Pass the sick bag: Eating your way through Hyperemesis Gravidarum

If you’ve recently found out you’re pregnant, you may be dreading the potential onslaught of nausea and vomiting. Unhelpfully dubbed ‘morning sickness’, nausea and vomiting in pregnancy affects 50% of women, and can happen at any time of day. It is thought to occur due to all the hormonal changes, and thankfully usually improves by week 12-14. However, in 1-3% of pregnancies, this nausea and vomiting becomes very severe and debilitating, and Hyperemesis Gravidarum (HG) is diagnosed.

Potentially life-threatening, women with HG need specialist treatment, often requiring hospital stays. They may need intravenous fluids to treat dehydration, or need to be established on effective anti-sickness drugs. It can cause major disruption to routine and quality of life, especially if they work or have other children to look after. Symptoms include severe unrelenting nausea and vomiting, malnutrition, dehydration and rapid weight loss.

Will it harm my baby?

Women with HG may worry that the sickness will harm their baby. The reality is that your baby is safely cocooned inside you and can get all the nutrients it needs to grow healthily, and usually remains unaffected. There is a small risk that if you lose weight during your pregnancy, your baby may be born with a low birth weight. Hard as it is to believe though, most mums have normal birth weight babies.

“Why me?”

It’s important to remember that you are not to blame for your symptoms. Research suggests a number of causes of HG, including:

High levels of the sex hormones oestrogen and progesterone, and of the pregnancy hormone HCG
Nausea and vomiting in previous pregnancies, or a family history of HG. Having an awareness of your risk factors may help you to prepare mentally for another pregnancy
Obesity – having a body mass index (BMI) of 30 or more at the start of your pregnancy. If you are thinking about having a baby, losing weight before you start trying to conceive is beneficial, and may reduce your chances of getting HG. Ask your GP about referring you to a Dietitian to devise a weight loss plan if you are struggling yourself
Vitamin B6 deficiency

Could I have vitamin B6 deficiency, and what’s the remedy?

Research suggests a link between HG and vitamin B6 deficiency. Vitamin B6 has important roles, e.g. enabling the body to use and store energy from food, and helping form haemoglobin, the substance that carries oxygen around the body. If you were eating a healthy, balanced diet prior to conception and during pregnancy, you should obtain all the B6 you need. However, if you’re struggling to keep foods down, it may be difficult to meet your needs.

Top foods containing vitamin B6:

Brown rice
Wholemeal bread
Fish and poultry
Fortified breakfast cereals
Nuts
Green leafy vegetables

Should I be taking vitamin supplements then?

Yes – consider buying a multivitamin and mineral supplement made for pregnant women such as Pregnacare or supermarket/pharmacy own brand like Boots Pregnancy. These supplements, whilst containing folic acid, also contain other vitamins, including B6, in safe doses. Taking a supplement will help you to meet your requirements, especially when nausea and vomiting prevent you from eating well.

Avoid vitamin B6 supplements, or any other single vitamin preparations. This is because the safety of supplements containing high levels of vitamins is not known in pregnancy.

Don’t be afraid to pack in the calories when you’re struggling to eat

If you are finding it hard to eat, you may need some nutritional support. First, establish the time of day you feel most able to eat, then maximise your nutritional intake at this time. Try to eat foods high in energy and protein, to enable you to get the maximum nutrition from a smaller portion. Fortify the foods you eat to make them more nutritious. Examples include:

Add yoghurt, cream or evaporated milk to fruits;
Melt butter over vegetables;
Don’t be afraid to add extra cream and cheese to mashed potatoes, pasta dishes, soups and stews;
Use plenty of butter and jam/marmalade on toast;
Use whole milk and avoid diet yoghurts;
Include sugary and fatty foods and drinks, e.g. chocolate, biscuits, cakes and sugary drinks. These are useful to increase energy intake when your food intake is low. Take care not to eat too many of these in place of other foods, as they often contain empty calories.

Eat little and often – eat something every 1-2 hours if you can. Nourishing foods that are often well tolerated include cereal with milk, tuna/chicken sandwiches, peanut butter on toast, soups, crackers, breadsticks and other dry starchy foods.

If you can’t keep foods down, try not to worry. Keeping fluids down is the most important thing during severe bouts of sickness. Try drinking fluids high in energy and protein, to maximise the nutritional content of drinks. Milky drinks, like milkshakes and hot chocolate are great options as they contain energy and protein. You could even add a dash or cream and grated chocolate to pack in extra calories. Soups make a great drink too, as you can add extra cream and cheese to increase the calories.

If you are losing weight, your doctor or dietitian may recommend a short course of sip supplements. These supplements are available on prescription, and come in milkshake, fruit juice, soup or yoghurt styles, according to your preference. They are high in energy and protein, and contain added vitamins and minerals to help you to regain your energy and strength.

Complications of HG and dietary remedies

Dehydration, malnutrition and prolonged vomiting may lead to a number of associated symptoms, as shown in this table. Try these dietary remedies:

Complications	Dietary remedies
Constipation	Drink plenty. Increase fibre intake from fruits, vegetables and wholegrains. Try dried fruit or prune juice at breakfast.
Cracked lips and mouth sores	Drink plenty. Consider taking a multivitamin tablet suitable for pregnancy.
Acid reflux	Eat slowly, sitting upright. Eat small, frequent meals. Avoid fatty and spicy foods. Avoid eating within 2 hours of bedtime.
Sleep problems	Try a warm milky drink before bed.
Vitamin and mineral deficiencies	Eat a balance. Eat little and often, every 1-2 hours. Consider taking a multivitamin tablet suitable for pregnancy (take this at the time of day you are least likely to vomit).

Top tips for curbing nausea

Sipping on drinks throughout the day may help. Try cold drinks, fizzy drinks, smoothies and fruit drinks
Try ice lollies, icecream and ice cubes of frozen fruit juices; they’re a great way of keeping your fluids up too
Bland foods may be easier on the stomach. Avoid overly spicy food, sweet desserts, greasy or fried foods. If you can’t stomach meats and fish, go veggie and try more beans, chickpeas and lentils
You may tolerate dry foods better. Try crackers, toast or plain biscuits

What about ginger and herbal remedies?

A small study showed that fresh root ginger, or ginger taken as 250mg oral capsules 4 times a day may help (if taken for 4 days). Take ginger cautiously if you’re on anti-coagulant medication. You could also try ginger biscuits, ginger cake and ginger beer. Peppermint and chamomile teas are available and may have some effect in some women.

Where can I go for further support?

If you are suffering from HG and need further support through your pregnancy, you can get in touch with UK charity Pregnancy Sickness Support. As well as providing support by telephone, their website features useful resources and an online forum where you can connect with other HG sufferers and trained support volunteers.