Nausea During Pregnancy
Tips for Pregnant Moms
Use of Ginger in the Treatment of Nausea and Vomiting of Pregnancy
Ginger (Zingiber officinale) is a nutritive, herbal supplement considered safe by the Food and Drug Administration. It has been used for thousands of years in many countries such as Rome, Greece, India, and Arabia for digestive disorders. It is listed in the pharmacopoeias of the United Kingdom, Thailand, and China as effective treatment for nausea and vomiting of pregnancy. The components of ginger are gingetol and shogaol appear to have only local effects on the gastrointestinal system in comparison to prescription anti-nausea medications which effect the central nervous system. Nausea complicating pregnancy occurs in over 80% of women and therefore finding a natural, herbal remedy as first line therapy that health care providers can offer safely is highly desirable. Many articles are now being published that point to the safety and effectiveness of ginger in pregnancy. One of the most recent articles confirming these findings was an article published in March 2009 by Ozgoli where 67 pregnant women were part of a clinical trial that showed that 1000 mg a day of ginger decreased the intensity of the nausea and vomiting of pregnancy with no side effects. Other articles confirming these findings are found in the American J Obstet Gynecol 2006 and 2003, European J Obstet. Gynecol Reproductive Biolo 1991, and in Obstet/Gynecol article in 2001. Of brand new interest is also a study that was just released (May 2009) from the University of Rochester showing that cancer patients had a decrease in nausea after chemotherapy by 40% if ginger is taken prior to the chemotherapy. Other studies have shown ginger to be helpful for postoperative nausea and vomiting and also with treatment of motion sickness. The American College of OB/Gyn Practice Bulletin Guidelines (April 2004) lists ginger with beneficial effects and could be considered as a non-pharmacologic option for treating the nausea and vomiting of pregnancy. In conclusion: Ginger is a non-medicinal safe option for women who have nausea in pregnancy. Capsule form of approximately 1000 mg /day appears to be the most effective way of taking this remedy. Be aware of any interaction with other medications (in particular anticoagulants.)
Vitamin B6 for Treatment of Nausea and Vomiting of Pregnancy
Vitamin B6, also known as pyridoxine, is a water soluble B complex vitamin that is essential in the metabolism of lipids, carbohydrates, and amino acids. Several studies (authored by Niebyl et al. Vutyavanich et al, Czeizel et al, and Emelianova et al) have shown it to be the best vitamin to treat and prevent the nausea and vomiting of pregnancy. These controlled studies all show a decrease in pregnancy associated nausea and vomiting. Vitamin B6 is safe, efficacious, and inexpensive. The mechanism of action is unknown. There are no fetal side effects when given under 100mg daily. Most treatment protocols give 10 to 25 mg of pyridoxine several times a day. Vitamin B6 is therefore considered the first line therapy by most clinicians use in treating pregnant women.
Vitamin D Deficiency and Pregnancy
What is Vitamin D?
Vitamin D is a fat-soluble vitamin that plays a central role in calcium and phosphorous metabolism, which is critical for bone formation and maintenance.
Why is Vitamin D important?
Deficiency of this vitamin years ago resulted in rickets. New studies have demonstrated a resurfacing of vitamin D deficiency worldwide. This deficiency is especially critical in the pregnant and lactating woman. Studies have shown how important vitamin D is to skeletal, cardiovascular, and neurological development in the infant. Other studies have shown deficiencies linked to diabetes, asthma, and schizophrenia in children. Infants born to mothers with vitamin D deficiency had poor growth, and defects in enamel formation of teeth. A newborn’s vitamin D level is completely dependent on maternal levels. Vitamin D is believed to be critical in placental development and function, which may be associated with other complications during pregnancy including miscarriage, preeclampsia, and preterm birth. Low vitamin D levels have been linked to bacterial infections in the vagina in the first trimester of pregnancy. This can increase the risk of preterm birth and adverse pregnancy outcomes. There is one study that associates a four times greater risk of cesarean section with women that have low Vitamin D levels believed to be due to the fact that skeletal muscle contains vitamin D receptors and deficiency can result in muscle weakness and poor strength in labor. Vitamin D also regulates calcium levels and with deficiency, muscle strength is lowered in labor.
Where do we get Vitamin D?
Vitamin D is obtained from sunlight, diet, and supplements.
- Sunlight—Vitamin D is absorbed from the sun in an inactive form and then converted by the liver and the kidney to its active form.
- Diet—Very few food sources contain vitamin D. Oily fish such as salmon, sardines, mackerel, and tuna along with egg yolks, and fish liver oils.
- Supplements—Foods can be fortified with vitamin D such as milk, orange juice, some cereals, yogurt, cheese, and butter. Over the counter supplements are precursors to vitamin D, which get converted in the body.
What is considered Vitamin D deficiency?
Deficiency is defined as levels less than 20 mg per ml of 25-hydroxy vitamin D. Levels between 20 to 30 indicate insufficiency and anything above 30 is considered normal. Toxic levels are over 150 mg per ml and are exceedingly rare. Deficiencies appear to be more common among African-Americans, due to high levels of melanin which block light from entering the skin. In addition levels are lower in the winter months (November thru March) when less radiation reaches the earth. Levels are low in people living above 30 degree latitude, in cultures where the skin is covered (Arab countries) and in cultures where people avoid sunlight and use sunscreen. Certain medical conditions make one more prone to deficiency such as individuals with bowel absorption problems, people with renal disease, obese individuals, vegetarians, people with lactose intolerance, and people on certain medications. (anticonvulsants)
What are the requirements for vitamin D in pregnant and lactating women?
Current research has shown that pregnant women are at high risk of vitamin D insufficiency and prenatal vitamins are inadequate in meeting these demands. Current vitamin preparations have approximately 200 to 400 IU of D. Experts recommend 1400 to 2000 IU of vitamin D per day in pregnancy. This can be accomplished with the regular prenatal vitamins in addition to another supplement. It has been suggested that breast feeding women whose infants only get vitamin D from breast milk, need to ingest 4000 to 6000 IU of vitamin D per day. Vitamin D levels should be obtained at the first prenatal visit along with the other prenatal blood work. If they are Vitamin D deficient, they should be treated with 2000IU f vitamin D in addition to their prenatal vitamins for 1–2 months and repeat the level to show that it is above 30mg/ml. With continued supplementation of 1000 IU of vitamin D per day, levels should be sufficient for the remainder of the pregnancy. Occasionally borderline individuals might need another level third trimester. Ultraviolet light exposure can also increase the vitamin D content of human milk.
Lime in the Treatment of Nausea
In the winter of 2009, while driving in the windy, mountainous roads in Michouacan, Mexico to observe the Monarch butterflies, my daughter developed motion sickness. We stopped the car and the old Indian guide handed her a lime from his pocket with instructions to smell and bite into the fruit. In spite of our extreme skepticism, the results were immediate. Her symptoms completely disappeared and we were able to continue on our journey. On returning back to the States, I tried to do a literature search on the use of lime to treat nausea but very little literature exists. One study found in Israel showed that healthy volunteers suffering from severe motion sickness demonstrated a decrease in salivary flow rates in 80% of subjects tested. Lime has been found to increase salivary flow rates and in turn correct the nauseas feeling. In addition, many patients in my practice from India were very familiar with the therapeutic effects of lime when used for nausea.
