Nausea and Vomiting of Pregnancy

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The exact cause of nausea and vomiting of pregnancy remains unclear, but it is generally mild, self-limited condition that may be controlled with conservative measures. Few data support the theory that psychological factors are responsible for nausea and vomiting of pregnancy. Delayed gastric motility caused by progesterone, may be responsible for nausea and vomiting of pregnancy, but the roles of other hormones (human chorionic gonadotropin and estrogen) which also increase during pregnancy, are controversial.

A small percentage of pregnant women have a more profound course of nausea and vomiting, with the most severe form being hyperemesis gravidarum, which affects one in 200 pregnant women. The clinical features of hyperemesis gravidarum include persistent vomiting, dehydration, ketosis, electrolyte disturbances, and weight loss (more than 5% of body weight). Multiple gestation, gestational trophoblastic disease, triploidy, trisomy 21 syndrome (Down syndrome), and hydrops fetalis have been associated with an increased incidence of hyperemesis gravidarum. A recent study suggested that chronic infection with Helicobacter pylori may play a role in hyperemesis gravidarum. Hyperemesis gravidarum, may have negative implications for maternal (e.g. esophageal rupture) and fetal health (e.g. fetal growth restriction and mortality).

Pregnant women with persistent nausea and vomiting or worsening symptoms or if nausea and vomiting begin after nine weeks of gestation, should be carefully evaluated to rule out the most common pregnancy-related (hyperemesis gravidarum, acute fatty liver of pregnancy, and preeclampsia) and nonpregnancy-related causes of vomiting (gastrointestinal disorders, genitourinary tract disorders, metabolic disorders, neurologic disorders, and drug toxicity or intolerance).

Initial treatment for women with mild nausea and vomiting of pregnancy should be conservative and should involve dietary changes and emotional support. They should be instructed to eat frequent, small meals and to avoid smells and food textures that cause nausea. Solid food should be bland tasting, high in carbohydrates, and low in fat. Salty foods (e.g. salted crackers, potato chips) usually can be tolerated early in the morning, and sour and tart liquids (e.g. lemonade) often are tolerated better than water. Pregnant women with depression or other affective changes should receive appropriate emotional support.

Women with more complicated nausea and vomiting of pregnancy may need pharmacologic treatment. Pyridoxine (vitamin B₆) has been shown to be safe and effective treatments. If Pyridoxine therapy is unsuccessful, a trial of antiemetics/ antihistamines/ anticholinergics/ motility drugs is warranted (e.g. metoclopramide, diphenhydramine, meclizine, dimenhydrinate, or ondansetron).

Pregnant women with severe vomiting may require hospitalization to have intravenously administered therapy and enteral or total parenteral nutrition.

Anemia in Pregnancy

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Introduction

Anemia is one of several health problems which can be found during pregnancy. So, it is extra important to ensure that we are getting the recommended daily intake of iron since the baby will be drawing from our iron reserves. A lack of sufficient iron from the diet can result in anemia, which can put both mother and the baby at risk.

What is anemia?

Anemia refers to a condition whereby the body lacks of appropriate amount of hemoglobin, or red blood cells. Red blood cells are an important part of the body’s blood system as they carry oxygen to other cells in the body. Having a shortage of these blood cells means that the body must work harder to get that oxygen to its organs and tissue, and we are likely to feel lethargic.

The role of iron in anemia

Anemia can be caused by a variety of things. The most common form of anemia is due to vitamin or nutrient deficiency. Known as nutritional anemia, a lack of iron, folic acid, or vitamin B12 can result in a woman developing anemia.

Normally, the recommended daily intake of iron for an adult woman is 18 mg per day. During pregnancy, though, this increases to 27 mg per day due to the rise in maternal blood volume. Unfortunately, most women already have low iron stores prior to their pregnancy. Even if we eat a well-balanced diet while pregnant, it is still unlikely that we will get the recommended 27 mg of iron a day since even the most nutritional diet only provides us with a small amount of iron.

Sign and symptom of anemia

Many women do not realize that they have developed anemia. It is not unusual for women with a mild condition to fail to notice any symptoms of an iron deficiency. Several typical signs of anemia include:

• Breathlessness
• Tiredness, weakness, or fainting
• Paleness, infrequent:
• Palpitations or an abnormal awareness of the heartbeat
• Inflamed, sore tongue,
• Nausea
• Headache
• Jaundice

Causes of anemia

• Poor diet with inadequate iron
• Folic acid deficiency
• Loss of blood from bleeding hemorrhoids or gastrointestinal bleeding
• Even if iron and folic acid intake are sufficient, a pregnant woman may become anemic because pregnancy alters the digestive process.
• How to determine that we have an iron deficiency

Anemia treatment

If the test indicates anemic condition, an iron supplement 60 to 120 mg a day or more should be consumed. To make sure the iron is absorbed as much as possible, the iron pills should be taken on an empty stomach. Wash them down with water or orange juice as vitamin C helps with absorption, but not with milk (calcium hinders absorption)

How to get enough iron

There are many iron rich foods that make up a healthy diet. Red meat is perhaps one of the best sources of iron but fish and poultry come in at a close second. For those of you who prefer to get your iron from non-meat sources, look to include tofu, egges, leafy green vegetables, broccoli, whole-grain bread, iron fortified cereals and dried fruit in the diet.