All-day morning sickness

IT’S quite common for pregnant women to experience nausea in the early hours of the day, but more women are reporting that they struggle with ‘morning sickness’ at much later hours. Obstetrician-gynaecologist at ICON Medical Centre Dr Keisha Buchanan says that even though less common, this is completely normal.

“Morning sickness, which is the vomiting that occurs in pregnancy, may affect a woman at any time during the day or night. In fact, the term ‘morning sickness’ may be a bit misleading, as some pregnant women vomit more at night than in the day, and a few women vomit only at night,” she explained.

She pointed out that vomiting occurs because of a steady rise in the pregnancy hormones such as beta human chorionic gonadotropin (Beta HCG). This hormone, which is produced during pregnancy, is the one detected by a pregnancy test when positive.

Nocturnal vomiting can be likened to a nightmare because it steals so much sleep time, and for working women in particular, this can be quite difficult.

“Vomiting at night does not only disrupt sleep but can cause exhaustion throughout the following day. This can significantly contribute to poor performance at work, loss of days at work, lethargy, nutrient deficiency, weight loss, dehydration, electrolyte derangement and weight loss,” Dr Buchanan outlined.

She said that while most pregnant woman tend to experience bouts of vomiting, some women are more prone because of varying existing medical conditions.

“Women more prone are those who have gastroesophageal reflux disease (GERD), who have severe vomiting – such as with hyperemesis gravidarum, women with twins, triplets and other types of multiple pregnancies, and those with deformities in the stomach/oesophagus – for example, a hiatal hernia. In a hiatal hernia the stomach protrudes from the abdominal cavity, where it should be, into the chest cavity, and this gets worse at night and triggers vomiting,” Dr Buchanan explained.

However, Dr Buchanan said that no matter what the causes, women don’t have to suffer through it. Below she suggests some ways that you can get relief.

1. Modify your diet and pay close attention to what is eaten in the day. “Adhering to a bland diet consisting of complex carbohydrates, high-protein meals, and avoiding overeating and caffeine should give you some relief.

2. The regular diet in pregnancy should consist of three regular meals and two to three snacks throughout the day. Try to stay as close to this recommendation as possible.

3. Avoid spicy or greasy meals, carbonated beverages and acidic foods or drinks during the day.

4. Always eat in small portions. Also, avoid gobbling down large quantities of food close to bedtime. This will help to prevent vomiting at night.

5. Have a supper that consists of ginger tea or peppermint tea or ginger biscuits or other foods consisting of ginger. You can also chew a piece of ginger or have ginger- flavoured drinks to prevent or decrease vomiting.

6. Avoid strong odours – such as strong-smelling body washes at bedtime, or strong perfumes or lotions, and ask your spouse to avoid exposing you to these, as they can trigger nausea and vomiting.

7. Rinse your mouth thoroughly before going to bed. Practise good oral hygiene such as brushing the teeth and flossing, as this will help to remove food particles. Some food residues in the mouth may trigger the urge to vomit.

8. Avoid getting hungry throughout the day and at bedtime, as hypoglycaemia (low blood sugar) can trigger nausea and vomiting. Have a small snack between meals and close to bedtime.

9. Take your prenatal vitamins and additional vitamins such as B6 25 mg three times per day. This will help to prevent nausea and vomiting at night.

In some instances, however, Dr Buchanan acknowledges that non-medical options may not be enough. She said to support these women there are a number of drugs available.

“Medications can help to prevent or treat vomiting such as dimenhydrinate, granisetron, antihistamines, ondansetron, and reflux disease can be treated with proton pump inhibitors such as lansoprazole and antacids. These medications are safe in all trimesters and will not cause birth defects or harm the baby. In fact, they can improve the pregnancy and prevent complications such as stomach bleeding, dehydration, nutrient deficiencies, daytime drowsiness (drowsiness from lack of sleep can increase the risk of accidents during the day). All of these can have potentially serious complications,” Dr Buchanan shared.

She also advised women to seek medical attention, especially when vomiting is severe, since not all forms of vomiting are pregnancy-related and could be a sign of gallstones, an inflamed gallbladder, or peptic ulcer disease. Naturally, pregnancy-related vomiting will subside by the early second trimester, although a few women will vomit until the third trimester. In case vomiting develops later in the pregnancy, Dr Buchanan said that medical attention should be sought, because it may be linked to something serious.

“Vomiting at this stage may be due to gastroenteritis or reflux disease, but more serious conditions such as preeclampsia (very common), and liver disease (rare) can be heralded by vomiting. Vomiting that starts in the late second or third trimester is rarely ever morning sickness,” Dr Buchanan cautioned.