"...all doctors should be able to diagnose and treat nutritional deficiencies."

Royal College of Physicians. Nutrition and Patients: A Doctor's Responsibility. London 2002

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Vomiting in Pregnancy

Mild nausea and vomiting in pregnancy is a common problem affecting 3% of pregnancies.  It is probably due to the hormonal changes that occur in pregnancy and curiously its presence, if mild, is associated with a slightly better outcome.  A small percentage of women will experience repeated vomiting which can result in weight loss, disturbance in the balance of minerals and other nutritional deficiencies.  This situation is termed hyperemesis gravidarum, HG, which typically develops between the fourth and sixth weeks of pregnancy and often improves by the twentieth week but may continue throughout the pregnancy. 

The risk of developing hyperemesis gravidarum is increased in younger women, multiple or female pregnancy, non-smokers, non-whites, if there is a family history of others being affected, previously affected pregnancies and if there is underlying gastrointestinal disease.  Psychological factors are now thought to be much less important that they were.

Treatment of Mild Nausea and Vomiting

Those with mild symptoms may benefit from:

  • Eating little and often
  • Eating dry forms of carbohydrate e.g. white bread and toast, cream crackers, biscuits or flapjacks
  • Ginger as crystallised ginger four times per day or ginger capsules 250 mg four times per day may be helpful.  Ginger tea and ginger biscuits can also be consumed but are unlikely to be of benefit by themselves
  • Vitamin B complex e.g. Vitamin B Compound Strong tablets one three times per day after food.
    Each tablet typically contains: nicotinamide 20 mg, pyridoxine 2 mg, riboflavin 2 mg and thiamine 4.85 mg.  Similar but stronger tablets containing approximately 5-10 mg of each of the above B vitamins are also available.  Supplements of folic acid or multivitamins containing folic acid should be continued
  • Acupuncture or use of wrist bands, Sea Band – available from chemists, that apply pressure to the P6 point on the inner aspect of the wrists
  • Avoiding triggers such as foods or smells can be helpful
  • Anti-sickness medication may also be required from your doctor.

However, severe vomiting in pregnancy that compromises food and fluid intake is a serious matter and requires medical attention, especially if any of the features below are present:

Assessment of Those with Severe Nausea and Vomiting in Pregnancy

Warning Features:                                                                            Potential Nutritional Significance
Weight loss >1lb per week or underweight at the commencement or during the pregnancy                       Lack of energy intake and fetal growth retardation is possible
Lack of urine output and excessively low blood pressure that falls further on standing                                             Dehydration
Ketosis - a sweet slightly sickly smell to the breath or in the urine Lack of carbohydrate and energy and if Persistent foetal growth retardation is possible
Profound fatigue                                 Lack of potassium, magnesium or vitamin B1
Mental confusion                                                                Dehydration, lack of vitamin B1, sodium, potassium or magnesium imbalance
Double vision                                                       Severe vitamin B1 deficiency
Loss of co-ordination                                         Severe vitamin B1 deficiency

Any woman with these features requires urgent medical attention for assessment of possible medical causes including liver disease and thyrotoxicosis and is likely to require intravenous fluid replacement and urgent correction of energy and nutrient deficiencies. 

If vitamin B1 – thiamine deficiency is suspected then treatment should be given without delay usually by intravenous/intramuscular injection and before results of laboratory tests are available.

Those involved in the care of such patients should refer to The Royal College of Physicians Report on Alcohol: Guidelines for Managing Wernicke’s Encephalopathy in the Accident and Emergency Department.  Thomson AD, Cook CCH, Touquet R, Henry JA.  Alcohol and Alcoholism Vol 37, No. 6, pp513-521, 2002. 

References:

www.nhsdirect.nhs.uk/articles/article.aspx?articleId=2067&sectionId=6#
www.emedicine.com/emerg/TOPIC479.htm
www.cvsa.org.uk  The Cyclical Vomiting Association



Copyright Dr. Alan Stewart M.B.B.S.M.R.C.P. (UK)M.F. Hom.
47 Priory Street, Lewes, East Sussex. BN7 1HJ
Tel 01273 487003 Fax: 01273 487576