Handling Nausea In Pregnancy

Copyright 1996-1997 Kmom@Vireday.Com. All rights reserved.

Is Good Nutrition Really That Important?
Good nutrition is extremely important before and during pregnancy. This is
a critical issue, according to Dr. Tom Brewer and many others, who see poor nutrition
implicated in a whole host of pregnancy complications, especially pre-eclampsia (also known
as toxemia or Pregnancy Induced Hypertension/PIH). Since pre-eclampsia is one of the most
common complications large women can face during pregnancy, it is absolutely vital that a
pregnant woman pay strict attention to her nutrition throughout pregnancy. The authors of the
1996 JAMA journal articles on neural tube defects in babies of heavy women also speculate
that nutritional factors may be involved, and some people feel that large swings in blood sugar
during the pregnancies of vulnerable women may also contribute to development of
gestational diabetes, another risk for the pregnancies of larger women. Therefore, exemplary
nutrition is critical throughout pregnancy, and may be especially so for larger
women, who may be entering pregnancy with poor eating habits or nutritional deficiencies
from years of dieting (especially if they dieted just before pregnancy).
"Don't Worry, The Baby Will Get What It Needs"---NOT!
Unfortunately, nausea can interfere disastrously in the quest for sound nutrition,
especially in the critical first trimester of pregnancy when the basic formation of all the baby's
systems and organs are taking place. Just when you need terrific nutrition the most, you feel
the sickest! Most women finish the nausea stage by the end of the first trimester, but some
women experience it through the second trimester, and a few even have it for the whole
pregnancy. It's a situation that is often ignored or downplayed by doctors. Many patients are
left to deal with it on their own or given a pat on the back and told not to worry about it, the
baby will take what it needs from mom anyway. They may be told that baby takes so little in
the first trimester that any difference in mom's nutrition is not important; they may be
encouraged to avoid certain categories of food or to just eat "when you feel up to it."
Dr. Brewer and others feel that this is a disastrous approach, and they strongly
disagree with the idea that baby will adequately get what it needs from mother. They also feel
that the poor nutrition resulting from this approach can often compromise the pregnancy later,
and that this is poorly recognized among many members of the medical community. While
some experts disagree, it is probably true that making an effort to keep nutrition as even and
qualitative as possible is the most sensible, least-intervention approach. So make every effort
to find a way to deal with the worst of the nausea, try to prevent the nausea from getting
worse, and strive for good nutrition in spite of everything.
There is no simple cure for pregnancy nausea; what 'works' will vary from person to
person greatly. It is a miserable time for many, and sometimes it's just a matter of outlasting
and surviving the nausea while still keeping intact the best nutrition possible under the
circumstances. A number of coping suggestions that have helped others will be offered here,
but no one can guarantee that they will work for you. Most often it is a matter of trying to
minimize the nausea you do experience until it goes away; don't believe anyone who promises

you a sure cure! A certain amount of unpleasantness is just going to have to be endured if you
are one of the unlucky who experience nausea. However, it is of the utmost importance that
the nausea not be allowed to interfere with the good nutrition that is so vital in
pregnancy. This cannot be stressed enough. If you are one of the unfortunate women who do
not respond at all to the nausea self-care suggestions and your nausea is severe or debilitating,
it is critical that you find a health provider who will be proactive in trying to find a way to
help you. Don't suffer in silence; if you need extra help, get it!
The Possible Role of Blood Sugar Levels
What causes nausea is unknown. Hormonal changes (possibly progesterone or hCG
levels), emotional factors (especially stress), the rapid stretching of the uterine muscles,
swings in blood sugar, etc. have all been pointed to as possible causes. Of critical importance
(especially to larger women) is preventing swings in blood sugar. Throwing up or going
without eating because of nausea often causes a dip in blood sugar, which can significantly
worsen the nausea that is already there. Since the mother now feels even worse, she eats even
less, lowering her blood sugar even more, leading to quite a vicious cycle. When she does eat,
her blood sugar then surges with its new energy, which in some may cause an insulin surge in
response, which will then suppress blood sugar levels, causing more nausea----------see the
cycle? So often the mother, by not eating when nauseous, is led into even worse nausea.
If a woman is somewhat prone to diabetes already (and many larger women may
be) and her blood sugars dip and surge continually like this, it's possible that this may be
implicated in developing gestational diabetes later in pregnancy (though not everyone agrees).
Women who do develop GD in pregnancy are strongly advised to maintain euglycemia
(steady normal blood sugars) in order to minimize risks to the baby, and often women who
may be at risk for GD are counseled to do the same. Therefore, it may be even more critical
for larger women to keep their blood sugar on an even keel, despite their nausea.
Doing this, of course, is easier said than done. Forcing yourself to eat when nauseous
is unpleasant, and it's very easy to skip meals or forego foods. However, your baby is counting
on you. Keep that uppermost in your mind as you are tempted to skip meals. No one should
minimize that nausea is unpleasant and difficult to manage, but some steps can be taken to try
to lessen its impact on the baby. Again, if none of these work and your symptoms are severe
or you become dehydrated, it is very important to seek medical help before the nausea
compromises your pregnancy. Don't be shy about getting help.
Ideas for Minimizing Nausea
Remember, all of these are just ideas that have worked for some people. There
are no guarantees! Not all of these suggestions will work for you, and sometimes nothing
works. All you can do in that case is endure while trying to minimize the impact on your
pregnancy, and seek help if needed.
1. Keep your blood sugar levels even by eating small, frequent meals high in protein and
complex carbohydrates.
Simple carbohydrates (foods high in sugar and even unsweetened fruit juice) are
turned quickly into blood sugar in your system. Complex carbohydrates take longer to turn
into blood sugar, so they will keep your blood sugars from spiking quickly and then dropping,

and will provide longer-term energy. High fiber foods, fats, and proteins also slow down the
carbohydrate conversion, which will keep your blood sugar more even. Never eat
carbohydrates without an accompanying fat or protein food. Frequent small snacks work
better for nausea than big meals. Try eating 5-6 small meals or snacks a day, and be sure to eat
before bedtime. Also, carry with you a portable snack such as nuts and fruit or cheese and
crackers for use if you start feeling nauseous---even though it's very hard to try and eat when
you feel queasy, you may be able to prevent a worse nausea episode if you do get something
down).

2. Eat before you are hungry.

If you wait until your body tells you it is hungry, you may already have lowered your
blood sugar too much and the acid production in your stomach may also worsen nausea.
Strike first by eating frequent small snacks (a carbohydrate and a protein are best) before your
blood sugar has a chance to dip. Also, eating while you are still feeling relatively good will
help food go down and perhaps stay down, and may prevent a nausea attack. Try not to let
more than 3-4 hours go by between eating something.
3. Eat a substantial bedtime snack, including protein.
It's a long time between your last meal of the day and your breakfast the next morning,
so it's very easy for blood sugar to become too low during this time, causing nausea upon
rising. Shortly before bedtime, try eating a fairly significant snack of complex carbohydrates
and protein. The protein will help slow down the release of the complex carbohydrates,
enabling you to have more steady blood sugar levels through the night. Sometimes, some
women even need to get up in the middle of the night and get a little extra snack, like a glass
of milk, in order to help their morning nausea. It's worth a try!
4. Try eating before getting out of bed in the morning, then take it slowly.
Before getting out of bed in the morning (like 20-30 minutes ahead of time), have a
high-carbohydrate snack. Common suggestions are crackers, but some women find other
foods work better. Experiment till you find your best choice (some like salty foods, others do
not). Once you are up, ease yourself into the day as gradually as your schedule allows; rushing
and quick movements at first tend to aggravate nausea. Give the morning snack a chance to
take effect and raise your blood sugar.
5. Be sure to get enough fluids.
Dehydration is a danger to those with nausea, so it is important to stay hydrated. Some
women find they tolerate fluids best with meals; others find it better to take them only
between meals. Small sips, taken frequently, may also help. Remember, fruit juices are a
simple carb and may cause a quick surge and then crash in some women, so try to use water
instead (or at least take a protein with your fruit juice). If fluids give you a lot of trouble, try
fruits and vegetables with a high water content. You may also want to consult your health
provider if you are having trouble keeping down fluids.

6. Try ginger.
Some women reportedly have luck with small amounts of ginger added to their food.
Be careful not to use too much, however. (Good excuse for a ginger ale.)
7. Be sure to take your prenatal vitamin, but try switching brands or times.
Some women note a sensitivity to certain prenatal vitamin brands, especially the
prescription type. Try switching for a week to an over-the-counter brand (be sure it has
enough folic acid), or try asking your doctor for a different prescription type. Sometimes
changing the time of day that you take the vitamin can help---try taking it at the time of day
when you have the least nausea (if there is such a time!). Bedtime may be a good choice.
8. Ask your health provider about trying extra vitamin B-6.
Some women find relief if they add extra vitamin B-6 to their diet. 50 mg. is usually
the dosage tried, but remember to clear it first with your health provider (very important!).
9. Avoid trigger foods and substitute alternatives as needed; get enough protein.
Some foods seem to act as triggers to nausea. If carrots bother you, avoid them for a
while. However, it IS important to substitute something else for the important vitamin A to be
found in carrots. An alternative might be dried apricots, squash, cantaloupe, or even--if
desperate-- pumpkin pie or muffins (in conservative amounts!). Try to keep a variety of foods
as much as possible, and be creative in your choices so that the essential nutrients are covered.
Don't forget the importance of significant amounts of protein in your diet as well---Brewer
recommends 80-100 g of protein per day (but remember that foods like milk, yogurt, and even
spinach do have protein in them and count towards this total).
10. Rinse or brush after throwing up.
Having the smell or taste of vomit in your mouth after one bout can lead to another.
Try brushing your teeth afterwards, but if you are one of the people for whom brushing can
induce nausea, try a gentle rinsing instead. Over time you will find your physical triggers
(such as brushing, strong smells, or moving too fast) and you will learn to avoid them or adapt
to them. But finding a way to refresh yourself after a bout of nausea is important--do whatever
works for you.
11. Try Sea Bands.
These small bands worn on each wrist put pressure on the inner wrist and often help
nausea. They have no side effects and can be found at many pharmacies or marine shops.
They are also worth a shot when desperate.
Nausea is not an easy thing to deal with and no one should downplay the discomfort
involved. Try as many approaches to managing nausea as you can but be realistic---no
suggestion is going to 'cure' you. Sometimes, all you can do is endure. For most women, it
does go away with time, and often it is worst in the first 3-4 months. You may or may not
experience it again in subsequent pregnancies; each pregnancy is different and you must be
prepared for the possibilities. In the meantime, hang in there and try to wait it out! It will end
eventually!