like soft drinks which may cause more bloating.

Medication may be necessary if the above do not seem to improve the condition. Pyridoxine(vitamin B6), metoclopramide, promethazine or dimenhydrinate are some commonly used medications to treat morning sickness. Ginger capsules may also be used as initial treatment. Ondansetron is sometimes used if the above-mentioned medications are not working well.

There is no effective method to prevent morning sickness, explain Dr Kew. However, the food and fluid intake advice given earlier will help to reduces the chances of feeling sick and help alleviate the discomfort. Also, avoid exposure to smells that makes you feel sick. Get sufficient rest and sleep as tiredness and lack of sleep may make you more likely to feel unwell or sick.

Having medical conditions existing prior to pregnancy seem to increase the risk of morning sickness. These conditions include hyperthyroidism diabetes, problems with the stomach or intestines and asthma. Increase body weight also seems to be associated with higher risk. Therefore it will be advisable to maintain good health and a healthy body weight, and get your pre-existing medical conditions checked and treatment optimized by the doctor before pregnancy, advises Dr Kew.

Seeking Professional Help

For mothers with severe morning sickness associated with persistent vomiting and/or very poor oral intake of food and fluids, it is important to seek medical attention as potential complications may result.

If the vomiting persists or worsens progressively, it may be advisable to seek medical attention early to ensure that this is not due to other underlying causes such as a urinary tract infection, a thyroid disorder, or a molar pregnancy, explains Dr Lim.

When you are dealing with morning sickness, eating healthy could be a challenge. Your stomach will have a definite opinion on what it will or will not tolerate, so let it guide you. Stick to what works, even if it’s the same thing daily. Don’t worry if you don’t gain weight in the first trimester due to morning sickness. It’s more important to have weight gain in the following trimesters.

KEEP THE QUEASINESS AT BAY

While morning sickness may not be entirely preventable, the following measures can be taken to reduce the severity of the symptoms, explains Associate Professor Tan Thiam Chye, Head and Senior Consultant, Inpatient Service Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital.

• Adequate hydration by taking small sips of water (about 30ml hourly) or taking small amount of fluids containing electrolytes, e.g. isotonic drinks
• Consume small frequent meals consisting of dry and easily digestible foods like porridge, dry crackers, toast
• Avoid lying down flat after food. Use an extra pillow during sleep
• Alter the surrounding environment to minimize the stimuli for nausea, e.g. remove sources of unpleasant odours

If the above measures do not relieve the symptoms, the patient may need to consult a doctor for further assessment.