Heartburn in Pregnancy

 Obstetrics  Comments Off on Heartburn in Pregnancy
May 262012

What is Heartburn?

Heartburn (acid reflux) is a condition where the acid in your stomach can back up in to your esophagus (the tube from your mouth to your stomach).

What are the symptoms of Heartburn?

Heartburn is characterized by a burning sensation in the chest or throat, acid taste in the mouth, nausea or vomiting or difficulty swallowing.

Many women get heartburn in pregnancy and symptoms typically worsen as the pregnancy progresses. It usually goes away after the baby is born. Women who have acid reflux in one pregnancy are likely to get it again in future pregnancies.

How can I treat heartburn in pregnancy?

  • Eat 4-6 small meals per day instead of 3 large ones.
  • Avoid eating within 3 hours of bedtime. Sitting up after eating allows gravity to help with reflux.
  • Avoid foods that make your heartburn worse (typically caffeinated beverages, chocolate, citrus, spicy and fatty foods).
  • Sleep with extra pillows to raise your head or raise the head of your bed

What Medications can I take for heartburn in pregnancy?

When the conservative measures are just  not, medications can be very helpful to alleviate symptoms and —Yes, they are safe and over-the-counter. Just take as directed on the label.

  • Mild or occasional heartburn: mild heartburn symptoms can be treated with antacids such Tums or Maalox.  While these are very safe to use, be sure not to exceed the recommended dose on the label. These are medicines taken as needed.
  • Moderate heartburn/reflux: second line therapies include the histamine blockers such as Pepcid, Tagamet and Zantac. These can be used on an as needed basis or taken daily.
  • Severe heartburn symptoms: third line medical therapy is with the proton pump inhibitors (PPI) Prilosec and Prevacid. Both of these are now over-the-counter and work best taken daily to prevent heartburn instead of using on an “as needed” basis.

What heartburn symptoms may require more immediate attention?

  • Severe or persistent nausea and vomiting
  • Vomiting blood or coffee ground like material
  • Black or Tarry stools
  • Weight loss
  • Difficulty swallowing

Back Pain in Pregnancy

 Obstetrics  Comments Off on Back Pain in Pregnancy
May 252012

One of the most common pregnancy complaints is  is low back pain. Over two-thirds of women will develop some form of back pain in pregnancy with most of this occurring in the later trimesters.

What Causes Back Pain? 

Along with an expanding uterus comes a shift in your center of gravity that can put a new strain on your spine and back muscles. Additionally, the hormonal changes you experience cause loosening of the joints and ligaments that attach your spine and pelvis making  you feel less stable when sanding, walking or lifting.

How to treat back pain in pregnancy

    • Avoid High Heels and other shoes that do not provide adequate support
    • Bend your knees to pick something up instead of bending your back
    • Avoid sleeping on your back
    • Sleep with a pillow between your knees
    • Wear a pregnancy support belt under your lower abdomen
    • Get plenty of rest and elevate your feet
    • Get physical therapy or chiropractic care
    • Prenatal yoga and prenatal massage
    • Stretching exercises

Here is a great Youtube video on Yoga and Stretching in pregnancy. I encourage you to check out the rest of their videos as well.

Nausea and Vomiting in Pregnancy

 Obstetrics  Comments Off on Nausea and Vomiting in Pregnancy
May 132012

Nausea and Vomiting occurs commonly during pregnancy and between 50 and 90 percent of women have some degree of nausea, with or without vomiting.  Symptoms may vary between patients but usually develop by 5-6 weeks of pregnancy and peaks at 9 weeks. The majority of patients will have complete resolution of the symptoms by 12-14 weeks of gestation.

Mild to Moderate Nausea and Vomiting of Pregnancy

Although the term for mild pregnancy-related nausea and vomiting is “morning sickness”, symptoms may occur at any time of day and in most cases persist throughout the day.  Many women do not need to see a healthcare provider for treatment of their symptoms and can manage without medication or with over the counter medication. Below are some suggestions for management of your symptoms.

Non-Medical Therapy

  • Dietary Changes — Women with nausea and vomiting in pregnancy should eat before or as soon as they feel hungry in order to avoid an empty stomach, which may aggravate nausea.  Women are advised to eat snacks frequently and have small meals that are high in carbohydrates and low in fat. Eliminating spicy foods and eating salty or high protein snacks/meals appears to help some women.
  • Fluids are better tolerated if cold, clear, and carbonated or sour (ginger ale, lemonade) and if taken in small amounts between meals.  Aromatic therapies involving lemon (lemonade), mint (tea), or orange have also been described as useful.
  • Avoidance of Triggers — One of the most important treatments for nausea and vomiting is to avoid odors, tastes, and other activities that trigger nausea.  Examples of some triggers include: stuffy rooms, odors, heat, humidity, noise, and visual or physical motion. Brushing teeth after eating, quickly changing position, and not getting enough rest may also aggravate symptoms.  If prenatal vitamins worsen symptoms, try taking them at bedtime. If symptoms persist, it is reasonable to stop the vitamins until the nausea passes.
  • Acupuncture and Acupressure — Acupuncture or acupressure wristbands do not require a prescription and have become a popular treatment for morning sickness.  Clinical trials have not shown these wristbands to be more effective than sham (fake, look-alike) wristbands, although some women find them helpful. Acupuncture or acupressure have no known harmful side effects.
  • Ginger — Powdered ginger may help to relieve symptoms of nausea in some women. However, further clinical studies are needed to confirm that this treatment is both safe and effective.

Over the Counter Medical Therapy

Medications that reduce nausea and vomiting have been proven to be effective in some women and are safe to take during pregnancy.

  • Vitamin B6 and Doxylamine — Vitamin B6 and Doxylamine together three to four times per day has been shown to be safe and effective in reducing nausea and vomiting in pregnancy.  Doxylamine is found in the over-the counter medication Unisom Sleep tablets.  Suggested dosing is ½ Unisom tablet and 25 mg Vitamin B6 three to four times per day.  For patients that have only nausea without vomiting, vitamin B6 alone may alleviate symptoms.
  • Antihistamines and other Anti-Nausea Medications — Antihistamines and other over-the-counter nausea medications such as Dramamine and Emetrol are safe and effective treatments for pregnancy-related nausea and vomiting.
  • Antacids — Pregnant women often develop gastroesophageal reflux (heartburn), which can worsen nausea and vomiting. An antacid treatment may be recommended in this case. This is particularly useful for nausea in later pregnancy.

Severe Nausea and Vomiting of Pregnancy

Hyperemesis Gravidarum is the term usually used to describe severe nausea and vomiting. There is an associated weight loss, dehydration and inability to keep down food and liquids throughout the day. Patients with severe nausea and vomiting may need more aggressive medical therapy, IV fluids or even  hospitalization.

When to Seek Help

Women with more severe nausea and vomiting need to be evaluated by their obstetrical provider.  If you have one or more of the following, you are advised to seek care;

  • Signs or symptoms of dehydration, including infrequent urination, dark-colored urine, or dizziness upon standing.
  • Vomiting repeatedly, especially if blood is seen in the vomit.
  • Abdominal or pelvic pain or cramping.
  • Inability to keep down any food or drinks for more than 12 hours.