The concept of pregnancy has never ceased to amaze me, the merging of 2 teeny tiny reproductive cells under specific conditions plus a whole lot of time and change in between results in a whole new person. WHOA!
What is less joyous, however, is the onset of pregnancy side effects. You know the side effects I’m talking about: nausea, vomiting, constipation, fatigue, breast tenderness, heart burn and haemorrhoids. For some, this can be comforting on some level, but for the most part it can make the day to day a bit of a struggle!
What changes are occurring?
So many amazing changes happen in pregnancy: the uterus increases from 50g to 1100g, breasts double in size, blood volume increases, the body becomes better at absorbing some nutrients, respiratory rate increases, the body retains more fluids and salt, and much more!
Ultimately these changes are aimed at maintaining the pregnancy, ensuring the developing foetus has what it needs to grow, helping support mum’s increased needs for fluid, nutrients and waste removal, and preparing for birth and beyond. Physiology is pretty cool.
Nausea and Vomiting of Pregnancy (NVP) and Hyperemesis Gravidarum (HG)
Nausea is the most common side effect of pregnancy, with studies reporting it impacts 70-80% of pregnant women [1].
NVP usually kicks in around 4-10 weeks’ gestation and resolves around 20 weeks’ gestation. Although for some women, this can persist for much longer.
For a small subset of pregnant women (0.3-10.8% [2]), NVP can be severe and is termed Hyperemesis Gravidarum (HG) [3]. HG can lead to a significant reduction in oral intake and weight loss, +/- dehydration and electrolyte disturbance.
What causes NVP and HG?
It’s not currently clear what exactly causes NVP or HG. Its likely to be due to a combination of genetics, hormones and gastrointestinal factors [4].
Fascinatingly, there appears to be a genetic correlation between occurrence, duration and severity of NVP. So, if you have a first degree relative who had NVP, you are more likely to also experience it.
In terms of hormones, early in pregnancy there is an increase of Human Chorionic Gonadotropin (HCG) production, which leads to an increase in oestrogen and progesterone production. These are important to maintain the pregnancy (i.e., stop periods, help the uterus lining grow and store nutrients), which is great, except it also appears to impact the motility of the gastrointestinal tract [4] . Which is a fancy way of saying that it changes the contractions of the muscles that help move and mix gastric contents. Thus, potentially resulting in slower transit time (ahem, constipation) and nausea.
Constipation and haemorrhoids
So, we know changes in hormones can contribute to constipation, but a diet lacking in fibre can also lead to constipation, which can also lead to haemorrhoids (swollen veins in the anus and rectum).
Haemorrhoids are more common in the second and third trimesters, due to increase in pressure on the rectal veins by the growing baby and increased blood flow.
Heart burn
Heart burn is a symptom of gastro-oesophageal reflux disorder (GORD), which occurs when stomach contents flow back up into the oesophagus/mouth and causes a burning sensation in the throat and/or chest [5].
What causes heartburn?
Those pesky but wonderful hormones relaxing the muscles at the lower end of the oesophagus, and later in pregnancy, the pressure of a growing bub on the stomach forcing the contents back up the oesophagus.
Why is it important to manage?
NVP can significantly impact one’s quality of life and finances (through impact on work participation). For some, the symptoms can increase feelings of depression which can negatively impact every aspect of their lives, from work to household duties to relationships [4].
What are some practical things you can do about it?
First and foremost, if it is having a significant impact on your quality of life, don’t put up with it and seek medical advice. In the meantime, here are some tips:
Nausea
- Small, regular meals
- Avoid extremes of temperature
- Avoid high fat foods
- Avoid strong smelling foods
- Don’t skip meals, nausea can often get worse
- Consider ginger and Vitamin B6 supplementation
Vomiting
- Replace electrolytes
- Keep your fluids up with small, regular sips!
Constipation and haemorrhoids
- Focus on fibre through fruits, veggies, whole grains and legumes
- Aim for 2 pieces of fruit per day – add some to your breakfast and/or as a snack
- Add chia seeds or psyllium husks to your breakfast cereal
- Add extra vegetables to your meals
- Ensure adequate fluid intake
Reflux
- Avoid lying down soon after meals
- Avoid large meals, aim for small regular meals
- Avoid your known triggers
- Consider antacids
Do you want individualised advice on how to manage your pregnancy side effects? We are here to help!
References:
[1] Heitmann, K., Nordeng, H., Havnen, G.C. et al. The burden of nausea and vomiting during pregnancy: severe impacts on quality of life, daily life functioning and willingness to become pregnant again – results from a cross-sectional study. BMC Pregnancy Childbirth 17, 75 (2017). https://doi.org/10.1186/s12884-017-1249-0
[2] Liu, C., Zhao, G., Qiao, D., Wang, L., He, Y., Zhao, M., Fan, Y., & Jiang, E. (2022). Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities. Frontiers in medicine, 8, 809270. https://doi.org/10.3389/fmed.2021.809270
[3] Society of Obstetric Medicine of Australia and New Zealand (2019). SOMANZ Guideline For Management Of Nausea And Vomiting Of Pregnancy And Hyperemesis Gravidarum (2019). SOMANZ. https://www.somanz.org/content/uploads/2020/07/NVP-GUIDELINE-1.2.20-1.pdf
[4] Bustos, M., Venkataramanan, R., & Caritis, S. (2017). Nausea and vomiting of pregnancy – What’s new?. Autonomic neuroscience : basic & clinical, 202, 62–72. https://doi.org/10.1016/j.autneu.2016.05.002
[5] South Eastern Local Health District. (March, 2021). Heart Burn In Pregnancy And Breastfeeding. South Eastern Local Health District. https://www.seslhd.health.nsw.gov.au/sites/default/files/groups/Royal_Hospital_for_Women/Mothersafe/documents/heartburnpregbr2021.pdf
