Treating pregnancy-related nausea and vomiting with ginger

OBJECTIVE: To review literature assessing the safety and efficacy of the use of ginger to treat nausea and vomiting in pregnancy. DATA SOURCES: Iowa Drug Information Service (1966-September 2004), International Pharmaceutical Abstracts (1971-September 2004), MEDLINE (1966-September 2004), and EMBASE (1966-September 2004) were searched. Key terms included ginger, nausea, vomiting, emesis, and pregnancy. DATA SYNTHESIS: Studies evaluating the safety and efficacy of ginger in the management of nausea and vomiting in pregnancy were reviewed. Various doses and forms of ginger were used to treat women during their first and second trimesters of pregnancy. Ginger has been shown to improve the symptoms of nausea and vomiting compared with placebo in pregnant women. CONCLUSIONS: While data are insufficient to recommend ginger universally and there are concerns with product quality due to limited regulation of dietary supplements, ginger appears to be a fairly low-risk and effective treatment for nausea and vomiting associated with pregnancy. In low doses, this may be appropriate for patients not responding to traditional first-line therapies.     

Prevention of iron deficiency anemia in adolescent and adult pregnancies

OBJECTIVE: Worldwide attention over iron deficiency anemia (IDA) in pregnancy has shifted recently from providing supplements during pregnancy to attempting to ensure that women, especially adolescents, have adequate iron stores prior to conception. We sought to determine whether adolescent and/or adult women still need supplements during pregnancy to avoid IDA, even if iron stores are adequate, and whether the IDA translates into maternal and/or infant morbidity and mortality. DESIGN: Randomized, double-blind clinical trial with placebo control. SETTING: Multicenter clinic setting in central Wisconsin. PARTICIPANTS: Adolescent women 18 years or less in their first pregnancy, and adult women 19 years or older, who were found to be healthy and iron sufficient at their first prenatal visit. METHODS: Participants were randomized to receive iron supplementation (60 mg/day elemental iron) or placebo. Serum ferritin of 12 ng/mL or less with simultaneous hemoglobin of 11 g/dL or less defined IDA. When IDA occurred at the second trimester, a therapeutic supplement of 180 mg of elemental iron per day was initiated. RESULTS: Forty-seven percent of all placebo-supplemented and 16% of all iron-supplemented patients exhibited IDA (p<0.001); 59% of adolescent placebo-supplemented and 20% of adolescent iron-supplemented patients exhibited IDA (p=0.021). Nausea, vomiting, diarrhea, and constipation were not significantly different in the iron supplemented group compared to the placebo group, and no significant differences were seen in maternal or neonatal health, but the number of women studied was limiting for analysis of these adverse events. CONCLUSION: IDA is common in healthy, iron-sufficient adolescent pregnant women during the second trimester, and body stores of iron decline in both adolescent and adult pregnancies. The incidence of IDA during adolescent and adult pregnancies is substantially reduced with 60 mg of elemental iron per day. However, there remains no clear evidence that maternal or neonatal health will benefit from correcting these deficits.     

Treatment of heartburn and acid reflux associated with nausea and vomiting during pregnancy

QUESTION In addition to suffering from nausea and vomiting of pregnancy, which is being treated with antiemetics, some of my pregnant patients complain of heartburn and acid reflux. Should these symptoms also be treated and, if so, which acid-reducing medications are safe for use during pregnancy?ANSWER Increased severity of nausea and vomiting of pregnancy is associated with the presence of heartburn and acid reflux. Antacids, histamine-2 receptor antagonists, and proton pump inhibitors can be used safely during pregnancy, as large studies have been published with no evidence of adverse fetal effects.     

Nausea and vomiting of pregnancy

Nausea and vomiting of pregnancy, commonly known as "morning sickness," affects approximately 80 percent of pregnant women. Although several theories have been proposed, the exact cause remains unclear. Recent research has implicated Helicobacter pylori as one possible cause. Nausea and vomiting of pregnancy is generally a mild, self-limited condition that may be controlled with conservative measures. A small percentage of pregnant women have a more profound course, with the most severe form being hyperemesis gravidarum. Unlike morning sickness, hyperemesis gravidarum may have negative implications for maternal and fetal health. Physicians should carefully evaluate patients with nonresolving or worsening symptoms to rule out the most common pregnancy-related and nonpregnancy-related causes of severe vomiting. Once pathologic causes have been ruled out, treatment is individualized. Initial treatment should be conservative and should involve dietary changes, emotional support, and perhaps alternative therapy such as ginger or acupressure. Women with more complicated nausea and vomiting of pregnancy also may need pharmacologic therapy. Several medications, including pyridoxine and doxylamine, have been shown to be safe and effective treatments. Pregnant women who have severe vomiting may require hospitalization, orally or intravenously administered corticosteroid therapy, and total parenteral nutrition.     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

Iron requirements of pregnancy

To maintain the necessary maternal iron stores, the pregnant patient needs to receive iron supplements during the last half of pregnancy. These needs are particularly great during the last trimester, increasing from the usual requirement of 3-4 mg/day to 5-6 mg/day. Dietary and oral supplementation therapies are the most efficient methods of supplementing iron in normal pregnant women and those experiencing iron deficiency.     

Placental Impact of Dietary Supplements: More Than Micronutrients

PurposeMaternal nutrition is a key modifier of fetal growth and development. However, many maternal diets in the United States do not meet nutritional recommendations. Dietary supplementation is therefore necessary to meet nutritional goals. The effects of many supplements on placental development and function are poorly understood. In this review, we address the therapeutic potential of maternal dietary supplementation on placental development and function in both healthy and complicated pregnancies.MethodsThis is a narrative review of original research articles published between February 1970 and July 2020 on dietary supplements consumed during pregnancy and placental outcomes (including nutrient uptake, metabolism and delivery, as well as growth and efficiency). Impacts of placental changes on fetal outcomes were also reviewed. Both human and animal studies were included.FindingsWe found evidence of a potential therapeutic benefit of several supplements on maternal and fetal outcomes via their placental impacts. Our review supports a role for probiotics as a placental therapeutic, with effects that include improved inflammation and lipid metabolism, which may prevent preterm birth and poor placental efficiency. Supplementation with omega-3 fatty acids (as found in fish oil) during pregnancy tempers the negative effects of maternal obesity but may have little placental impact in healthy lean women. The beneficial effects of choline supplementation on maternal health and fetal growth are largely attributable to its placental impacts. l-arginine supplementation has a potent provascularization effect on the placenta, which may underlie its fetal growth–promoting properties.ImplicationsThe placenta is exquisitely sensitive to dietary supplements. Pregnant women should consult their health care practitioner before continuing or initiating use of a dietary supplement. Because little is known about impacts of many supplements on placental and long-term offspring health, more research is required before robust clinical recommendations can be made.     

Dietary Information to Support a Healthy Pregnancy in Vietnamese Americans

Because optimal nutrition is vital during pregnancy, there are specific U.S. dietary guidelines and recommendations for pregnant individuals. However, Vietnamese Americans often have insufficient access to dietary recommendations for pregnancy that pertain specifically to their culture and cuisine. Healthful components of the traditional Vietnamese diet include vegetables, herbs, fruits, fish, and some unsaturated fats. Adjustments to the traditional and acculturated Vietnamese diet, such as reduced sodium intake from fermented foods and sauces, less sugar, more diverse carbohydrate consumption, more fiber, and less fat intake, would improve overall health and potentially reduce the common pregnancy complications pregnant Vietnamese women face, including gestational diabetes and certain micronutrient deficiencies. Understanding the traditional Vietnamese diet can help nurses provide culturally competent care to Vietnamese Americans.     

Rhodes Index of Nausea and Vomiting--Form 2 in pregnant women. A confirmatory factor analysis

BACKGROUND: Despite widespread application of Rhodes Index of Nausea and Vomiting-Form 2 (INV2) in practice and research, empirical analyses have not been consistently performed to verify the a priori factors that guided the subclass construction of the symptoms. OBJECTIVES: To examine the dimensional structure of Rhodes INV in a sample of pregnant women. METHOD: Data were collected from 152 pregnant women who were experiencing some degree of nausea and vomiting during early pregnancy and analyzed using structural equation modeling techniques. Five competing measurement structures were tested and compared. The structure (model) that provided the closest fit to the data was selected and relationships (factor loadings) between the constructs and indicators were established. RESULTS: The model fitting the data the closest was a three-factor structure measuring nausea, vomiting, and retching as three separate, but correlated dimensions. The factor loadings were high (0.73-0.96) and significant (p < .001). The model treating nausea and vomiting as a one-factor concept as well as the model including two factors named symptom occurrence and symptom distress did not fit the data. CONCLUSION: Rhodes INV2 is a valid measurement tool if subscales are formed to reflect the multidimensional structure of nausea and vomiting in pregnancy.     

Health care providers' attitudes toward current food safety recommendations for pregnant women.

Semistructured interviews were conducted with 23 health care professionals who work with pregnant women in a preliminary study to understand health care providers' attitudes regarding current food safety recommendations for pregnant women and interest in education and patient materials on food safety during pregnancy. Only 8 of 23 interviewed currently provided food safety information to their pregnant clients. Limited understanding of food safety issues and limited time with patients were barriers to providing such information. Based on their contact time with patients, background, and interest in food safety issues, nurses, visiting nurses, and Special Supplemental Nutrition Program for Women, Infants and Children professionals should be targeted as conveyers of food safety information to pregnant women.     

Nutrition during pregnancy. A continuous challenge

An increasingly greater number of discoveries convince us that the mother's diet can affect foetus body composition, thus modulating aspects of the child's health ant development in the early years and even in adulthood. Pregnancy is a physiological period in a woman's life and, therefore, should be treated as such. However, nutritional needs increase in order to meet growth requirements. Such needs can be met by maintaining a balanced diet. It should not, however, be assumed that pregnant woman always have correct nourishment prior to pregnancy. The body experiences metabolic changes in order to face the changes that pregnancy entails, though each organism adapts differently to these changes, which makes it difficult to standardise the recommendations for women as a whole. Despite this, there are International Organisations that assume the task of establishing the dietary guidelines considered optimum for pregnancy. A rich and varied diet meets the requirements of pregnancy and lactation, but the needs increase in a different manner for each nutrient and the increase of intake should be selective. There should be particular control of proteins, essential fatty acids and certain vitamins (folic acid specially) and some minerals (such as calcium, phosphors, iron and zinc). Consequently, pregnancies with a risk of suffering nutritional alterations should be ruled out, the diet should be watched and, if necessary, specific dietary supplements should be used.     

Dietary supplement survey of pharmacists: personal and professional practices

OBJECTIVE: To survey pharmacists about personal/professional practices regarding dietary supplements, specifically personal use and recommendation patterns, reference usage, and desired computerized decision-support features. DESIGN: Anonymous, self-administered survey. SETTING/LOCATION: National pharmacy association meeting. SUBJECTS: Practicing pharmacists who answered questions about dietary supplements. OUTCOME MEASURES: Acceptability of specific references, desired features in computerized decision support, frequency of personal use, and recommendations to patients, family, or friends. RESULTS: Seventy (70) pharmacists completed the survey. A majority (52.9%) reported taking dietary supplements including echinacea, zinc, and chromium picolinate. Fewer than half of pharmacists stated they have recommended a dietary supplement to a patient. Pharmacists stated that the top information sources were: published clinical trials, allopathic health care providers, alternative medicine practitioners, and word of mouth. The Internet was an important source for recommendations although not for personal use. The most highly accepted (>70%) print references included The Review of Natural Products and the World Health Organization Monographs on Selected Herbal Products. More than 90% rates the ability to view reference citations and computerized alerts on drug-dietary supplement interactions "very important" or "important". Interest was high in accessing computerized monographs. CONCLUSIONS: Pharmacists are self-educating about dietary supplements. Among pharmacists surveyed, there was some consensus as to which references were acceptable. There is a demand for dietary supplements information to be included in pharmacy computer systems, specifically to check for interactions against the patient's.drug profile. Although practitioners in Western and alternative medicine, as well as journal articles, are preferred information sources, the Internet and word of mouth are also important sources. Personal use of dietary supplements correlated with a twofold increase in the likelihood that a pharmacist would recommend a dietary supplement to a patient.     

Knowledge and use of folic acid supplementation: a study of Colorado women whose pregnancies were affected by a fetal neural tube defect.

OBJECTIVES: To determine whether women who have ha da pregnancy in which the fetus is affected by a neural tube defect (NTD) know of current folic acid recommendations; whether the recommendations are followed before or during the pregnancy associated with an NTD and subsequent pregnancies; and to insure that women who have had an NTD-affected pregnancy have access to proper information about NTDs and folic acid recommendations. METHODS: Women living in Colorado who had a pregnancy in 1996 or 1997 in which the fetus had an NTD were interviewed in 1998 about their knowledge and use of folic acid supplementation. RESULTS: Twenty-one of 42 eligible women were interviewed. All women first learned of the folic acid recommendations either during or after their affected pregnancy. Only 23.8% of the women took vitamins containing folic acid during the 1 to 3 months before becoming pregnant. None who had a subsequent pregnancy followed the recommendation to consume 4.0 mg/d of folic acid, beginning at least 1 month before conception. Women who had subsequent pregnancies became pregnant on average of 9 months after their affected pregnancy ended. CONCLUSIONS: Most women who have an NTD-affected pregnancy are unaware of the national folic acid recommendations and do not follow these recommendations for subsequent pregnancies. However, such women are receptive to information about folic acid supplementation. Health care providers and public health officials should consider their role in assuring that education is provided in an effective and timely manner to women with NTD-affected pregnancies.     

Cardiovascular and respiratory agents during pregnancy: implications for fetal development

The management of common medical problems in pregnancy often requires adjustments in drug therapy to assure a healthy fetus. The management of steroid-dependent bronchial asthma in pregnancy requires oxygen supplementation as well as vigorous treatment of airway obstruction to protect the fetus from maternal hypoxemia. The hypertensive pregnant patient should discontinue dietary sodium restriction and diuretic therapy and should be managed with alphmethyldopa or beta-blocker therapy. Hydralazine may be added if hypertension is severe. Mitral valve prolapse appears to produce no difficulties during pregnancy and the use of prophylactic antibiotics is probably not necessary for routine vaginal delivery, unless complications occur. Digoxin and quinidine are safe to use in pregnancy, provided careful monitoring is maintained. Oral anticoagulants are contraindicated in pregnancy and should be replaced with heparin if pregnancy is desired.     

孕期食物结构与妊娠结局的相关性分析

目的探讨孕期食物结构与妊娠结局的相关性。方法选取2016年4月至2019年4月我院收治的50例不良妊娠结局孕产妇为研究组,同期50例正常妊娠结局孕产妇为对照组,采用统一拟定的调查问卷统计妊娠期食物结构和使用频次,并将采集数据录入相关性分析软件进行处理。结果研究组坚果禽肉结构、薯类水果结构、腌制油炸结构、速食为主结构评分高于对照组(P <0. 05)。妊娠期高血压疾病、妊娠期糖尿病、妊娠期贫血、低体重儿与多频次和不合理饮食结构存在正相关关系(P <0. 05)。结论护理人员应对备孕和已孕者进行孕期饮食结构指导,并根据阶段性母婴营养状况反应水平合理调整膳食计划,降低妊娠合并症所致不良妊娠结局的发生率。     

The regulation of dietary supplements

PURPOSE: To discuss the regulatory history of dietary supplements, define the term dietary supplement, clarify ingredient and nutrition information labeling, and discuss safety issues and implications for practice. DATA SOURCES: Review of primary and secondary sources, including both Internet sites and journal articles. CONCLUSIONS: In the United States, 6 out of every 10 people use dietary supplements. For decades, the Food and Drug Administration (FDA) protected the public from mislabeled and unsafe products by regulating as foods those dietary supplements that included only essential nutrients. The Nutrition Labeling and Education Act of 1990 included herbs as dietary supplements. When the Dietary Supplement and Health and Education Act (DSHEA) of 1994 was passed, the FDA lost its regulatory power. The DSHEA expanded the definition of dietary supplements beyond essential nutrients. Dietary supplements are no longer considered food additives, which makes them exempt from prescreening or any safety and efficacy studies before they are released to the public. Under the DSHEA, the FDA may take action if a product poses a direct health threat and only after adverse health effects have already occurred. IMPLICATIONS FOR PRACTICE: A good understanding of the regulatory procedures for dietary supplements will aid nurse practitioners (NPs) in patient education regarding these products. Patients should be advised to choose supplements that are made by nationally known food and drug manufacturers that belong to trade groups. NPs and patients can contact the manufacturer directly and can access government Internet sites for more product information.     

Isolation from "being alive": coping with severe nausea and vomiting of pregnancy

BACKGROUND: Despite ongoing investigations into specific causes of and treatments for pregnancy-related nausea and vomiting, it remains a common phenomenon of varying intensity that affects the quality of life for both affected women and their families. OBJECTIVE: To understand how women cope with severe nausea, vomiting, and/or retching during pregnancy. METHOD: Women hospitalized with severe symptoms (N = 24) were purposely selected to participate in 24 semistructured interviews and one focus group (N = 4). RESULTS: A process was identified wherein women experienced severe and unrelenting nausea and related symptoms which became progressively more debilitating, leaving them feeling uncertain about when and if they would recover. This caused the women to isolate themselves from their world in an effort to cope with symptoms. CONCLUSIONS: Severe nausea and vomiting of pregnancy is a complex and overwhelming syndrome. Rather than emphasizing a specific treatment for a particular symptom (e.g., vomiting), nurses can intervene to reduce the impact of factors that affect the magnitude of nausea, vomiting, and retching.     

7931名早孕期女性营养素补充剂使用状况调查

  目的  了解我国早孕期女性营养素补充剂的使用现状,并分析其影响因素。  方法  本研究数据来自中国孕产妇队列研究(Chinese Pregnant Women Cohort Study,CPWCS),该项目于2017年7月25日至2018年7月24日招募早孕期女性,应用在线问卷的方式调查孕妇营养素补充剂使用状况,包括是否使用营养素补充剂及使用种类。采用多因素Logistic回归分析各种营养补充剂使用的影响因素。  结果  共入选7931名符合纳入标准的早孕期女性。其中使用营养素补充剂7431名(93.7%,7431/7931),各类营养素补充剂使用率由高至低依次为叶酸(88.7%,7034/7931)、复合维生素(43.5%,3451/7931)、钙(29.0%,2297/7931)、维生素D(23.8%,1891/7931)、益生菌(22.4%,1778/7931)、铁(21.9%,1739/7931)、膳食纤维(18.9%,1497/7931)及二十二碳六烯酸(17.0%,1350/7931)。使用2种及以上营养素补充剂者最多(60.0%,4678/7931),其次为使用1种营养素补充剂者(34.7%,2753/7931),未使用营养素补充剂者最少(6.3%,500/7931)。多因素Logistic回归分析表明,孕妇年龄、孕妇及其配偶文化程度是影响早孕期孕妇使用营养素补充剂的主要因素。  结论  早孕期女性使用营养素补充剂较普遍,其种类以叶酸、复合维生素为主,存在同时使用多种营养素补充剂的现象。孕妇及其配偶的社会经济地位与营养素补充剂的使用有关。     

Clinical course of a pituitary macroadenoma in the first trimester of pregnancy: probable lymphocytic hypophysitis

Recent findings revealed that the clinical features of lymphocytic hypophysitis are more complicated than previously thought. It is rarely described in the first trimester of pregnancy and signs of meningeal irritation are infrequently reported. In this study, a pregnant woman in her first trimester of pregnancy with clinical and radiological characteristics of a pituitary macroadenoma is described. The patient's pituitary profile revealed a relatively low prolactin for her stage of pregnancy. Unusual findings were neck stiffness associated with headache, nausea and vomiting. She was treated conservatively. Spontaneous complete resolution of the pituitary mass in the postpartum period led us to conclude that the correct diagnosis should be hypophysitis. Hypophysitis should be considered in the differential diagnosis of a pituitary mass presenting in early stages of pregnancy with symptoms mimicking hyperemesis gravidarum and/or meningeal irritation.