Ways to treat 'morning sickness' updated in Canadian guide

Morning sickness can really put a damper on the experience of being pregnant, but the Society of Obstetricians and Gynaecologists hopes updated treatment guidelines will help women better manage the gut-wrenching condition.

Between 50 and 80 per cent of women are affected by nausea and/or vomiting during pregnancy, yet many don't seek treatment because they worry about the potential risks of medications on the developing fetus, said Dr. Jennifer Blake, CEO of the professional medical organization.

Managing the condition "can have a profound effect on improving women's health and their quality of life during pregnancy. However there are many safe and effective pharma and non-pharmacological options available," Blake said in a statement following Thursday's release of the guidelines.

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Most women who experience morning sickness find it passes by the end of their first trimester, said Kim Campbell, a registered midwife at the University of British Columbia who co-authored the guidelines. Others, however, will suffer throughout their pregnancy.

Stomach-churning symptoms range from mild to severe, she said. "It's the spectrum — a little bit [of sickness] or you could be throwing up many times a day."

Sometimes, women can't ingest either liquids or food and are in danger of being dehydrated and not getting adequate nutrition; some end up being admitted to hospital, as was the case with Catherine, the Duchess of Cambridge.

"In the more extreme cases, where you can't keep anything down, you can't socialize properly, you can't go to work, you can't look after your children, you can't care for your family and yourself," Campbell from Vancouver.

"So it can be significantly debilitating."

The SOGC document advises women suffering from pregnancy-related digestive upset to start with non-drug treatments such as ginger, vitamin B6 and acupressure to ease their symptoms.

In the more extreme cases, where you can't keep anything down, you can't socialize properly, you can't go to work, you can't look after your children, you can't care for your family and yourself.- Kim Campbell

"There are some new medications on the market, but there isn't necessarily a magic bullet," she said. "What we have now is more information about some natural approaches that are accessible to everybody, like the ginger and the acupuncture and acupressure.

"These are things women should feel completely free to do and they're easily accessible and they're very affordable for them."

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Vitamin B6 is another option for quelling a rebellious stomach, with a recommended dose of 10 milligrams, four times a day.

There is also new evidence that women experiencing nausea and vomiting during pregnancy may safely stop taking iron-containing prenatal vitamins during the first trimester — when extra iron is not yet needed — and substitute folic acid or a vitamin supplement low in the mineral.

Foods that a woman eats may not be as important as once thought. In the past, women with morning sickness were advised to eat small, bland meals and avoid fatty foods like potato chips. But research shows changing the diet may have limited effectiveness, and doctors say women should eat whatever pregnancy-safe foods appeal to them.

Foods to avoid

Foods considered possibly unsafe during pregnancy include those with a potential to cause infection.

"So we teach women to avoid foods that have a higher risk of carrying Listeria," said Campbell, noting vegetables should be washed well, while deli meats, uncooked meats, unpasturized dairy products and soft cheeses should be given a pass.

Pregnant women often have a strong aversion to odours — including certain foods — so they "may want to limit what they're exposed to because there's triggers that set them off," she said.

For Campbell, it was the smell of meat cooking.

"I definitely was motivated to write this," she said of the SOGC guideline document, "because I was definitely affected with my second pregnancy.

"And morning sickness is the wrong name — it affected me all day. I would walk around feeling as if I was about to throw up at any minute."

The guidelines are, of course, also aimed at physicians, who can work their way down the list of potentially effective treatments, including medications that contain antihistamines, if one therapy or another doesn't work.