Wednesday, September 26, 2018
Health

Mayo Clinic Q&A: morning sickness; GERD or something more serious?

MAKING MORNING SICKNESS LESS UNPLEASANT

I'm 15 weeks pregnant and have had horrible morning sickness. I've lost weight and worry that will affect the baby's health. Is this normal? What can I do to get back to eating while feeling nauseated all the time?

Nausea and vomiting during pregnancy can make you feel bad. It also can be worrisome, especially when it causes weight loss. For most pregnant women, though, morning sickness doesn't pose a health threat. And it usually goes away as a pregnancy progresses. In the meantime, there are steps you can take to ease morning sickness.

Morning sickness is most common during the first trimester. Exactly what causes morning sickness is unknown. It's likely related to the hormones hCG and estrogen, which are high during pregnancy.

Women who have significant morning sickness often lose weight early in pregnancy. Only in rare circumstances does this cause problems. The nausea usually subsides over time. As that happens, most women are able to catch up and gain a healthy amount of weight.

Although morning sickness is hard to prevent, you may be able to make it less bothersome. Nausea tends to be worse when your stomach is completely full or empty. So rather than eating three large meals a day, eat smaller amounts more often. You can eat whatever foods appeal to you and don't cause nausea. Some women find snacking on soda crackers or dry toast can quell feelings of queasiness. Ginger also can help.

Drink plenty of fluids throughout the day, but don't drink too much at one time. Some women find drinking beverages with a meal makes nausea worse. If so, take in solid foods and liquids separately.

The smell of certain foods, especially during cooking, can be a problem. Avoid those foods if you are preparing meals, and ask someone to help make meals if cooking triggers nausea.

Pay attention to when and how you take your prenatal vitamins. Taking them in the morning can sometimes makes nausea worse. Taking them with food may help.

Acupressure and acupuncture seem to reduce morning sickness for some women.

If nausea continues, your doctor may suggest over-the-counter medications. Antinausea medications and medications to reduce acid production can be useful. A combination of doxylamine succinate, a sleep aid, and vitamin B-6 may be recommended to decrease symptoms. If that doesn't work, a prescription medication may help.

A small percentage of women develop serious nausea and vomiting during pregnancy called hyperemesis gravidarum. Women with this disorder often become dehydrated and lose weight. If it isn't treated quickly, hyperemesis gravidarum may require hospitalization. Rarely, it can lead to premature birth or low birth weight.

If you notice symptoms in addition to nausea, such as lightheadedness, a fast heartbeat or inability to keep food or fluids down for more than 12 hours, contact your health care provider.

Julie Lamppa, APRN, CNM, OB-GYN, Mayo Clinic, Rochester, Minn.

GETTING TO THE ROOT OF CHEST PAIN

My dad recently went to the emergency room with terrible chest pain and sweating, and was concerned he was having a heart attack. Doctors said his heart was fine and that his symptoms were probably due to heartburn. Should I suggest he have more tests?

It's important for your father to have a followup appointment with his primary care physician to confirm the underlying cause of his symptoms. The physician can do a more thorough evaluation and refer him for more tests and a consultation with a cardiologist, if needed.

Heartburn, a burning sensation under the breastbone, is a symptom of gastroesophageal reflux disease, or GERD. It happens when stomach acid backs up into the esophagus — the tube that carries food from your mouth to your stomach. Although a burning sensation in the chest is common with GERD, its symptoms can vary widely. In some cases, GERD may feel like a dull ache or pressure in the chest, or, if it's severe, GERD can lead to crushing chest pain. A heart attack, heart disease and other cardiac concerns can trigger similar symptoms.

Distinguishing the difference between the symptoms of GERD and those that could be related to a heart condition can be difficult. That's because the nerves that lead to the heart and those that lead to the esophagus are close to one another, so determining where symptoms come from can be a challenge.

With that in mind, it's important to confirm that chest pain is not heart-related. So, even if results of heart tests such as an electrocardiogram look fine in the emergency care setting, a more comprehensive evaluation still is needed. In many cases, that assessment includes a stress test. Based on the severity of his symptoms and your father's medical history, his physician can determine if he needs to see a cardiologist.

It is possible that another condition unrelated to GERD or a heart condition could be causing your father's symptoms, such as gallstones. In most cases, however, chest pain comes from a cardiac concern or GERD.

If the followup assessment shows that your father's symptoms are due to GERD, there are a number of steps he can take to help prevent symptoms. Overeating or eating a large meal and then lying down are the two most common heartburn triggers. Eating smaller meals and not eating two to three hours before going to bed often can reduce symptoms. Avoiding high-fat foods, spicy foods and citrus juices can be helpful, too. Many people who experience heartburn also find that reducing alcohol, caffeine and nicotine may decrease the frequency of symptoms.

Typically, GERD does not require treatment from a health care provider. Over-the-counter antacid medications are often enough to decrease symptoms, along with lifestyle changes. Some symptoms, however, should prompt a medical appointment, including food sticking in the esophagus, dark or bloody stools or bouts of heartburn that happen more than two or three times a week.

Jeffrey Alexander, M.D., Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. Email a question to MayoClinicQ[email protected] For more information, visit mayoclinic.org. © 2017 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency LLC. All rights reserved.

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