Hyperemesis gravidarum, nausea vomiting of pregnancy

The Minocha Home page                    Facebook Anil Minocha, Shreveport, LA

Morning Sickness aka Nausea and Vomiting of Pregnancy

Key points

• Modification of diet and avoidance of triggers plays an important role in prevention
• Expert meta-analysis and  reviews on the role of acupressure/acupuncture have come to conflicting conclusions
• Studies on the role of hypnotherapy have shown encouraging positive results
• Most data indicates ginger is effective and superior to vitamin B6 

Read below for more detailed discussion of nausea and vomiting of pregnancy

Pregnant women frequently suffer from nausea and vomiting during pregnancy. Although the term “morning sickness” is used in everyday conversation, symptoms may occur any time.

Hyperemesis gravidarum is he most severe form of the nausea and vomiting of pregnancy. Hyperemesis gravidarum is usually accompanied by weight loss and may be accompanied by liver abnormalities. Symptoms resolve in most but not all cases by the third trimester.

A silver lining: Women who suffer from nausea vomiting during pregnancy may have reduced risk of miscarriage.

Multiple factors have been implicated in causing of nausea and vomiting of pregnancy including but not limited to the following:

• psychogenic
• stress
• hormonal imbalance
• gut dysmotility

Can you prevent or reduce nausea and vomiting of pregnancy?

Avoid triggers

• Small crowded rooms
• Bright light
• Smells including foods and perfume
• Smoking or smoke filled atmosphere 
• Heat
• Noisy places (stay in calm quiet room)
• Motion due to driving, flying
• Medications like NSAID painkillers like aspirin, ibuprofen etc, oral iron

Treatment of nausea and vomiting of pregnancy

General measures

• Usual management is supportive
• Adequate hydration/fluids
• Minimizing contact with family members away can alleviate symptoms in some cases
• Patients with severe form usually respond to bowel rest and intravenous hydration.
• Drug treatments usually involves antiemetics and acid suppressive agents.  
• Enteral and/or parenteral nutrition support may be needed in refractory cases. 

Nutrition

• Small frequent, low fat, high carbohydrate meals.
• Cold food may be better tolerated in some casessince food aroma may be trigger for nausea and vomiting
• Prefer protein-predominant meals 
• Consume frequent snacks in small amounts like nuts, crackers
• Effect of spicy/salty foods is diverse. They are trigger for symptoms in some  while  others are helped by eating such foods.
• Drink cold, clear drinks like ginger ale, mint tea etc. Electrolyte-replacement drinks and oral nutritional supplements are beneficial consuming small quantities ast a time
• Avoid empty stomach! Eat a little bit as soon as hungry
• Avoid brushing teeth immediately after eating.

Role of acupressure/acupuncture

• Application at acupoints of Foot-Yangming Meridian causes enhanced gastric motility, improves gastric mucosal blood flow and regulates the motilin and somatostatin levels in sinus ventriculi and bulbus.
• Acupressure, especially on the P6 point (Neiguan) on the inside of the wrist is popular remedy for nausea and vomiting.

Human data

• Randomized controlled trials have shown that acupressure and vitamin B6 to relieve nausea and vomiting in pregnancy to a similar degree.
• Self-administered nerve stimulation therapy at the P6 using commercial devices has also been found to be helpful.
• Reviews in recent years have come to different conclusions regarding efficacy of acupressure.
• My thought: Above contradictory conclusions notwithstanding, even if placebo effect in some subjects, it is a cheap and relatively harmless way to accomplish goals in hypermesis gravidarum. 

 Adverse effects of acupressure

• No pregnancy related adverse events have been reported with P6 acupressure. Moreover,  acupressure is more convenient and can be self-administered

Ginger

Randomized controlled trials have confirmed efficacy of powdered ginger ( dose 1-1.5g/d in 3-4 divided doses).

• A randomized controlled trial compared the effect of capsule ginger (0.5 g bid) capsule dimenhydrinate (50 mg bid). The treatments were equally effective but ginger group experienced fewer side-effects especially drowsiness.
• Ginger lollipops may be used. Another option is to chew on thin slice of fresh ginger root two to four times a day as needed. It is equal in efficacy to vitamin B6.
• Studies indicate that there is a wide variation in the gingerol content of ginger root powder from different manufacturers.
• Ginger does not have fetotoxity. 

Pyridoxine (Vitamin B6)

Randomized controlled trials on use of pyridoxine alone are limited.

• A double blind placebo controlled trial for the treatment of nausea and vomiting of pregnancy in 59 women found that subjects with severe symptoms and receiving vitamin B6 (25 mg tid x 3d) had significantly better nausea scores a as compared to the placebo. Overall, at the completion treatment eight of 31 patients in the vitamin B6 group had any vomiting in contrast to 15 of 28 patients in the placebo group  (P <0.05).  
• A recent large randomized, double-blind, multicenter placebo controlled trial examined the effect of   Diclectin (doxylamine succinate 10 mg-pyridoxine hydrochloride 10 mg, delayed-release preparation). Diclectin group demonstrated  a significantly greater  improvement in symptoms of nausea and vomiting of pregnancy as compared to  placebo. Of note, doxylamine was withdrawn from US market for concerns of toxicity.

    Pyridoxine dose 75 mg/d. 

Hypnosis or hypnotherapy

• Hypnotherapy using a variety of techniques has been successfully used treatment of nausea and vomiting of pregnancy.
• Its use as an adjunctive treatment option has also been suggested in addition to other therapies.
• A  review of 45 studies was published in 2010. Analysis of six studies fulfilling the inclusion criteria. Indicated that while there was variation in methodology, all of them reported encouraging positive outcomes.  

Psychotherapy

 Psychotherapy may be of benefit especially in those with lot of anxiety/stress.

Review some more topics below...... or click to Anil Minocha Shreveport home page        Facebook Doctor Anil Minocha Minocha

Toileting posture  to take care of business	Fructose sweetener and weight control: Good, bad or ugly?
Morning sickness or Nausea, vomiting of pregnancy	Chronic abdominal pain in kids
Do antioxidants lower cancer risk	Is folic acid supplementation, good or bad
Do zinc supplements help respiratory infection	Eat fast, get fat: control your weight
Black raspberries and cancer risk http://goo.gl/DvW3j	Diet for Crohn’s disease patients
Irritable bowel syndrome or IBS	Milk banks: when you want to feed breast milk but can't

 

What causes alcohol hangover?	Coconut oil for healthy, beautiful skin
Evidence based natural treatments of fibromyalgia	Gift of health "Natural Stomach Care"
Herb/spice in kitchen to prevent cancer & boost immunity	Yoga improves blood pressure & diabetes
Food triggers for migraine	Botox works at both ends. Cheers!
Fish type, mercury toxicity risks versus benefits	How to stop heartburn?
Depressed? Want alternative medicine options?	Risks of heartburn and ulcer medications
Constipation? Think your colon has kinks?	Confused about probiotics on market? Knowledge is power

 References

•  Niebyl JR. Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med. 2010 Oct 14;363(16):1544-50.
• McCormack D. Hypnosis for hyperemesis gravidarum. J Obstet Gynaecol. 2010;30(7):647-53.
• Chittumma P, Kaewkiattikun K, Wiriyasiriwach B. Comparison of the effectiveness of ginger and vitamin B6 for treatment of nausea and vomiting in early pregnancy: a randomized double-blind controlled trial. J Med Assoc Thai. 2007 Jan;90(1):15-20.
• Ensiyeh J, Sakineh MA. Comparing ginger and vitamin B6 for the treatment of nausea and vomiting in pregnancy: a randomised controlled trial. Midwifery. 2009 Dec;25(6):649-53.

Disclaimer: Everything on this site is for your information only. I am not your physician. Do your own due diligence and consult physician. The ads have potential to generate income for the blogger.

Home page                    Facebook Dr. Minocha

Comments

[answer pregnancy test]

Morning sickness is not really a type of "sickness" since it is just a natural response of the body during the early stages of pregnancy. Due to hormonal imbalances, the body tends to heighten its responses to normal outside stimuli. Just perfectly natural.

[pregnant quiz]

pregnant is a positive pregnancy test. Home pregnancy tests measure the pregnancy hormone hCG in your urine. The most sensitive home pregnancy tests will show a positive result when the hCG levels reach 20, which can happen as early as four days before your period is due, or approximately 10 days after ovulation.

[morningsicknessfix.com]

Morning sickness is a misnomer since the symptoms can act up any time, even at night. If you are having a hard time coping with morning sickness, try some natural morning sickness treatment. It's a safer approach than taking medications during pregnancy.