Morning Sickness

Jan 29, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I've delivered way more papers in my forties than I ever did in my teens. I wasn't a regular Winnipeg Free Press paper boy in Pinawa, but I filled in for my friend Dave Bjornson a few times. Emily delivered the Herald and the Shopper for about 3 years. Then Eric inherited the route and is on year 2. This winter, Eric seems to have a whole bunch of out of town hockey games on Tuesday's and Thursday's. That means Doris is driving to places like Hamiota and the poor people of my neighborhood get a really old slow paper boy.

Eric is big and strong enough to deliver papers about twice as fast as I can. He even throws in the occasional jab about how old and slow I am. But he has been harassing us for a long time now. When Doris was pregnant with Eric, we used to joke about pregnancy brain and how she would forget the oddest things. Despite the obvious physical changes and the less obvious mental ones, pregnancy can be a wonderful time for many women. However, 50 to 80% of pregnant women experience morning sickness. Morning sickness is more properly called nausea and vomiting of pregnancy as it can happen at any time of the day or night. Morning sickness is considered a normal, if annoying, part of pregnancy. It can be more than just annoying, though. The Society of Obstetricians and Gynaecologists of Canada describes the nausea and vomiting of pregnancy to be about as severe as a typical patient experiences during cancer chemotherapy. We don't really understand why morning sickness happens. It probably involves genetics, hormones, things in the pregnant woman's environment, factors in the gut and the pregnant woman's psychosocial situation. One interesting theory says morning sickness is a defense mechanism. Meat, fish, poultry and eggs are some of the foods most likely to trigger morning sickness. All of these foods could carry pathogens that cause infectious diseases. In our evolutionary past, these foods could potentially have harmed the fetus. There are other researchers that claim that some women with morning sickness have lower risk of miscarriages and preterm deliveries. That is also interesting, but not universally accepted. And the foods that trigger nausea in pregnant women varies. About half of pregnant women develop morning sickness by 6 weeks gestation. Virtually all women have at least some symptoms of nausea and vomiting by 9 weeks gestation. Fortunately, most women have the symptoms of morning sickness go away by week 16. An unlucky 10% of pregnant women have nausea and vomiting that last beyond 20 weeks of gestation. Morning sickness really is a misnomer. The nausea and vomiting of pregnancy can happen at any time of the day or night or it can be constant throughout the day.

Hyperemesis gravidarum is a serious condition that affects 0.3 to 2% of pregnant women. It is vomiting during pregnancy that can't be stopped. The vomiting starts in the first trimester and can continue throughout the pregnancy. This type of continuous vomiting is not a normal part of pregnancy. The continuous vomiting can lead to dehydration, electrolyte disturbances, nutritional deficiencies and maternal weight loss. Hyerpemesis gravidarum can threaten the life of mother and fetus.

To reduce morning sickness, the pregnant women can try to eat small, bland, frequent meals. She can avoid fried and spicy food and drink small amounts of fluid regularly between meals. There is evidence that high protein food can cause less nausea than high carbohydrate meals. In general, if something makes the pregnant woman nauseous, she should avoid it. For my wife, the smell of cooking ground beef was a trigger. Unfortunately, that was harder to avoid than you'd think, as she was working in a kitchen when she was pregnant with Emily. Also getting lots of sleep seems to help morning sickness symptoms.

Prenatal vitamins can be a trigger for some women. The problems are often due to the large table size and the iron content. If your prenatal vitamin is making you nauseous, call your pharmacist. In conjunction with your doctor, we can usually find a work around. Depending on your case, we might give you a tiny folic acid pill by itself for a few weeks. Or maybe we can give you a multivitamin without iron in it.

There have been some studies of using accupressure to treat morning sickness. Look at your wrist. Start at the crease below your palm and go three finger widths towards your elbow. Push the fourth finger down in the middle of your forearm between the two tendons you feel there. This is the accupressure spot to prevent nausea. You can try pushing there for about 5 minutes every fours hours. Or you can try placing a Sea-Band there continuously. People have had success with each, but it is uncertain if either of these methods are more effective than placebo. However, they are safe and inexpensive.

If medication is needed for morning sickness, the drug of choice in Canada is dicletin. Dicletin contains 10 mg of pyridoxine (Vitamin B6) and doxylamine (an antihistamine). The usual dose is up to 4 tablets in a day and it works best if it is taken regularly. Dicletin is less effective if taken as needed. If a woman wants to try something without a prescription, she can try Vitamin B6 (pyridoxine) by itself. Gravol or dimenhydrinate is safe and effective for morning sickness, but it is generally considered second line if someone fails on Dicletin. Ginger may also be effective in reducing morning sickness. There are some theoretical risks of ginger affecting the fetus as there are cytotoxic chemicals in ginger. However, there appears to be no harm to the fetus if the daily dose of ginger is kept at under 1 g per day.

Delivering The Herald and The Shopper at -7C with no wind is actually a pleasant, if somewhat long, walk. Delivering papers at - 27C with a wind sucks. If you don't like the weather in Manitoba, wait 5 minutes and it'll change, right? That's a nice thought when you work inside in a pharmacy. But if my day job consisted of regular long -27 C plus a wind walks, I'd be looking for a new job pretty quick. This old slow paper boy takes his hat off to everyone who works outside in a Manitoba winter. Or I would if I wasn't sure my ears would fall off.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Mother Risk - How to Survive Morning Sickness - http://www.motherisk.org/women/morningSickness.jsp

Management of Nausea and Vomiting of Pregnancy - The Society of Obstetricians and Gynaecologists of Canada - http://sogc.org/wp-content/uploads/2013/01/120E-CPG-October2002.pdf

 


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