Dr Girija Wagh, Obstetrician, Gynecologist, IVF expertMD, FICOG, DIP ENDO, FICS
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Vomiting is the very first symptom of pregnancy making one wonder whether it is truly normal or abnormal. Many beliefs, myths surround this symptom of feeling sick ( nausea ) and being sick ( vomiting ). Many treatments have been proposed and many theories abound. About 60-70% women suffer from vomiting during pregnancy and this is called as emesis gravid arum. Excessive vomiting is called hyperemesis and may need hospitalisation. Many times women learn to overcome this symptom but quite a few times it may be taken for granted and lead to problems. It is vital to address this symptom a little more seriously and also accept it with the right attitude and deal with it scientifically. This note is an endeavour to help pregnant women and their families to deal with this very common symptom of a natural physiological process of pregnancy.
VP is nausea and vomiting of pregnancy and can be a precursor and an extension of the same underlying mechanism respectively. As the conception occurs when the embryo gets attached to the lining of the womb a typical pregnancy hormone by the name of chorionic gonadotropin ( HCG ) is released into the blood and the same hormone also is, detected in the urine. HCG is detected in the urine when a pregnancy test is done in some situations is needed to be checked in blood. HCG keeps on rising in the blood on a daily basis as pregnancy grows. Rising HCG levels is one of the important reasons for the pregnancy vomiting.
Rising levels of HCG is primarily thought to be responsible for NVP as the peak levels of the hormone and the maximum symptoms coincide at the same time. In addition, glucose levels in the blood are low (hypoglycemia ) due to increased metabolic needs of the pregnant mother’s body. Sometimes women with underlying acidity can experience exaggeration of the symptoms. Psychosomatic underplay also has been identified as the cause where in there is an inability to adjust to the pregnancy related changes.
Usually, NVP starts within a week of missing periods and gradually increases in intensity and frequency with heightened symptoms between 8 to 10 weeks that are from two to two and a half months. It may sometimes start as early as the 4th week that is immediately after one has missed the period and may extend to 14 weeks. Vomiting beyond 14 weeks may be due to gastritis or acidity. Vomiting anytime later needs evaluation and if occurs towards 7th month onwards can be a sign of something serious.
Nausea is common especially at waking up and gradually subsides as the day progresses.Vomiting once is acceptable. Excessive vomiting is abnormal as it can be result of an underlying problem such as a molar pregnancy ( pathological tumor of the pregnancy cells giving rise to very high HCG levels ), multiple gestations such as twins or triplets and can also be a predictor of preeclampsia (pregnancy related rise in blood pressure leading to complications ). Excessive vomiting can lead to complications such as dehydration, ketosis ( increased ketone bodies in the blood and urine which can be harmful to baby’s growth ), electrolyte imbalance, bleeding through vomitus if excessive retching accompanies NVP. Sometime rarely vomiting can occur in the later part of pregnancy and can be a symptom of an underlying serious disease such as liver dysfunction or raised blood pressure and needs evaluation.
It is proposed that women who are disturbed, sensitive, unhappy, overworked have NVP often and also become sick and may need admission. Sometimes it can be an attention-seeking act or a reflection of a wrong attitude towards pregnancy, other surroundings and abnormal response to the changing hormonal effects. Sometimes anxiety and depression can present as NVP of a severe kind.
Lack of sleep, irregular eating schedule, junk food, excessive spicy food, starvation, strong smells such as tadka, motion as in getting into a lift or riding or driving can act as a trigger. Over eating can also cause vomiting.Generally, a working mom would want to stuff herself with food not wanting to eat outside food or the loving family wants her to eat to help the baby grow etc resulting in forced feeding can also trigger NVP
First, accept that queasiness is going to be there. Self-audit your diet and identify whether you are taking proper food and identify what foods suit you best. Identify your triggers and deal with them and avoid the typical cooking which is the cause of the trigger. Introspect and identify your own mood swings, irritability and try to mend your attitude and thought processes. Consult a doctor and ask for assistance with these issues too. Try to be content, happy and rested and always maintain a positive attitude. Do not starve and over eat. Take light bland meals and easy to cook foods where the cooking does not tire you.
1. Warm water with honey and shredded fresh ginger
2. Take 4 almonds and chew them and add two or three nachani / ragi ( finger millet ) or whole meal biscuits
3. After a while take some amla juice
4. Take small bowl of semolina or oats porridge with fruits and nuts and room temperature milk. You can add a boiled egg here, midmorning have a light tea with khakara or a besan laddoo with some cold flavoured milk
5. Lunch : rice with curds / ghee or have plain dal with roti and ghee with some raita
6. Evening snack can be a dhokla / upama / sprouts salad /moong chila
7. Fruit plate or vegetable smoothie can be added
8. Moong dal khichadi with kokam based saar or kadhi
9. Alway carry some chocolates, fruits and nuts and dry snacks with you
10. Drink water sip by sip
11. Brush with a soft bristle brush and be gentle with your tongue cleaning as it can trigger NVP
Ginger, amla and kokam, alovera are known to be of great help due their contents of specific ingredients which can help prevent vomiting
Yes, starting pyridoxine ( Vitamin B6 ) earlier in pregnancy can help alleviate the severe NVP. But for hyper emesis fluid therapy, anti-vomiting medicines and gradual food initiation checking the tolerance may be needed .Rarely hospitalisation may be needed . The severity is checked clinically by the doctor and also with the help of some lab tests.
Yes excessive vomiting needs to be differentiated and diseases such as hepatitis ( jaundice ), viral infections, diabetic ketoacidosis etc need to be ruled out. It can also be gastroenteritis or food poisoning.
Saujanya is working in an IT firm and has night shifts is now 7 weeks pregnant. She eats chips and drinks coke in the night and comes home tired in the morning and crashes to wake up only at 12 midday and starts vomiting and is brought in for dehydration and continuous vomiting. On clinical evaluation, she has gastritis, dehydration and ketoacidosis. She is hospitalised for 3 days.
Carry some dry healthy home made snacks and some cold milk, yogurt for the night. Avoid tea coffee etc. After reaching home take a cereal with some fruits and then sleep. Simple modifications help
Yes it may if excessive and if other issues coexist
Happy reading and happy nurturing your pregnancies.
Love you all readers and feel free to connect whenever you need me.
Dr. Girija Wagh, MD (Obstetrics & Gynaecology), FICOG, FICP, Diploma (Endoscopy, Infertility), Fellowship of Indian College of Ob-Gynec, Women health care specialist, Academician, Acclaimed Orator & Researcher, B. J. Medical 1990-1992, Topper University Of Pune 1992
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