Symptoms of nauseaand vomiting of pregnancy (NVP) has been widely documented for the past severalyears already. It can range from mild nausea and vomiting, which we commonlyterm as “morning sickness”, to hyperemesisgravidarum, an extreme case of nausea and vomiting that needs medicalattention.
Although the usual nausea and vomiting in pregnancy, is commonlyknown as “morning sickness” the National Health Service (NHS) stated that theterm can be misleading because the feeling of nausea and vomiting can affectthe mother anytime of the day or even throughout the day. This not only bringdiscomforts to the mother, but in extreme cases such as the hyperemesisgravidarum, it puts both the mother and baby at risk for depletion of nutrientsand dehydration. In a study by Lee and Saha (2011), 70% – 80% of all pregnantwomen experience “morning sickness”. With regards to demographic variables andits relationship to NVP, it is more prevalent in younger women, first timemothers, women with less than 12 years of schooling, obese, and non-smokers.
Althoughthe factors that lead to such condition cannot be pinpointed to only one, ithas been linked with metabolic and endocrinal factors, and most of it originatesfrom the placenta. We, however, are talking about the continuous presence ofhormones in the woman’s circulation. For severalyears, female hormones are well researched on its importance and functionalityon the female’s body. Produced by the different glands in the body such as thepituitary glands and ovaries, it is carried all throughout the circulation andreleases its full effects on the woman’s body affecting her emotions,physiologic cycles, and sensations.
We might probably think that duringpregnancy, hormones are being suppressed by the development of a growing fetusand the cessation of the menstrual cycle but unfortunately no. In fact,additional hormones are being produced even at the start of implantation, oneof which is what we call the human chorionic gonadotropic hormone (hCG), whichalso clinically indicates a positive pregnancy. In most cases, nausea andvomiting have been associated with the presence of hCG in the system of themother. The peak of hCG usually happens in the 12-14th week ofpregnancy (Lee and Saha, 2011), thus “morning sickness” usually takes place inthe first trimester of pregnancy specifically in the first 16 weeks ofpregnancy. Human chorionicgonadotropin may not be the only culprit in the occurrence of a pregnantmother’s episodes of “morning sickness” hormones such as estrogen andprogesterone were also linked to have caused the episodes. Progesterone when combined with estrogeninfluences the condition by decreasing smooth muscle contractility of thegastro-intestinal system (which is of course made up of smooth muscles) and thusalter gastric emptying which then leads to increased nausea and vomiting.
Otherchemical mediators in the body that have an effect on gastric contractility areplacental prostaglandin E2 (PGE2) which is increased in level’s within the 9thto 12th week of pregnancy, and mother’s level of interleukin-1 beta.There are anumber of ways that doctors (or even blogs across the net) may advice pregnantwomen so as to decrease the effects of the “morning sickness”. One way is tohave frequent small food intake, another is to avoid gastric irritating foodssuch as fatty and acidic food.
As mentioned by Lee and Saha (2011), Jednak,Shadigian, Kim, et.al in 1999, presented that meals with high proteinwere linked to decreased occurrence of the symptoms of nausea and vomiting Fluidsshould also be frequently taken to avoid dehydration, avoid odors that cantrigger. The doctor may also prescribe antiemetic medications that can preventnausea and vomiting but this can have side effects.
Phenothiazines for example,which is a form of antiemetic, was found to have slightly increased the risk ofbirth defects in the fetus in the first three months of pregnancy. In additionto that, pregnant women who took another form of antiemetic, chlorpromazine,have infants who manifested extrapyramidal signs and yellowing of the skin.However, since the condition is also related with the occurrence of heartburnand acid reflux during pregnancy, the doctor can also prescribe antacids asthere are no written conclusions that it has untoward effects on the fetaldevelopment (Law, 2010). Antihistamines may also work as antiemetics and aresafe to take during pregnancy. Nevertheless, with regards to pharmacologicmanagement, the most important thing is, pregnant mothers should see theirdoctors first before taking in medications. There are also sources that speakon the alternative remedies to counteract the effects of NVP. In a systematicreview done by Festin in 2009 on “morning sickness” in the early part of pregnancy,it found out that ginger and the use of P6 acupressure (an acupressure thatstimulates the P6 acupoint on the wrist) may reduce nausea and vomitingcompared to placebo, although with regards to ginger, results of studies regardingthe remedy were inconclusive, also, in some countries like the UK, gingerproducts are not licensed so it is better to purchase them from a trustedsource like the pharmacy or supermarket. The NHS posted on their webpage onadditional advice.
Getting plenty of rest and avoiding being tired may minimizethe effects of nausea. Also, in the morning, if a mother feels nauseous, it iswise to just move up slowly and, if tolerable, consume plain and dry toasts (ora soda cracker perhaps) before getting up in bed. Instances which requires further management inextreme cases of NVP includes inability to keep any food or drinks for 24hours, dark colored urine, severely weak and dizzy, pain in the abdomen,presence of fever or when vomiting blood. Pregnancy is basically a wonderful thing for anexpecting mother and family, however with the presence of this “morningsickness” it can be very uncomfortable.
A person’s understanding (which ofcourse should include the significant others of the pregnant mother) on thecauses and management of “morning sickness” is very important in having apositive experience during pregnancy.