DEAR DR. MONA: My daughter is pregnant and cannot keep anything down.  She’s been to the hospital several times to help her resolve this without success. She doesn’t like to take medicine and would like some kind of natural resolution for this problem. — Shaula

DEAR SHAULA: I am sure your daughter’s doctor is dealing with her severe morning sickness known as hyperemesis gravidarum. This is different from the typical morning sickness which is very common in pregnancy and affects up to 90 percent of pregnant women. Morning sickness occurs in the first trimester and resolves at about 12 weeks, although some patients may have persistent nausea. The causes are unclear but it could be related to hormonal changes, as well as some hormonal changes in the thyroid and possibly liver disease.

From the description you gave me it sounds like your daughter has hyperemesis gravidarum — the more severe form of morning sickness. Women who experience this often become dehydrated, have decreased urination, may lose more than 5 percent of their body weight, and may experience lightheadedness or confusion. Medical treatment for this may consist of IV fluids to re-hydrate the body, add nutrients and to restore electrolyte balance.

Let’s discuss some strategies to avoid the nausea and vomiting of pregnancy. Maintaining fluid intake is important; trying sips of water or ginger ale or sucking on hard candy, ice chips or ice pops may be helpful. Foods rich in carbohydrates and low in fat digest well. Salty foods are often helpful as well as foods that contain ginger. 

Snacking often (crackers or a piece of dry toast) with small amounts of food is more effective than a large meal. Foods rich in fat, such as fast foods and meats, may be especially problematic so it is best to avoid these foods when nausea and vomiting are at their worst.

Occasionally taking the prenatal vitamins cause nausea; vitamin supplements are important so try snacking before taking them or try taking them at night. In some cases, Flintstone chewable vitamins are the only solution during the time nausea is severe. It is important to avoid nausea triggers. 

Taking Vitamin B6, 25 mg, twice each day provides relief for some women. It should also be mentioned that getting plenty of rest and avoiding stress are components of any solution.

Alternatives remedies

Acupressure — Acupressure wristbands are available without a prescription in most pharmacies. Although acupressure wristbands haven’t been found to be more effective than sham therapies, some women seem to find them helpful.

Acupuncture — Acupuncture involves inserting hair-thin needles into your skin. Acupuncture isn’t a proven way to treat morning sickness, but some women seem to find it helpful.

Ginger — Herbal ginger supplements alleviate morning sickness for some women. Most research suggests that ginger can be used safely during pregnancy, but there’s some concern that ginger may affect fetal sex hormones.   Peppermint may also help.

Hypnosis — There isn’t much research on this, but some women have found relief from morning sickness through hypnosis.

If morning sickness does not get better after conservative measures, and nausea and vomiting are unrelieved, there are some danger signs to be aware of.   If urine is dark in color, or if there is a sensation of feeling faint when standing up, if the heart races, or vomiting blood occurs, it is important to contact the doctor.

Dr. Mona Alqulali is a board certified OB-GYN.

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