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Nausea and Vomiting in Pregnancy

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July 10, 2017
nausea and vomiting in pregnancy

Nausea and vomiting in pregnancy is common as up to 85% of pregnant people experience it. Symptoms usually begin around weeks 6-8, peaking around week 9 and Subsiding before 20 weeks. A more severe condition, Hyperemesis gravidarum, can last throughout your entire pregnancy.

We don’t exactly know why this condition happens, but but it’s thought to be due to rising estrogen and HcG levels. Other factors that can affect it are: an empty stomach, low blood sugar, strong smells, nutritional deficiencies, lack of sleep and even stress!

For most, the nausea and vomiting will eventually go away, but in the meantime it’s important to address because it can impact your quality of life. 

Treatments for Morning Sickness

Medication

The common medication you might be offered is called Diclectin (doxylamine/pyridoxine). This medication comes with its controversies however, and its side effects include diarrhea, disorientation, epigastric pain, insomnia, headache, and palpitations.

Natural Therapies

Did you know that a study put out in 2016 listed ginger, acupuncture/acupressure, and Vitamin B6 as first line treatments for nausea and vomiting?

Ginger

Ginger has been compared against placebo in multiple studies, and showed a significant anti-nausea effect, as well as a decrease in vomiting. Some studies have shown ginger to be more effective than vitamin B6 at reducing nausea. When compared to doxylamine/pyridoxine, there was no significant difference between the two. 

Vitamin B6

Compared to placebo, vitamin B6 had a greater anti-nausea effect, with no difference in vomiting. While in another study compared to ginger, Vitamin B6 had a greater anti-vomiting effect. Over a longer period of treatment, vitamin B6 was shown to be more effective than ginger. 

Acupuncture/Acupressure

Acupuncture, as well as acupressure, has been shown to reduce symptoms of nausea and vomiting.
One study demonstrated that women receiving weekly acupuncture treatments, experienced less nausea after 3 weeks compared to sham and no acupuncture.

Next Steps

Other things you can do is avoid foods and smells that nauseate you, get plenty of rest, go for walks and if you can keep some food down make sure you’re getting in some protein and complex carbs. Because dehydration is an issue, be sure to carry around water or tea!  

Interestingly enough, a recent study has shown that nausea and vomiting during pregnancy were associated with a reduction in the risk of pregnancy loss. Suggesting nausea and vomiting is actually protective. And while that’s good news – feeling as well as you can in the first few weeks is key. If you’re looking to use a natural product and avoid side effects, I would recommend working with a ND to ensure that you’re using a high quality supplement at an optimal dose.

If you have natural tips for dealing with morning sickness during pregnancy, be sure to post them below. And if you have any questions or are interested in learning how naturopathic medicine can help during pregnancy book an appointment!

References

Khorasani, F., Aryan, H., Sobhi, A., Aryan, R., Abavi-Sani, A., & Ghazanfarpour, M. et al. (2019). A systematic review of the efficacy of alternative medicine in the treatment of nausea and vomiting of pregnancy. Journal Of Obstetrics And Gynaecology, 1-10. doi: 10.1080/01443615.2019.1587392

McParlin, C., O’Donnell, A., Robson, S., Beyer, F., Moloney, E., & Bryant, A. et al. (2016). Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy. JAMA316(13), 1392. doi: 10.1001/jama.2016.14337

Updated Oct. 2019

Why Aren’t You Getting Pregnant?

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You might think that you can get pregnant at any time during the month – but that isn’t true. There are about 6 days in your cycle when you’re actually fertile. So it’s important to figure out if your body is ovulating, and aim to have sex around that time (including up to 5 days before). Some people become concerned if they don’t get pregnant on the first shot, but it’s actually not that common to do so. About 84% of couple get pregnant within their first year of trying, while 92% of couples get pregnant after 2 years of trying. Depending on your age, there’s a certain time period where you might want to do some investigating if you haven’t become pregnant.

Types of Infertility

Primary Infertility (also known as Subfertility)

This happens when you’re younger than 36, and haven’t gotten pregnant within 1 year of having regular, unprotected sex, or you may not be able to carry a pregnancy to term. If you’re 35 or older, you might have primary infertility if you haven’t become pregnant within 6 months of having unprotected sex, or you may not be able to carry a pregnancy to term. This might be due to the declining egg quality as you age.

Secondary Infertility

This happens if you haven’t been able to get pregnant after 1 year of having regular, unprotected sex, or you can’t carry a pregnancy to term, DESPITE being able to have done so at least once. Women who are experiencing irregular or absence of periods, endometriosis, PCOS, painful periods, pelvic inflammatory disease, more than one miscarriage, should seek care before the 6 month or 1 year mark. 

What Causes Infertility?

Female Factor

You need to be ovulating and have unobstructed fallopian tubes for conception to occur. Keep in mind that this may not account for unexplained infertility if both those factors are normal. When you aren’t able to ovulate, this is known as anovulation. Some conditions that can affect ovulation are:
  • PCOS: A condition that may cause anovulation in women, or irregular periods
  • Diminished ovarian reserve: Fewer eggs remaining in the ovaries than normal
  • Hypothalamic functional amenorrhea: Symptoms include low body weight, excessive stress and exercise
  • Premature ovarian insufficiency: Decline of ovarian function at a younger age (ie. before your 40s).
  • Menopause: A decline in ovarian function, usually when you are in your 50s
An egg needs to pass through a fallopian tube to be fertilized by semen. But some conditions may cause obstruction. These include:
  • History of pelvic infection
  • History of sexually transmitted infections like chlamydia and gonorrhoea
  • Endometriosis
  • History of abdominal surgery

Male Factor

Men may also contribute to infertility, and it’s commonly based on sperm parameters. These parameters include: sperm count, how the sperm is moving, if the sperm is moving in the right direction, the size and shape of the sperm, total semen volume, and if sperm can transition from a gel-like to liquid state after ejaculation. Causes may also include testicular trauma, chemotherapy, hernia surgery, or infertility with another partner.

Unknown Factor

Sometimes we don’t know why infertility happens. This is known as unexplained infertility.

Risks of Infertility

In women, risks include:
  • Age
  • Smoking
  • Excessive alcohol intake
  • Extreme weight gain or loss
  • Excessive physical or emotional stress

Fertility Tests

A diagnostic workup can include:
  • Hysterosalpingogram: an X-ray investigating the shape of your uterine cavity and fallopian tubes, as well as investigating if there are any obstructions within your fallopian tubes.
  • Sonohysterography: ultrasound exam that will create images of your uterine lining. It uses fluid (administered into the cervix) and sound waves to do so.
  • Laparoscopy: The insertion of a thin telescope-like instrument vis a small incision in your belly button. It allows doctors to visually examine your abdominal and pelvic organs (uterus, fallopian tubes, ovaries), and determine if you have endometriosis, scar tissue, fibroids, or any other ‘defects’.
  • Lutenizing Hormone: This is the hormone that triggers ovulation. If there is no LH surge mid-way through your cycle, it’s suggestive of anovulation. It can also provide information about your ovarian reserve, and if your ovaries are functioning normally.
  • Hysteroscopy: Examining your cervix and the inside of your uterus using a thin, tube called a hysteroscope.
  • Transvaginal Ultrasound: Examining a your uterus, ovaries, tubes, cervix and pelvic area, using a ultrasound probe inserted in your vagina.
  • Ovarian Reserve Time: Estimating the supply of remaining eggs within your ovaries.
  • Other blood tests
In men, a work-up includes: a semen analysis and blood work to evaluate testicular function. These usually include: testosterone, follicle stimulating hormone (supports sperm production), lutenizing hormone (prompts testosterone production), and sex hormone binding globulin.

Final Thoughts

Trying to get pregnant and not being able to do so can be isolating and frustrating. You might be trying to do all the things on this fertility journey, like tracking cervical mucus and temperature, using LH strips. You might even be cutting back on smoking, drinking alcohol, or trying to lose weight. Sometimes treatment can be as easy as reducing toxic exposure (like smoking or alcohol), decreasing stress, or losing weight. It really all depends what you’re ready to do. If you’re looking for support getting pregnant, let’s work together to make the process less stressful, figure out what’s going on if there are any changes can you and/or your partner can make now, to help in the longterm. If you found this information helpful, be sure to sign up for my monthly newsletter called The Flow for more informative articles like this!

How Endometriosis Affects Pregnancy

April 19, 2017
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A recent study has suggested a link between endometriosis and pregnancy complications. This study followed women in Denmark who gave birth to a single child between September 1, 1989 and December 31, 2013. Women who were diagnosed with primary or secondary endometriosis (whether they were diagnosed before or after the pregnancy) were primarily studied. Diagnosis for endometriosis included the gold-standard laparoscopic surgery (small incisions are made within the abdomen to assess the organs for any endometrial tissue, removal of the tissue typically occurs with this surgery).

The outcomes measured were: pre-eclampsia, c-section, postpartum hemorrhage, preterm birth, and small for gestational age.

  • Preterm birth included: very preterm birth (before 32 weeks) and moderate preterm birth (32-36 weeks). Preterm birth was also classified as spontaneous (labour or premature rupture of the membranes) or induced (elective c-section, acute c-section before labour, or induction of labour).

  • Small for gestational age was considered as 2 standard deviations away from the average birth weight for gestational age. 

  • C-section differentiation included acute (less than 8 hours after making this decision to deliver) or planned. 

  • Postpartum hemorrhage was defined as losing 500mL or more of blood within 24 hours of delivery. 

  • Pre-eclampsia was not defined in the paper, however has characteristics of high blood pressure, protein within the urine and fluid retention.  

Overall, 1231 women and 1719 pregnancies were studied over the course of 23 years. The women who had endometriosis also had a higher maternal age and had a greater use of assisted reproductive technology (ART). In women with endometriosis the risk of very preterm birth (before 32 weeks) was higher, and women with endometriosis often chose to have a c-section. Women may have opted for a c-section to further avoid pelvic pain (often associated with birth). Lastly there was an increase risk of pre-eclampsia in women with a diagnosis of endometriosis. 

There was no association between endometriosis and small for gestational age infants or postpartum hemorrhage. 

So what does this mean?

Currently, no one is clear on why adverse pregnancy outcomes are occurring, although inflammation has been suggested as a possibility. Pre-eclapsia is also said to occur as a result of inflammation within the body, and while it’s not curable (aside from delivering the placenta), there are preventative measures that women can take to decrease their risk of pre-eclampsia beginning with nutrition. Look out for a future post on the issue. When it comes to inflammation, there’s a lot that women can do: support and nourish the immune system, consume foods high in antioxidants, decrease foods that are pro-inflammatory (including foods you may be sensitive to).

Similarly, there are ways that women can be supported if they choose to have a planned or an acute c-section. This includes immune support for both mom and baby, as well as conversations around scarring and healing. 

Before beginning any specific diet protocol or taking supplements, speak to a health-care professional like a Naturopathic Doctor or Medical Doctor. 

If you found this information helpful, please sign up for my monthly newsletter called The Flow for great and informative content like this!

Reference

Glavind, Maria Tølbøll et al. “Endometriosis And Pregnancy Complications: A Danish Cohort Study”. N.p., 2017. Print.