Im in 2nd Trimester and Vomites My Prenatal Vitamins After Eating. Should I Drink Again?
Can Fam Physician. 2007 December; 53(12): 2109–2111.
Language: English | French
Treatment of nausea and airsickness in pregnancy
An updated algorithm
Abstract
QUESTION
My patient has severe nausea and vomiting of pregnancy (NVP). I am having difficulty treating her, as nix she has tried and so far has been actually effective. I heard that at that place is some new information regarding the treatment of this condition.
ANSWER
Fifty-fifty a less severe example of NVP tin can have serious adverse furnishings on the quality of a woman's life, affecting her occupational, social, and domestic functioning, and her general well-beingness; therefore, it is very important to treat this condition appropriately and effectively. There are safe and constructive treatments available. Nosotros have updated Motherisk's NVP algorithm to include recent relevant published data, and we depict some other strategies that deal with secondary symptoms related to NVP.
RÉSUMÉ
QUESTION
Une de mes patientes souffre de graves nausées et vomissements de la grossesse. J'ai de la difficulté à la traiter parce que rien de ce qu'elle a essayé jusqu'à présent n'est vraiment efficace. J'ai entendu dire qu'il y a avait du nouveau concernant le traitement de ce problème.
RÉPONSE
Même dans les cas les moins graves, les nausées et les vomissements de la grossesse peuvent sérieusement nuire à la qualité de vie d'une femme, sur le plan professionnel, social et domestique, et à son bien-être général. Il est très important de traiter ce problème de manière appropriée et efficace. Il existe des traitements sûrs et efficaces. Nous avons mis à jour l'algorithme de Motherisk sur les nausées et vomissements de la grossesse, qui inclut toutes les données pertinentes récemment publiées, et nous décrivons certaines autres stratégies pour prendre en charge les symptômes secondaires associés à ce problème.
Nausea and vomiting of pregnancy (NVP) is the most common medical condition of pregnancy, affecting upward to 80% of all pregnant women to some degree. In nigh cases, it subsides by the 16th week of pregnancy, although up to 20% of women proceed to have symptoms throughout pregnancy. Astringent NVP (hyperemesis gravidarum) affects less than ane% of women, but it tin be debilitating, sometimes requiring hospitalization and rehydration.i Women suffer not only physically, but too psychologically, which has been documented in a number of studies.2 – 4 In addition, some women have decided to stop their pregnancies rather than tolerate the severe symptoms.5
Pharmacotherapy
We systematically reviewed the literature pertaining to the symptomatic treatment of NVP from January 1998 to September 2006. The updated algorithm includes this recent relevant published information (Figure i 6 , 7). The drug of selection for treatment in Canada remains Diclectin, the delayed-release combination ofdoxylamine andvitamin B6.8
Algorithm for treatment of nausea and vomiting of pregnancy: If no comeback, keep to adjacent step.
Other pharmacologic treatments with relatively good safe profiles and varying degrees of effectiveness include antihistamines, ondansetron, phenothiazines, metoclopramide, and corticosteroids.ix – 12 Herbal products such every bit vitamin B6 and ginger have besides been used safely with varying degrees of effectiveness.7 , thirteen – 17
Nonpharmacologic treatments
Acupressure and acupuncture at acupoint P6 have been used with varying degrees of effectiveness.12 , 18
Overcoming secondary symptoms
There are several strategies that have been helpful in dealing with secondary symptoms related to NVP.
Diet
Mixing solids and liquids tin can increment nausea and vomiting because it can brand the stomach feel fuller and, in some women, tin can cause gas, bloating, and acrid reflux. Eating small portions every 1 to 2 hours and eating and drinking separately can be helpful. For case, consume a small portion of food, wait twenty to 30 minutes, then take some liquid.
Remind women that they should eat whatever they tin tolerate. Other than in the case of astringent malnutrition, fetuses generally receive the nutrition they require—sometimes to the detriment of the female parent. For example, the calcium depletion from the fetus can crusade a female parent's teeth to disuse.
In that location are supplements on the market place that the mother can eat if she is unable to assimilate a total meal, such every bit liquid supplements, puddings, and protein bars to replace the lack of essential maternal nutrients.
Fluids
A pregnant adult female should endeavour to eat at to the lowest degree 2 litres of fluids daily in minor amounts taken frequently. Colder fluids, including ice chips and Popsicles, appear to be easier to tolerate and tin decrease the metallic sense of taste in the oral fissure. There are also commercial products bachelor that maintain the electrolyte balance (sports drinks, etc).
Prenatal vitamins
Vitamins can worsen nausea, primarily considering of the iron content and large size. The well-nigh common side effects from using prenatal vitamins are constipation, nausea, and vomiting. In the first trimester, a woman can take folic acid alone or take a multivitamin that does not comprise iron, as this form does non announced to increment NVP. Later on in the pregnancy when the NVP subsides, she can resume taking her regular multivitamin.
Antacids
Weather condition such as heartburn, acid reflux, indigestion, gas, or bloating can also exacerbate NVP and tin can exist very uncomfortable. It is important that these symptoms are treated effectively. Minor symptoms can be treated with antacids containing calcium carbonate; yet, if these are not effective, histamine (Hii) blockers and proton pump inhibitors are safety to take.19 , twenty
In addition, there are over-the-counter products available that can assistance with excess gas and bloating. Some women have reported becoming lactose-intolerant during pregnancy; they should switch to lactose-gratis products. There is also some evidence that effectively treating Helicobacter pylori with antibiotics can mitigate the symptoms of NVP.21 , 22
Fibre for constipation
Women who practise not consume plenty fibre should attempt to increment their fibre intake past eating well-tolerated high-fibre foods (eg, cereal, dried fruit). If this is non effective, they tin try over-the-counter products such every bit psyllium and a stool softener (eg, docusate sodium).
Spitting and oral cavity washing for excessive saliva
Women should exist brash not to swallow excessive saliva, as this can increase the symptoms of NVP. Spitting out the saliva and frequent mouth washing can be helpful.
Management
Considering NVP affects a big number of significant women, some with serious consequences, it cannot be ignored, especially when in that location are safe and effective treatments bachelor. Inquiring near NVP when interviewing meaning women during their first visits to health care providers is an essential role of the history. Many women do not volunteer this information considering their symptoms might have been minimized past others, or they accept been informed that it is a normal part of pregnancy and something they have to tolerate.
Wellness care providers should be aware of the evidence-based information regarding various treatment modalities and offering them to their patients when appropriate. Nausea and vomiting in pregnancy manifests itself differently in each woman, and its management should be tailored for each private.
Nausea alone should not be minimized, as this can affect the quality of life as much as—or more than—airsickness. Nausea treatments tin be either pharmacologically based or holistic, or an constructive combination of both. Timing of NVP treatment is also important, as early treatment can prevent a more than astringent course from occurring, reducing the possibility of hospitalization, fourth dimension lost from paid employment, and emotional and psychological problems. It is important that women and their wellness intendance providers understand that the benefits of safe and constructive NVP treatment predominantly outweigh any potential or theoretical risks to the fetus; thus, all handling options should be considered.
Conclusion
Since we adult the algorithm in 2002,23 there has been some new evidenced-based information published on the safety of various pharmacotherapy treatments, as well as some other strategies that we accept found helpful for these women. As family physicians are often the beginning health care providers women arroyo when their pregnancy is confirmed, it is important they have this information to assist these women during this extremely unpleasant phase of pregnancy.
References
i. Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract. 1993;43(371):245–8. [PMC free commodity] [PubMed] [Google Scholar]
ii. Mazzotta P, Stewart D, Atanackovic One thousand, Koren G, Magee LA. Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy. J Psychosom Obstet Gynaecol. 2000;21(3):129–36. [PubMed] [Google Scholar]
three. Chou FH, Lin LL, Cooney AT, Walker LO, Riggs MW. Psychosocial factors related to nausea, vomiting, and fatigue in early on pregnancy. J Nurs Scholarsh. 2003;35(2):119–25. [PubMed] [Google Scholar]
four. Swallow BL, Lindow SW, Masson EA, Hay DM. Psychological health in early on pregnancy: relationship with nausea and airsickness. J Obstet Gynaecol. 2004;24(ane):28–32. [PubMed] [Google Scholar]
v. Mazzotta P, Stewart DE, Koren One thousand, Magee LA. Factors associated with elective termination of pregnancy amongst Canadian and American women with nausea and vomiting of pregnancy. J Psychosom Obstet Gynaecol. 2001;22(1):7–12. [PubMed] [Google Scholar]
6. Atanackovic Grand, Navioz Y, Moretti ME, Koren One thousand. The condom of higher than standard dose of doxylamine-pyridoxine (Diclectin) for nausea and vomiting of pregnancy. J Clin Pharmacol. 2001;41(8):842–5. [PubMed] [Google Scholar]
7. Shrim A, Boskovic R, Maltepe C, Navioz Y, Garcia Bournissen F, Koren Thou. Pregnancy outcome following use of big doses of vitamin B6 in the first trimester. J Obstet Gynaecol. 2006;26(8):749–51. [PubMed] [Google Scholar]
9. Einarson A, Maltepe C, Navioz Y, Kennedy D, Tan MP, Koren Chiliad. The safety of ondansetron for nausea and airsickness of pregnancy: a prospective comparative report. BJOG. 2004;111(nine):940–3. [PubMed] [Google Scholar]
ten. Asker C, Norstedt Wikner B, Kallen B. Use of antiemetic drugs during pregnancy in Sweden. Eur J Clin Pharmacol. 2005;61(12):899–906. Epub 2005 Nov xviii. [PubMed] [Google Scholar]
11. Berkovitch 1000, Mazzota P, Greenberg R, Elbirt D, Addis A, Schuler-Faccini L, et al. Metoclopramide for nausea and vomiting of pregnancy: a prospective multicenter international study. Am J Perinatol. 2002;19(6):311–6. [PubMed] [Google Scholar]
12. Jewell D, Young G. Interventions for nausea and vomiting in early on pregnancy. Cochrane Database Syst Rev. 2003;(4):CD000145. [PubMed] [Google Scholar]
13. Portnoi K, Chng LA, Karimi-Tabesh L, Koren G, Tan MP, Einarson A. Prospective comparative study of the prophylactic and effectiveness of ginger for the handling of nausea and airsickness in pregnancy. Am J Obstet Gynecol. 2003;189(five):1374–7. [PubMed] [Google Scholar]
14. Thaver D, Saeed MA, Bhutta ZA. Pyridoxine (vitamin B6) supplementation in pregnancy. Cochrane Database Syst Rev. 2006;(ii):CD000179. [PubMed] [Google Scholar]
15. Nordeng H, Havnen GC. Employ of herbal drugs in pregnancy: a survey among 400 Norwegian women. Pharmacoepidemiol Drug Saf. 2004;13(6):371–lxxx. [PubMed] [Google Scholar]
16. Borrelli F, Capasso R, Aviello G, Pittler MH, Izzo AA. Effectiveness and condom of ginger in the treatment of pregnancy-induced nausea and vomiting. Obstet Gynecol. 2005;105(iv):849–56. [PubMed] [Google Scholar]
17. Mills East, Duguoa JJ, Perri D, Koren Chiliad. Herbal medicines in pregnancy and lactation: an testify-based approach. New York, NY: Taylor & Francis; 2006. [Google Scholar]
eighteen. Heazell A, Thorneycroft J, Walton 5, Etherington I. Acupressure for the in-patient handling of nausea and vomiting in early pregnancy: a randomized control trial. Am J Obstet Gynecol. 2006;194(3):815–twenty. [PubMed] [Google Scholar]
nineteen. Garbis H, Elefant E, Diav-Citrin O, Mastroiacovo P, Schaefer C, Vial T, et al. Pregnancy outcome afterwards exposure to ranitidine and other H2-blockers. A collaborative study of the European Network of Teratology Information Services. Reprod Toxicol. 2005;19(4):453–8. [PubMed] [Google Scholar]
twenty. Diav-Citrin O, Arnon J, Shechtman S, Schaefer C, van Tonningen MR, Clementi M, et al. The safety of proton pump inhibitors in pregnancy: a multi-centre prospective controlled report. Aliment Pharmacol Ther. 2005;21(three):269–75. [PubMed] [Google Scholar]
21. Penney DS. Helicobacter pylori and severe nausea and vomiting during pregnancy. J Midwifery Womens Health. 2005;50(v):418–22. [PubMed] [Google Scholar]
22. Golberg D, Szilagyi A, Graves Fifty. Hyperemesis gravidarum and Helicobacter pylori infection: a systematic review. Obstet Gynecol. 2007;110(three):695–703. [PubMed] [Google Scholar]
23. Levichek Z, Atanackovic G, Oepkes D, Maltepe C, Einarson A, Magee Fifty, et al. Nausea and vomiting of pregnancy. Evidence-based treatment algorithm. . Can Fam Physician. 2002;48:267–8. 277. [PMC costless commodity] [PubMed] [Google Scholar]
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231543/
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