Nausea and vomiting
Morning/all day sickness in pregnancy affects most of all pregnant women during the first trimester of pregnancy and it usually resolves around the 17th week of gestation. Women with morning sickness are functional and able to work and are not losing weight. This form of morning sickness may be helped by simple dietary measures. Small, frequent, dry meals of easily digested carbohydrate-containing foods may be tolerated by some women, whereas protein foods may reduce nausea for others. Protein rich meals reduce nausea and arrhythmic activity to greater degrees than fat and calorie free meals. Liquid meals may decrease arrhythmias more than solids do.
Some women do not tolerate fats because of the olfactory aspect of hot foods, room temperature foods containing fat such as potato chips, snack foods, crackers may be preferred by a sick women.
Also motion, noise, bright lights, and adverse climate conditions can increase nausea.
Women suffering with nausea should eat whatever reduces the sensation of nausea and avoid odors that trigger nausea. Vitamin B6 relieves symptoms in mild cases. Also smelling lemons has been found by many women to help block noxious background odors.
Pregnant women are aware of the importance of nourishing their babies and are often confused by comments that weight loss in early pregnancy is acceptable. Sometimes dry crackers and ginger ale are often prescribed for nausea, but they do not constitute a high-quality diet. Overhydrating a starving woman reduces ketones but does not indicate that adequate nutrition has been achieved.
Excessive vomiting develops in about 2% pregnancies and is associated with an increase in maternal free thyroid hormone.
When early pregnancy is characterized by excessive vomiting and weight loss, women nutritional status is greatly compromised. Fluid and electrolyte imbalances can require hospitalization for rehydration and nutritional support. Low levels of electrolytes can result in cardiac irregularities and respiratory failure.
Heartburn is a common occurrence during the latter part of pregnancy and it often occurs at night. In most cases this is an effect of pressure of the enlarged uterus on the intestines and stomach and may result in regurgitation of stomach contents into the esophagus. Relief may occur when pregnant woman eat frequent small meals. Dinner plates can be changed to smaller ones to remind a woman about reduced gastric volume.
Constipation and hemorrhoids
Pregnant women will become constipated if they don’t consume adequate water and fiber. Straining during stooling increases the risk of hemorrhoids. Increased consumption of fruits (prunes and figs) usually controls these problems, but some women may also require a bulking type of stool softener.
Edema in legs in pregnancy is caused by the pressure of the enlarging uterus on the vena cava, obstructing the return of blood flow to the heart. When a woman reclines on her side, the mechanical effect is removed and extravascular fluid is mobilized and eventually eliminated by increased urine output. No dietary intervention is required.
Women with pregnancy related leg cramps has low serum magnesium levels. The best evidence for the relief of leg cramps is to use magnesium supplement. Magnesium lactate or citrate may relieve leg cramps because pregnancy and lactation can lead to a secondary magnesium deficiency as evidenced by low serum magnesium levels. Signs of magnesium deficiency include muscle tremor, ataxia, tetany, constipation, and cramps.
Individualized, expert care is needed for the nutritional management of the pregnant women with diabetes. The risk of macrosomia, chorioamnionitis, prematurity, intrauterine fetal demise and fetal morbidity is significantly greater in the pregnant women with diabetes than in pregnant women without diabetes. Women who do not meet the criteria to be classified as diabetic but have elevated blood glucose during pregnancy also carry significant risk for pregnancy complications, including macrosomia, prematurity and chorioamnionitis.
Macrosomia is caused by hyperglycemia from maternal blood. The fetus responds to maternal hyperglycemia by increasing its own insulin production, leading to excessive growth and adiposity. Following delivery, the infant’s pancreas continues to secrete elevated amounts of insulin. Since the maternal supply of glucose is no longer available, many infants of mothers with diabetes rapidly develop hypoglycemia requiring a glucose infusion.
Successful pregnancy requires adequate dietary intake to meet the growth needs of the fetus, prevent ketosis and prevent depletion of maternal nutritional stores. The most important thing is to maintain optimal blood glucose level and avoid ketosis. Frequent glucose monitoring and appropriate insulin adjustments are crucial. Insulin requirements decrease in the first half of pregnancy because of fetal use of glucose and the mother may need only two thirds of her usual amount. Frequent changes in diet and insulin dosage may be necessary. The number of snacks may need to be increased, and for the insulin-dependent woman who is lactating, it is advised that she consume three small meals and four snacks to avoid drops in her blood glucose levels that can occur with a large milk output.
Gestational diabetes is usually diagnosed after 24 weeks gestation and may affect as many as 5% to 10% of all pregnant woman. Symptoms are similar to those of diabetes mellitus, including glycosuria and elevated blood glucose, there is also a greater likelihood of developing preeclampsia. Infants whose mothers have gestational diabetes are at increased risk for perinatal mortality, as
Gestational diabetes is treated largely through dietary changes and moderate exercise to maintain appropriate weight gain. Insulin is used if glucose levels do not respond to dietary manipulations. Pregnant woman with gestational diabetes should limit carbohydrates at breakfast 10 to 30 grams with the addition of 2 to 3 ounces of protein mid morning to decrease hunger and increase compliance.
Gestational hypertension and preeclampsia
Gestational hypertension is a maternal blood pressure equal to or greater than 140/90 with no proteinuria that develops after second trimester. These women may develop preeclampsia, which is defined by a systolic blood pressure of 140 or more or a diastolic blood pressure of 90 mmHg or more and urinary protein of 300 mg or more in a 24-hour urine sample. Preeclampsia is associated with decreased uterine blood flow, owing to vasospasm, leading to reduced placental size, compromised fetal nourishment. Preeclampsia also may result in maternal end-organ damage such as liver impairment, renal impairment, cerebrovascular events, and retinal damage. Warning signs to be on the lookout are sudden weight gain, headaches, dizziness or fainting, excessive edema or swelling, ringing in the ears.
The etiology of preeclampsia is unknown, but vascular injury to the placental blood vessels has been implicated. Very young women with first pregnancy and older pregnant women are more likely to encounter the problem. Preeclampsia is more common in dark-skinned women living in northern latitudes who typically have a higher prevalence of hypovitaminosis D than is found in comparable white women.
There is no cure for preeclampsia. Preeclampsia can be prevented with proper diet. Get 80-100 grams of protein (if you are not getting enough protein, and if you are not getting enough calcium/magnesium, your liver cannot function properly, and the tissues of the body begin metabolizing themselves to provide for your protein needs, specifically kidney tissue. Some of the protein that is broken down is excreted into the urine, which is why there will be protein in the urine. Blood pressure and edema (swelling) are due to poor mineral balance, specifically calcium/magnesium imbalance) a day, take oral calcium with magnesium, drink tons of filtered water and do not limit your salt intake (use sea salt).
Even if you do everything right nutritionally, it is still very important to monitor your blood pressure and urine protein.
Infections play a major role in premature contractions and subsequent early deliveries. Bacterial vaginosis is one of infections, affecting many pregnant women. The use of probiotics in pregnant women with bacterial vaginosis is compelling since certain lactobacilli strains can safely colonize the vagina and displace and kill pathogens.
Pregnant woman may notice a thin white or gray discharge with a foul or fishy smell. This odor is most apparent after sex, when the discharge mixes with semen. Also woman may have burning when urinate or irritation in genital area.
Pregnant women with BV should avoid sugar, caffeine, fermented foods, and foods high in carbohydrate.