Page 83 - MHF-FeedingMinds-final.indd

74 3.2 Pregnancy
experience symptoms of both nausea and vomiting
during early pregnancy, and 28 per cent experience
nausea only.
Symptoms commonly start 4–7 weeks after the
last menstrual period and cease by 12 weeks in 60
per cent of affected women. About 9 per cent of
affected women have symptoms that persist beyond
16 weeks and may persist until 22 weeks of
gestation. Symptoms often come and go and can
occur at any time during the day. Typical symptoms
include nausea, vomiting, fatigue, loss of appetite
and weight loss (usually around 5 per cent of
pre-pregnancy body weight).
Hyperemesis gravidarum is the most severe form
of persistent nausea and vomiting, leading to
dehydration, ketonuria, electrolyte imbalance and
weight loss greater than 5 per cent of pre-pregnancy
weight. It affects between 0.3 per cent and 2 per cent of the uterus can cause acid to be pushed back up from
all pregnant women and they need extra medical care.
The cause of nausea is thought to be the changing
pregnancy hormone levels and it can occur at any
time of day or night – not just in the mornings. It is
often triggered by certain foods, like coffee and fried
or spicy foods, or smells, such as perfume, cigarette
smoke or petrol. It can also be caused by hunger.
Advice to be given that may help includes:
●● eating small, frequent meals based on starchy
foods, once every two hours or so throughout
the day, including foods such as bread, toast,
plain biscuits or ginger biscuits, banana and
breakfast cereals
●● eating plain or ginger biscuits about 20 minutes
before getting out of bed in the morning
●● eating cold meals rather than hot meals, which
may prevent any smell-related nausea, as cold
food does not seem to give off as much smell as
hot food
●● taking glucose tablets to possibly help prevent
blood sugar levels from dropping (low blood
sugar levels may cause nausea)
●● avoiding any foods or smells that trigger
symptoms
●● avoiding drinking cold, tart or sweet beverages
●● avoiding caffeine and alcohol
●● having lots to drink to avoid dehydration but
drinking little and often rather than large
amounts to prevent vomiting.
Cravings and taste changes
Changes in taste, cravings and appetite may also be
related to hormonal changes or due to the removal
of energy substrates from maternal blood by the
fetus. Unless they alter the balance of a healthy diet
they do not present a problem. Pica is a term given
to the craving of non-food substances, such as soap,
chalk and coal.
Heartburn/oesophageal reflux
This is generally more common in multiple
pregnancies and during the last three months of
single pregnancies when pressure from the baby in
the stomach. The following changes may help:
●● smaller, more frequent meals
●● sitting up straight when eating to relieve the
pressure
●● not lying down flat after eating
●● sleeping propped up by extra pillows if it occurs
at night
●● avoiding any foods that cause discomfort.
Constipation
This is common at all stages of pregnancy and can be
relieved by increasing the amount of high-fibre
foods, such as fruit, vegetables, pulses and wholegrain
cereals. An increase in fluid intake to 6–8 drinks per
day or about 2 litres of all drinks may help. Iron
supplements tend to exacerbate constipation.
Promoting Breastfeeding
Antenatally
NICE recommends that:
Pregnant women should be offered
opportunities to attend participant-led
antenatal classes, including breastfeeding