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By Anil Minocha MD, author of Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
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
Is It Leaky Gut or Leaky Gut Syndrome?
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?
Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
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.
Is It Leaky Gut or Leaky Gut Syndrome?
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 hyperemesis 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.
Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
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.
Is It Leaky Gut or Leaky Gut Syndrome?
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.
