The dreaded nausea - you're not alone!

Some women (about 25%) manage to escape the dreaded nausea in pregnancy but for the majority, this is a challenge, particularly in the first trimester. It can be severe enough to interfere with work and family relationships and in 0.3 to 1% of pregnant women, may even require IV hydration and medication. But, for the majority, the American College of Obstetrics and Gynecology reports...

"About 50% of women have nausea and vomiting in early pregnancy, and an additional 25% have nausea alone," writes Jennifer R. Niebyl, MD, from the University of Iowa Hospitals and Clinics in Iowa City.

Dietary counseling to eat small amounts of food several times a day may be helpful, as well as to avoid exposure to odors, foods, or supplements that appear to trigger nausea, particularly fatty or spicy foods and iron tablets. Other helpful strategies may include eating and drinking fluids between meals or eating bland, dry, and high-protein foods.

n some women, alternative therapy remedies such as ginger and acupuncture may be effective, and these may be given at any point during the pregnancy.

For nausea and vomiting accompanying weight loss in the first trimester of pregnancy, pharmacologic therapy is indicated. Approximately 10% of women with nausea and vomiting in pregnancy require medication.

Evidence from randomized trials supports the use of vitamin B6 (pyridoxine), 10 to 25 mg every 8 hours, and doxylamine, 25 mg at bedtime and 12.5 mg each in the morning and afternoon. Unisom SleepTabs (Sanofi Aventis; oral vitamin B6 and doxylamine), which are available over the counter in the United States, have been studied in more than 6000 patients and control participants, with no evidence of teratogenicity. In randomized trials, this combination has been associated with a 70% reduction in nausea and vomiting, and the American College of Obstetricians and Gynecologists therefore recommends it as first-line therapy for nausea and vomiting in pregnancy." (Medscape)

Continuing nausea and/or vomiting that does not respond to the above regimen may require prescription medication. There are several options so this should be discussed with your health care provider. If dehydration occurs along with electrolyte imbalance, more aggressive treatment may be needed but IV therapy has its risks (infection is the most common) so this should only be used when there is a weight loss greater than 5% and in those who have not responded to these less invasive treatments. This is considered to be hyperemesis gravidarum. In some cases a single IV rehydration is all that is needed to reduce the risk of dehydration.

Dehydration

Two thirds of the human body is made up of water! Balance is obtained when you take in and excrete the same amount of water.

The summer is a time when many people become dehydrated from working and playing in the sun when the body loses fluid through perspiration and exercise. You may also be so busy you forget to drink water. For a pregnant mom, this is especially worrisome and if you have severe nausea in early pregnancy, you can dehydrate quickly. The main concern is that there might not be enough amniotic fluid produced and this can put the baby in jeopardy but of course it has negative effects on the mother as well. Your electrolytes are affected in dehydration and this causes malfunction of cells so transfer of fluids does not occur as it should. Blood pressure can also drop. This can lead to shock.

Inadequate hydration can also lead to contractions and preterm labor. If you start contracting, drink two full glasses of water and rest to see if they stop - a good indication that it was dehydration causing the problem. If they don't stop, call your doctor or go to your planned hospital L&D area if more than about 20-22 weeks' gestation. You may need to go to the ER if you are less than halfway through the pregnancy. It still could be due to dehydration and sometimes IV fluids are required to restore the correct fluid and electrolyte balance to your body. Hyperemesis Gravidarum occurs when "morning sickness" results in an inability to keep anything down, including water. It is a serious condition which requires early medical intervention. Antiemetics are available to help with nausea in pregnancy, so talk to your doctor even if you think it's normal to vomit regularly in the early weeks.

The common complaint of fatigue in pregnancy is often caused by inadequate fluid intake. Water truly is a miracle cure at times.

What are the signs of dehydration?
Some of the signs include:

• Dark yellow urine (Ideally it will be almost colorless or very pale yellow)
  

• More frequent contractions (May be "real" or "Braxton-Hicks")

• Headaches

• Thirst
  

• Dizziness (especially when rising or bending over) and/or confusion
  

• Constipation (the body conserves its water for vital needs wherever it can and will take from the bowels if not supplied otherwise)

• Dry mouth/chapped lips and/or dry skin
  

What do I do to prevent dehydration?

• Make sure you drink plenty of fluids. 8 oz/hour while awake would be ideal. If you are nauseous, try varying the temperature to see what you can best tolerate and keep a bottle of water with you for continual sipping, rather than gulping.

• At first sign of thirst, listen to your body, and get something to drink. In summer, extra fluids are needed by all of us.

• When traveling by car or bus, always keep bottled water with you. In the air, contact the attendant for extra water in the dry cabin air.

• Other drinks also count, but avoid alcohol. Even the small amounts of caffeine in some sodas doesn't result in a serious loss due to diuretic effects. We used to caution to avoid these for fear they would aggravate water loss, but we now know it is minimal. Fruit juice also counts as part of your water intake. Beware of the extra sugar in regular soda and fruit drinks that will contribute to excess weight gain.

Enjoy your summer activities but don't forget the thermos, canteen, or bottled water.