Q. During my pregnancy, I noticed that I am more prone to morning sickness and heartburn. What are the best ways to help manage these symptoms while pregnant?
A. As we have mentioned in earlier Ask the Pharmacist columns, pregnancy can be such a wonderful experience. However, as your baby grows, you may also experience some less than wonderful symptoms during your 9-month journey.
Morning sickness is a very common complaint amongst pregnant women and could be one of your first signs that you might be pregnant. That, and the obvious sign that you are late for your period. Though it is termed morning sickness, nausea and vomiting could be present at any time of day. It is quite common since 50-80% of pregnant women experience this. Thankfully, many women will find that their symptoms of nausea and vomiting may start early (around week 5 or 6) but generally peak by week 9 and are gone by week 16. However, some women are not that fortunate and may experience nausea and vomiting throughout their pregnancy. Since most people would prefer to not medicate, let’s first discuss some non-drug measures to relieve nausea and vomiting. Some of these might be obvious methods but it is still worth mentioning.
· Replace lost fluids with water, juice, soft drinks, brothy soups or electrolyte solutions.
· Eat smaller, more frequent meals and eat less when nausea is most severe
· Eat bland foods and avoid spicy, fried and fatty foods
· Drink between meals and not during them
· Avoid known triggers (smells, specific foods, stressors)
· Acupressure of P6 point using moderate pressure for 5 minutes every 4 hours. The P6 acupressure point is located on the inner forearm about 3 finger widths below the wrist.
If these measures are not alleviating your symptoms, you may wish to consider contacting your pharmacist to see if they can assess your condition. Nausea and vomiting due to pregnancy is a condition that pharmacists may prescribe for or in certain situations may refer you to your physician.
Consider the following:
· Iron, which is in your prenatal supplement, could be the culprit of your nausea. You could try stopping your prenatal supplement to see if this helps. Prenatal supplements also contain folic acid which is very important to continue, especially during your first trimester. If you do stop taking your prenatal vitamin to ease your nausea, ensure you take folic acid at a dose of 4mg for the duration of your first trimester (12 weeks gestation) and then 0.4mg thereafter.
- Pyridoxine (vitamin B6) can be taken at a dose of 25mg every 8 hours or 10mg every 6 hours
- Pyridoxine/doxylamine (10mg/10mg) is a common, safe prescription medication that is solely prescribed to treat nausea and vomiting due to pregnancy. It is commonly taken at bedtime to reduce morning sickness and throughout the day to combat daytime sickness
- You may not be surprised to learn that ginger has a role in reducing nausea. Think of the times you may have been given flat ginger ale to drink when you felt ill. Ginger can be taken as a supplement at a dose of 250mg every 6 hours as needed
- For more moderate and/or severe cases of nausea and vomiting, you may be suggested to take dimenhydrinate (Gravol) which is available without a prescription or promethazine which is only available only by a prescription.
Heartburn is another common ailment that pregnant women complain about since anywhere from 30-80% experience it. Some classic symptoms of heartburn are having a bitter or sour taste in your mouth, a burning feeling in your chest and/or throat, burping often. Some of the best methods to prevent heartburn are similar to the suggestions above for nausea and vomiting:
· Eating smaller, more frequent meals
· Eating more slowly. It is not a race!
· Be sure to sit up tall and avoid slouching while eating
· Drink between meals and not during them
· Eat bland foods and avoid spicy, fried and fatty foods
· Reduce /limit your caffeine
· Avoid carbonated beverages (pop, sparkling water)
· Avoid acidic foods like citrus fruits and juices
· Avoid smoking and drinking alcohol (this should already be avoided due to health problems on your baby)
· After eating, wait 2 hours or more to lay down or 3 hours to go to bed for the night
· Try keeping your head of your bed higher than the foot of your bed with the use of pillows or putting books underneath your mattress
You can try some natural remedies to reduce your heartburn such as eating yogurt or drinking milk. Some have suggested putting honey into warm milk helps as well. It has also been shown that chewing gum may help reduce the acid and therefore the heartburn.
If none of these tactics work to help ease your symptoms, you might want to connect with your pharmacist since heartburn is one of the minor ailments that they can assist you with. They can assess your situation and prescribe one or more options on top of the lifestyle changes discussed above. Treating heartburn in pregnant women is best done as a stepwise approach.
· Generally, the first choice of medication that pregnant women should opt for to treat their heartburn are antacids. Antacids contain magnesium and/or aluminum (Maalox, Diovol etc) and are known to provide fast, quick relief and is safe during pregnancy. It is strongly advised to avoid sodium bicarbonate (Alka Seltzer) as it may cause your body to retain fluid and throw off your body’s chemistry. Aglinates (Gaviscon) have also been found safe to use during pregnancy.
· If the above suggestions did not prove effective, you may consider adding an H2 receptor agonist such as ranitidine or famotidine. These are acid reducers that have been deemed safe to use during pregnancy however it is suggested to use them after lifestyle modifications and antacids have been proven ineffective.
· For those cases of heartburn that still won’t improve with ranitidine, then it may be time to try a proton-pump inhibitor (PPI). Some examples of PPI’s are pantoprazole (Pantoloc, Tecta), rabeprazole (Pariet), and omeprazole (Losec). The evidence to support the safety of PPI’s is very limiting although they do appear to be safe to take during pregnancy. However, due to this fact, it should be considered as a last resort. Knowing how heartburn can be quite debilitating and affect your nutrition, they should be considered when all else has failed.
Stay tuned for more common ailments during pregnancy in the coming weeks.
For more information on this or any other health topic, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination.
