Morning Sickness, All Day Long

Pregnancy sometimes causes nausea and vomiting. It is dismissed as normal morning sickness. In some cultures, vomiting is actually taken as proof of pregnancy.
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Morning sickness, however, is not necessarily confined to the morning, though 80 per cent of pregnant women fall in this category
. It can occur at any time of the day or night. The remaining 20 per cent of the women may show other signs of pregnancy such as eating ravenously.

Vomiting usually starts around the sixth week — around two weeks after the period is missed. It settles around the twelfth week, and then disappears around the fifth month. Any strong smell can precipitate waves of nausea — be it garbage or spices being fried in the kitchen.

Baffled scientists put forward many theories to explain this strange phenomenon. It was touted as an unconscious rejection of the pregnancy. Women were unsympathetically told to “control themselves”. Some blamed it on the hormonal changes during the period, which causes relaxation of the smooth muscles of the oesophagus and gall bladder and slows digestion.

Scientists have now discovered that the nausea is due to sensitivity to a hormone called HCG (human chorionic gonadotrophin). The vomiting coincides with peak levels of this hormone (six to 12 weeks).

The sensitivity varies and is genetically determined. Women who vomit during pregnancy often have mothers and sisters who had the same problem. It also tends to recur in each succeeding pregnancy, though, if the tolerance levels to HCG build up, the vomiting in the second pregnancy can be less than that in the first.

Excessive vomiting causes 1 per cent of the women who vomit to become morbidly ill. They lose 5 per cent or more of their pre-pregnancy weight. The violent retching can cause tears in the esophagus, resulting in blood in the vomit. The inability to retain any food in the stomach can result in dehydration severe enough to affect the kidneys. Blood may begin to clot in the veins. The brain may be affected as a result of electrolyte imbalance or dehydration. Loss of vitamins, particularly thiamine, may cause delirium.

This severe vomiting is also known as hyperemesis gravidarum (in Latin, gravid means pregnant, and hyper is excessive). It is more likely in younger women who are underweight before the pregnancy, pre-diabetic (abnormal GTT values) or have migraine headaches.

Persistent hyperemesis can be a danger signal. It can occur if the levels of HCG are higher than normal. This occurs when it is a twin pregnancy or if the baby has a chromosomal abnormality like trisomy 18 or 21. Or, it may not be a pregnancy at all but a tumour called hydatidiform mole that mimics pregnancy. An ultrasound examination at this stage will pick up all the above abnormalities.

Well meaning advice to tackle morning sickness with bed rest is counterproductive. The reclining position may further aggravate reflux from the stomach. Moreover, inactivity may lead to loss of muscle mass. This may make it difficult to withstand the rigours of labour and childbirth.

• To tackle morning sickness, consider the following.

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• A good diet with adequate vitamins, particularly folic acid.

• Exposure to fresh air. Try going for a walk outdoor for half an hour in the morning and evening.

• Eat several small meals instead of three regular ones.

• Avoid anything that triggers the vomiting even if it touted as being “good for the baby”.

Ginger helps as lozenges, ginger tea or lime juice. Supplements are available but since the other additives in the capsules are not known, it is probably better and safer to use the natural product.

Peppermint can be sucked as lozenges or peppermint oil used as inhalations.

Try acupressure. The pressure point to reduce nausea is located in the middle of the inner wrist, three finger-breadths away from the crease and between the two tendons. Locate and press firmly, one wrist at a time for three minutes.

Despite this, if uncontrollable vomiting occurs, with aversion to food, loss of weight, dark coloured urine, loss of consciousness, headache, confusion or fainting, it is better to seek medical help. Hyperemesis can be fatal.

An initial evaluation will rule out a correctable cause like a urinary tract infection, acid dyspepsia, chromosomal abnormalities or a hydatidiform mole. Intravenous fluids (IV) can be given to restore hydration, electrolytes, vitamins and nutrients.

If anti-nausea medications are used, the danger to the baby has to be weighed against the risk to the mother. Strict medical supervision and documentation of the dose and duration of treatment are required.

Source : The Telegraph ( Kolkata, India)

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