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Excessive morning sickness

MorningSicknes and its cure

Feb 14th

How to cope with extreme morning sickness

Experiencing extreme nausea and vomiting during pregnancy? Hyperemesis gravidarum (HG) is a pregnancy complication characterised by severe nausea, vomiting, dizziness, weight loss, and dehydration.

We speak to Caitlin Dean, a registered general nurse and vice chair for the charity Pregnancy Sickness Support and Dr Clare Bailey, a GP and founder of parenting support organisation Parenting Matters, about hyperemesis gravidarum diagnosis and treatment tips:

What is hyperemesis gravidarum?

It's estimated that around 10,000 women a year suffer from hyperemesis gravidarum (HG), a condition that at its most extreme can leave sufferers with a torn oesophagus, burst blood vessels, eroded tooth enamel and post traumatic stress disorder (PTSD).

But all too often the condition is dismissed as bad morning sickness - a term which in itself is misleading, as any women who has experienced the grind of all-day pregnancy nausea will tell you.'Hyperemesis gravidarum can result in vomiting up to 50 times a day and, in extreme cases, hospitalisation to combat dehydration and so that nutritional support can be given intravenously,' says Dean.

'To diagnose such women with "just" bad morning sickness only adds to their suffering,' adds Dean. 'Luckily, we're much more enlightened about the condition now, but even so, around 1000 women a year choose to have an abortion because they can no longer cope with the vomiting and constant nausea. Some women can't swallow because the saliva in their mouth makes them throw up, and others find the smell of their husband or children makes them feel sick, which is very distressing. Often the nausea can be worse than the sickness itself.'

Is it normal to feel sick?

For women expecting their first child, many assume what they're experiencing is normal – after all, up to 90 per cent of mums-to-be experience some form of sickness during the first trimester.

'Many women actually find feeling sick a comfort, as it's a sign the pregnancy hormones are kicking in,' says Dean. 'Hyperemesis gravidarum is a different proposition altogether, but it's amazing what some women put up with before realising their symptoms are not normal and seeking help.'

Maddie Caruthers, 32, had HG with her first child, Ben, now five, and her second, Edie, eight months: 'With Ben, it started at four weeks and eased off at about 20,' she says. 'I can only describe it as a living hell. One of the worst aspects was feeling as though I just wasn't coping – I'd never heard of HG and just assumed I needed to toughen up. When my symptoms carried on after the 12-week mark, I was devastated. I'd been so sure I'd start feeling better after that milestone and when I didn't, I was hysterical. Thankfully my GP came to see me at home and diagnosed HG – physically I felt as bad as ever, but at least now I knew it wasn't all in my head and I had somewhere to go for support. It made all the difference.'

What causes hyperemesis gravidarum?

As to what causes hyperemesis, it's thought there is a genetic element (you're 30 per cent more likely to suffer with it if your mum or sister did). 'It's multifactorial and often we're not sure why some women get it and others don't,' says Dean.

Sadly, if you've had it once, it's likely to recur with subsequent pregnancies, a fact that saw Maddie delay extending her family by a couple of years longer than she would have liked.

'It took me a long time to feel mentally ready to be pregnant again,' she says. 'It wasn't so bad the second time around, although I remember holding Ben's hand when we were out on the street one day and having to kneel down on the pavement while I was sick down a drain.'

What if you're too sick to work?

You are entitled to take time off work if you have hyperemesis. 'It's unlawful discrimination for an employer to treat a woman unfavourably because of her pregnancy or an illness relating to her pregnancy,' says Dean.

'There's also small crumb of comfort to be had from the fact that from around week 18 a lot of women start to feel significantly better, and after the baby is born the sickness stops completely.'

Will HG put your baby at risk?

A study by Dr Rebecca Painter of the Academic Medical Centre in Amsterdam, which looked at the babies of mothers who were pregnant during the Dutch famine of 1944-45 and severely undernourished during early pregnancy as a result, found that they were more susceptible to heart disease, stress-related conditions and obesity in later life.

'Unfortunately, it seems there might be some lifelong complications associated with severe malnourishment during the early weeks, which is why it's important to seek help sooner rather than later,' says Dean.

'It's just as important we rule out any other underlying cause for extreme sickness, which can sometimes occur as a result of an undiagnosed urinary tract infection (UTI), for instance,' says Dr Bailey. 'In a way, hyperemesis is a diagnosis of exclusion, but once confirmed, we can start to treat. If you lose more than five per cent of your pre-pregnancy weight, you might need nutritional intervention so inform your GP.'

Will anti-sickness drugs harm the baby?

There is absolutely no evidence that the standard anti-emetic (sickness) drugs used to treat HG are harmful,' says Dr Bailey.

'They're most effective if started as soon as possible and can be used in combination to find the most effective way of reducing sickness in each individual.'

What should you eat?

If you're struggling to keep anything down, dry, bland, foods such as crackers or plain white toast might help, if eaten very slowly – perhaps just a quarter of a slice of toast every 15 minutes, advises Dean.

Sucking an ice cube may be better tolerated than sips of water. You might want to avoid ginger, however, despite the fact it's oft mentioned as a traditional cure for sickness. 'You need to consider how it will feel to vomit ginger back up,' says Dean. 'It's painful. And one of the studies we've done on combatting pregnancy sickness showed it not to be effective anyway.'

Hyperemesis gravidarum help and support

For additional help and support, try one of the following resources:

❤️ NHS.UK: to check for any medical issues or be referred to a specialist, visit you GP.

Pregnancy Sickness Support: a national support network of trained volunteers who are peer-matched so that they can offer appropriate advice.

NCT.org: The UK's leading charity for parents through pregnancy, birth and beyond.

Dec 16th 2018

Pregnant Women May Now Have a New Way to Limit Unhealthy Weight Gain

Gaining too much weight during pregnancy is tied to an increased risk of complications for both mother and baby. However, some doctors are reluctant to recommend that pregnant women restrict their weight gain, in part due a lack of tools to help mothers do this safely.

But now, a new study finds that with the help of nutritional counseling and a smartphone app, pregnant women who are overweight or obese can safely restrict their weight gain in pregnancy.

In the study, women who were overweight or obese were assigned to follow a specific diet during pregnancy. The women received guidance from a nutritionist and used a smartphone app to log meals. At the end of the study period, these women had gained less weight than pregnant women in a control group who didn't follow the diet. The women on the diet gained 4.5 lbs. (2 kilograms) less than the other women. What's more, babies born to mothers in the diet group were not at increased risk of low birth rate or other problems. [Blossoming Body: 8 Odd Changes That Happen During Pregnancy]

It's "very reassuring" that babies born to mothers who restricted their weight gain during pregnancy were not at increased risk for harm, said Dr. Saima Aftab, the medical director of the Fetal Care Center at Nicklaus Children's Hospital in Miami, who was not involved in the study. Aftab added that doctors currently don't have specific tools to help pregnant women restrict weight gain, and so the type of program in the study "may be a solution in the future."

However, Aftab stressed that larger studies are needed to examine whether this approach ultimately leads to heathier pregnancies and healthier babies, because the current study wasn't designed to answer those questions.

The study, from researchers at Northwestern University Feinberg School of Medicine in Chicago, was published Sept. 24 in the American Journal of Preventive Medicine.

Extra weight in pregnancy

Women who are overweight or obese in pregnancy have a greater risk of pregnancy complications, including gestational diabetes and pregnancy-related high blood pressure, according to the Mayo Clinic. What's more, women who are overweight and obese are also more likely than women at a healthy weight to gain too much weight during pregnancy, which puts them at risk of having larger babies. That factor can lead to problems with delivery as well as low blood sugar levels in the newborn. Babies that are born larger than average may also be at higher risk for obesity in childhood, the Mayo Clinic says.

Because of these risks, the National Academy of Medicine (NAM) recommends that overweight women gain 15 to 25 lbs. (7 to 11 kg) during pregnancy and obese women gain just 11 to 20 lbs. (5 to 9 kg). For comparison, women of healthy weight should gain 25 to 35 lbs. (11 to 16 kg) in pregnancy, the NAM says.

Still, nearly half of U.S. women gain too much weight in pregnancy, according to the Centers for Disease Control and Prevention.

In the new study, the researchers analyzed information from 281 women who were overweight or obese at the start of their pregnancies. The women were divided into two groups: an intervention group and a usual-care group.

The intervention group met with a nutritionist, who counseled the women on how to follow the DASH diet, which is high in fruits, vegetables, whole grains, nuts, fish and lean protein and low in salt, sugar and saturated fat. The goal of the diet was not to help the women lose weight but to restrict their weight gain in pregnancy to meet the NAM recommendations. Women in this group also used a smartphone app to record what they ate, and a nutritionist reviewed these logs to provide feedback. In addition, the women were given a pedometer and told to aim for at least 30 minutes of physical activity, such as walking, per day.

Women in the usual-care group were given general advice on nutrition and physical activity in pregnancy but did not receive coaching or use the smartphone app.

At 35 weeks of pregnancy, women in the intervention group had gained 22 lbs. (10 kg), on average, compared with 26 lbs. (12 kg) in the usual-care group. In addition, about 31 percent of those in the intervention group stayed within the NAM recommendations for weight gain in pregnancy, compared with just 15 percent in the usual-care group.

Babies born to mothers in the two groups had similar birth weights, on average, and were not at increased risk of neonatal problems, the study said. [The Best Ways to Lose Weight After Pregnancy]

The current study looked at whether the intervention worked and was safe, but the research wasn't designed to look at whether women who followed the diet were at lower risk of pregnancy complications or had healthier babies, Aftab told Live Science. That's why larger studies are still needed before a program like this could be recommended by doctors.

In addition, unexpectedly, obese mothers in the intervention group were more likely to need cesarean sections than women in the usual-care group. This finding could have been due to chance, but it's another reason to take caution regarding the results and to conduct further studies, Aftab said.

Childhood obesity risk

More studies are also needed to determine if the children born to mothers who restricted their weight gain in pregnancy have a lower risk of obesity themselves. The researchers said they plan to follow the children until they are at least 3 to 5 years old to help answer this question.

In addition, although women in the intervention group tended to eat a healthier diet than those in the usual-care group, women in the two groups had similar levels of physical activity. That's because, even though women in the intervention group were encouraged to track their activity, they often did not and usually fell short of their exercise goals. The women reported time constraints, fatigue and work-life balance as barriers to meeting the physical activity goals, which shows that more efforts are needed to improve physical activity in this population, the researchers said.

 

Oct 5th 2018

Pregnant women can FINALLY get a prescription for morning sickness: Four times a day pill is licensed for use in the UK

Hundreds of thousands of pregnant women in the UK can now be prescribed a pill licensed for morning sickness for the first time in decades.

Xonvea is the first pill of its kind to specifically tackle nausea and vomiting during pregnancy (NVP) since Debendox was withdrawn in the 1980s.

The drug has been used for years in the US and Canada – but wasn’t licensed for pregnant women in the UK to take until this summer.

Xonvea has only been launched by a drug firm in the UK today. Pregnant women with NVP are recommended to take between two and four pills a day.

For years expectant mothers battling morning sickness in the UK have relied on general anti-sickness drugs to combat their symptoms

Several trials on pregnant women have shown Xonvea is around 23 per cent better than placebos at stopping symptoms of morning sickness.

It could be used by women who have already tried changing their diet and lifestyle to avoid sickness but still need medical help.

The British Pregnant Advisory Service said it hoped Xonvea would help reduce the number of women whose morning sickness is so bad they have an abortion.

Up to 80 per cent of all pregnant women suffer from NVP, which amounts to around 690,000 women in England and Wales.

 

Excessive morning sickness

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