VOMITING IN PREGNANCY
Nausea, vomiting and hyperemesis gravidarum
Many women have nausea and vomiting in the first trimester (3 months) of pregnancy, which is often called morning sickness. It happens commonly in the morning when the woman gets out of bed. Excessive salivation is an infrequent but troublesome complaint which is associated with a condition called hyperemesis gravidarum — caused by severe and frequent nausea and vomiting during pregnancy.
Hyperemesis is pronounced ‘hye-pur-em-ee-sis’ and means ‘excessive vomiting’. Gravidarum is pronounced ‘gra-vid-ah-room’ and means ‘during pregnancy’.
Hyperemesis gravidarum is a serious disorder, for which the woman needs to be admitted to hospital or a health centre.
The diagnosis of hyperemesis gravidarum is made if the woman loses 5 kg or more of her body weight due to frequent vomiting, loss of body fluids and nausea, making her fearful of eating, and is confirmed by the appearance of acidic chemicals (called ketone bodies) in her urine. The body starts to produce ketone bodies when it begins to break down proteins in a person’s muscles because there is no other energy source to keep them alive. The ketone bodies can be detected in urine by a dipstick test, which you can do in the woman’s home or at the Health Post if you have been provided with the appropriate dipsticks and shown how to ‘read’ the colour change if ketone bodies are present. A positive test result means she must be referred immediately to get replacements for the nutrition, body fluids and essential chemicals that she has lost, and receive preventive treatment to avoid further occurrence.
Management of mild nausea
If the nausea is mild, encourage the woman to try any of these remedies:
- Before bed or during the night, eat a food that contains protein, such as beans, nuts or cheese.
- Eat a few bananas, dry bread, dry kita, or other grain food upon waking up in the morning.
- Eat many small meals instead of two or three larger ones, and take small sips of liquid often.
- Drink a cup of mint, cinnamon or ginger tea two or three times a day, before meals. Put a teaspoon of mint leaves, or a stick of cinnamon, in a cup of boiling water and let the tea sit for a few minutes before drinking it. To make ginger tea, boil crushed or sliced ginger root in water for at least 15 minutes.
12.1.2 Food dislikes and food cravings
A pregnant woman may suddenly dislike a food that she usually likes. It is OK not to eat that food, and she will probably begin to like it again after the birth. She should be careful that the rest of her diet contains a lot of nutritious food. You will learn what advice to give women about good nutrition during pregnancy in Study Session 14.
A food craving (also known as pica) is a strong desire to eat a certain food, or even something that is not food at all, like black soil, chalk or clay (Figure 12.1). If a woman gets a craving for nutritious foods (like beans, eggs, fruits or vegetables), it is OK for her to eat as much as she wants.
Pica is pronounced ‘pye-kah’.
Figure 12.1 Food cravings are common in early pregnancy.
A woman who craves to eat things that are not food, like soil or clay, should be advised not to eat them. They may poison her and her baby. They may also give her parasites, like worms, that can make her sick. Encourage her to eat iron-rich and calcium-rich foods instead.
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