Controlling nausea in pregnancy
Dear Dr Mitchell,
I am currently eight weeks pregnant and having a difficult time with nausea and vomiting. Everything I eat comes back up — even water. My issue is that this prevents me from taking my prenatal vitamins and folic acid, as I can’t swallow anything. My doctor gave me Gravol but this just makes me feel worse, and I get extremely drowsy where I am unable to function. I am worried because I am 39 years old and I don’t want my child to have any defects. But how can I take my meds when I am always throwing up?
Vomiting in pregnancy is a common problem seen in the first 12 weeks (first trimester). It tends to be excessive in women who are expecting twins or other higher multiple pregnancies.
Also, a molar pregnancy is usually associated with excessive vomiting. A molar pregnancy is a condition in which the placenta undergoes abnormal changes and in most cases there is no development of the foetus. If the foetus is present (partial mole) it tends to be abnormal in its make-up. The placental tissues produce excessive amounts of the hormone beta-human-chorionic gonadotropin (BETA HCG).
Other causes of vomiting in pregnancy (such as acute appendicitis, kidney or bladder infections, gastritis, peptic ulcer disease and uncontrolled diabetes mellitus) should be checked for based on the presentation of other associated symptoms. In some women, psychological problems and an unplanned, unwanted pregnancy can also result in excessive vomiting. In these cases, counselling and reassurance are extremely important in the management of the patient to reduce repeated hospital admission.
Gravol (dimenhydrinate) is one of the most common medications used to reduce vomiting in pregnancy. It can be given through injections, tablets or rectal suppositories. In some women, the use of tablets by mouth does not work as well and they switch to injectables or rectal suppositories. This helps to significantly reduce the excessive vomiting. If Gravol does not work, there are other safe, effective medications available for controlling the vomiting.
Most of the drugs that are used to suppress vomiting cause drowsiness. Reducing the dosage to half a tablet three times daily can reduce this side-effect.
Avoiding spicy and greasy foods (along with other foods known to cause vomiting) can help to reduce the frequency of the vomiting. Consuming smaller meals more frequently also helps to control vomiting in pregnancy. A bland diet, especially first thing in the morning, will help. Ginger-based foods significantly reduce nausea and vomiting. Ginger sweets, biscuits and ginger tea go a long way in reducing nausea and vomiting in pregnancy.
The addition of vitamin B-complex helps to reduce complications from excessive vomiting in early pregnancy and should be considered. The consumption of prenatal vitamins in pregnancy may sometimes worsen vomiting. Discontinuation of vitamin supplementation in the first trimester should be considered until the nausea and vomiting settle down.
In some women, the problem worsens and admission to hospital with intravenous fluid administration is necessary to prevent dehydration. In severe cases, repeated hospital admission is necessary to control symptoms and prevent complications from excessive vomiting.
It is important to get a proper evaluation to rule out other underlying causes of excessive vomiting in pregnancy so that the primary problem can be managed appropriately moving forward in the pregnancy. Consult your gynaecologist, who will advise you further.
Best regards.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
