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Nausea and Vomiting in Pregnancy

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July 10, 2017
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About 70% of Canadian women experience some form of nausea and vomiting during their first 16 weeks of pregnancy, beginning around week 4. This condition is commonly known as morning sickness, but don’t be fooled – it can happen during any time of day! A more severe form of morning sickness can also occur – it’s known as hyperemesis gravidarum and is experienced by about 1% of pregnant women. Other symptoms include dehydration and weight loss.

Morning sickness can happen due to a couple of reasons: an empty stomach, low blood sugar, hormonal changes, strong smells, nutritional deficiencies, lack of sleep and even stress!

While nausea and vomiting will eventually go away, women will often turn to a med or natural health product to help ensure that they’re able to eat something.

Treatments for Morning Sickness

Medication

The common med given to women experiencing morning sickness is called Diclectin (doxylamine-pyridoxine). This med comes with its controversies however, and its side effects include diarrhea, disorientation, epigastric pain, insomnia, headache, and palpitations.

Natural Therapies

Some tried and true natural remedies include ginger, vitamin B6, and acupuncture. Although there are some other herbs that are generally great for digestive concerns like chamomile, peppermint – they haven’t been studied as extensively.

Ginger and Vitamin B6 (also called pyridoxine and is a component of Diclectin) have been studied against placebo, and have shown to be more effective than placebo. It should be noted that inconsistent forms of ginger have been studied (ie. syrup, extract, tea, cookie, etc.) making it difficult to determine the best dosage and form. With respect to acupuncture, PC6 is commonly known as the ‘anti-nausea’ point, but Kidney 21 was also assessed in some clinical trials.

Additionally, some tips to help cope with morning sickness are: 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 that this is actually protective for moms.

Next Steps

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!

Are you infertile?

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1 in 8 Canadian couples experience infertility. 

That’s a big number!

You might think that you can get pregnant at any time during the month. And that’s actually not true. There are about 6 days where you are actually fertile. So if you’re not seeing that big fat positive 2 weeks after you have sex, you simply might not be having sex at the right time. 

First things first, you need to figure out when your body is ovulating

If you know when you’re ovulating and timing sex around that, when should you be concerned? And if you don’t get pregnant on the first try, does that automatically make you infertile?

Types of Infertility

Primary Infertility

This might be you if you are younger than 35, and have not gotten pregnant within 1 year of having unprotected sex, or you may not be able to carry a pregnancy to term.

If you are 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

You might have secondary infertility if you have been able to get pregnant after 1 year of having 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. 

Infertility Numbers

Female Factor

43% of infertility is because of women. Causes include endometriosis, tubal factor including completely blocked fallopian tubes, scarring from pelvic inflammatory disease, etc. 

Male Factor

32% of infertility is due to men, and is 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

About 25% of infertility cases are due to an unknown factor, otherwise known as unexplained infertility. 

What Causes Infertility?

You need to be ovulating and have unobstructed fallopian tubes for fertility to occur as per normal. Although this may not account for unexplained infertility if both those factors are normal. 

When you’re not 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: Premature menopause (before you turn 40), your ovaries are unable to function normally

  • 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 gonorrhea

  • Endometriosis

  • History of abdominal surgery

Risks of Infertility

In women, risks include:

  • Age

  • Smoking

  • Excessive alcohol intake

  • Extreme weight gain or loss

  • Excessive physical or emotional stress

Fertility Tests

Your diagnostic workup can be overwhelming and 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

Ironically (or should I say infuriatingly), the diagnostic workup for men simply involves a semen analysis. Although at recent conference that I attended, one of the speakers had mentioned that sperm DNA methylation could serve as a biomarker for male infertility.

Final Thoughts

Trying to get pregnant and not being able to do so can be frustrating, frightening and overall incredibly depressing when you are trying to grow your family. Not to mention the effects that it has your psyche. 

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.

Waitlists to meet with a reproductive endocrinologist can be long, so in the meantime you can work with me so we can figure out what’s going on and which changes can you and/or your partner can make now, to help in the longterm. And who knows? Maybe you’ll get pregnant, and not need that REI appointment after all! 

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.