Nausea during pregnancy is subjectively unpleasant sensations in the pharynx and epigastrium that disturb pregnant women at different periods of bearing a child, usually accompanied by other digestive disorders and autonomic dysfunction. Most often, the symptom is associated with the development of early toxicosis. Nausea also occurs with pathologies of pregnancy, concomitant diseases of the gastrointestinal tract. To identify the causes, ultrasound, gynecological examination, laboratory tests are performed. To reduce symptoms, non-drug methods, sedatives, prokinetics are used.
Causes of nausea during pregnancy
During normal pregnancy
Nausea is periodically observed in perfectly healthy pregnant women due to changes in eating habits and the amount of food consumed. Symptoms are caused by neurohumoral changes that occur in the body of the expectant mother and are aimed at maintaining pregnancy and preparing for childbirth. Unpleasant sensations associated with physiological causes occur episodically and are easily eliminated by non-drug methods. The most common causes of nausea in pregnant women:
- Overeating . Expectant mothers often have an increased appetite, which is manifested by eating large portions of food at a time. Because of this, the wall of the stomach is overstretched, the load on the pancreas and the biliary system increases, and unpleasant sensations appear. Nausea during pregnancy is also the result of a change in taste preferences and the use of incompatible foods.
- Enlargement of the uterus . In the third trimester of pregnancy, the bottom of the uterus presses on the stomach, the nerve endings of its wall are irritated, reflex nausea develops. Painful sensations intensify after eating, bending the torso. Pregnant women may complain of severe shortness of breath, which is associated with limited diaphragm mobility and the inability to fully expand the lungs.
- Constipation . Delayed bowel movements are a frequent complaint of women in the second half of pregnancy. In case of violations of bowel emptying, reflex nausea often occurs, which is due to intense impulses from the intramural nerve plexuses and the so-called fecal intoxication. The symptom can be combined with pain in the left iliac region, bloating. The intensity of discomfort decreases after the act of defecation.
Early toxicosis
This condition is the most common cause of nausea during gestation. According to statistics, toxicosis of varying intensity occurs in 60% of women. Initial signs appear after 5-6 weeks of bearing a child. There are several theories of the origin of this condition: neurogenic, immunological, hormonal. Modern research proves the role of genetics - several specific genes have been found in pregnant women suffering from severe nausea. The severity of symptoms correlates with the severity of toxicosis.
With a mild degree, nausea is observed in the morning and vomiting up to 5 times a day. There may be changes in taste and smell, intolerance to certain odors. The general condition of the woman is satisfactory, sometimes the blood pressure decreases, as evidenced by dizziness, weakness. The average degree of toxicosis is characterized by vomiting up to 1 time per day, constant nausea, which makes normal nutrition difficult. Pregnant women lose up to 3-4 kg of weight per week. Sleep is disturbed, the pulse quickens, laboratory tests of blood and urine change.
A severe form of toxicosis during pregnancy (hyperemesis) is manifested by constant painful nausea, repeated vomiting (up to 20-25 times a day), the impossibility of normal nutrition. The body is severely dehydrated, causing the skin to lose elasticity. Possible yellowness of the skin. Weight loss reaches 7-1 kg per week. In severe toxicosis, a pregnant woman must be urgently hospitalized in a hospital for intensive care.
Pathologies of pregnancy
In pathological conditions associated with childbearing, pregnant women are often concerned about various dyspeptic disorders. Nausea occurs reflexively due to increased impulses from the receptors of the gastric and intestinal mucosa or due to increased blood pressure. If nausea is accompanied by severe headache, blurred vision, muscle twitching, you should immediately consult a doctor. Nausea is provoked by:
- Gestosis . Another name for pathology is late toxicosis. It is observed after 2 weeks of pregnancy and is characterized by a triad of symptoms: severe edema, increased blood pressure, and the presence of protein in the urine. Nausea with intense headaches, weakness and dizziness usually indicates arterial hypertension and the threat of preeclampsia.
- Cholestasis of pregnancy . According to statistics, the disorder occurs in 0.1-2% of all cases of pregnancy, due to the effect of an increased amount of estrogens on the chemical composition of bile and bile duct motility. Women are concerned about intense skin itching, nausea, belching, heaviness in the epigastric region. 1-2 weeks after the manifestation of cholestasis, the skin may turn yellow.
- Hyperthyroidism . An increase in the production of thyroid hormones in the first trimester of pregnancy is a physiological reaction of the body, but with an excessive increase in thyroid function, unpleasant symptoms occur. Hyperthyroidism is manifested by increased sweating, muscle trembling, skin hyperemia. Later, dyspeptic disorders join in the form of increased urge to defecate, abdominal cramps, nausea, and vomiting.
- Polyhydramnios . An increase in the amount of amniotic fluid is diagnosed in 1% of pregnant women. For complications, late toxicosis is typical, which is combined with severe pastosity of the anterior abdominal wall, rapid weight gain. On the skin of the abdomen, rough stretch marks and a venous pattern may appear, in many women a symptom of fluctuation (squishing in the abdomen) is determined, which is aggravated by movement.
- Eclampsia . The disease is the most severe form of preeclampsia and often leads to serious complications for the mother and child. With eclampsia, after a short period of headaches, nausea, vomiting, blurred vision, convulsions begin, consciousness is disturbed. Attacks are provoked by external stimuli, pain, emotional stress. Sometimes the condition develops right during childbirth.
Ovarian hyperstimulation syndrome (OHSS)
Pathology occurs mainly in women who have resorted to in vitro fertilization methods or have received hormonal drugs for the treatment of infertility for a long time. As a result, the ovaries begin to produce excessive amounts of progesterone and estrogen, which has an adverse effect on the body. Intense nausea appears from the first weeks of pregnancy, its severity depends on the degree of OHSS. In addition to dyspepsia, patients complain of tachycardia, shortness of breath, dizziness against the background of low blood pressure.
Diseases of the gastrointestinal tract
Nausea during pregnancy is due to extragenital pathology, which manifests itself during the gestation period. Hormonal imbalance, functional changes in the digestive system - all this predisposes to the exacerbation of concomitant diseases that were previously asymptomatic. Subjective discomfort is combined with other dyspeptic disorders. The causes of nausea are usually:
- GERD . Gastroesophageal reflux during pregnancy is formed due to an increase in intra-abdominal pressure and a decrease in the tone of the lower esophageal sphincter under the influence of progesterone. Women complain of nausea on an empty stomach, sour belching and heartburn, pain in the epigastrium and behind the sternum is also observed. Symptoms are aggravated in the supine position, with the torso tilted forward.
- pancreatitis . With exacerbation of chronic inflammation of the pancreas in pregnant women, the exocrine function of the organ is inhibited, the motility of the pancreatic duct is disturbed, and the release of enzymes into the intestinal lumen slows down. Patients are concerned about nausea and vomiting, a feeling of heaviness in the abdomen after eating, pain of varying intensity in the epigastric zone and left hypochondrium.
- Chronic gastritis . With an exacerbation of the disease, a woman experiences pain in the epigastric region, nausea, belching with air or sour. The processes of digestion of food are disturbed, which leads to flatulence, a change in the frequency of defecation and the nature of feces. Gastritis during pregnancy is usually accompanied by asthenovegetative disorders.
- Functional dyspepsia . Disruption of the digestive system, not associated with organic pathology, is caused by changes in the neurohumoral regulation of the functions of the gastrointestinal tract in pregnant women. Dyspepsia is manifested by various complaints that suddenly appear and disappear during the day. Concerned about nausea, heaviness in the abdomen and a feeling of early satiety. Symptoms worsen in stressful situations.
- Dysbacteriosis . A decrease in the activity of the main digestive enzymes and the suppression of the normal intestinal microflora during pregnancy provokes an increased reproduction of pathogenic bacteria. Pain and discomfort are felt along the intestines, bloating, the stool becomes unstable. Nausea is provoked by the entry into the brain of a large number of impulses from irritated nerve endings in the mucous membrane of the digestive tract.
Survey
With complaints of nausea during pregnancy, women turn to an obstetrician-gynecologist, who, according to indications, after collecting an anamnesis and assessing the objective status, refers the patient to consultations with other specialists (most often, a gastroenterologist). It is necessary to conduct a comprehensive examination aimed at establishing the root cause of the deterioration of well-being. In diagnostic terms, the most informative are:
- Ultrasound . Ultrasound of the abdominal cavity is a non-invasive diagnostic method widely used during pregnancy due to its safety for the fetus. Sonography helps to assess the morphological features of the gastrointestinal tract, to identify signs of organic lesions or inflammatory diseases. In the 3rd trimester, due to the growth of the uterus, the method is not informative enough.
- Intragastric pH-metry . The acidity of gastric juice is measured with a possible exacerbation of extragenital diseases of the gastroduodenal zone. The total pH and the amount of free hydrochloric acid are estimated. If necessary, an additional 24-hour measurement of acidity in the esophagus is performed.
- Fecal analysis . In pathologies that are accompanied by nausea and other signs of digestive disorders, the normal parameters of the coprogram often change. According to the indications, an extended study is performed with the determination of the intestinal microflora. A fecal elastase test is recommended to rule out pancreatic involvement.
- Biochemical study of blood . To clarify the degree of protein-energy deficiency in toxicosis, the levels of total protein, its fractions, and glucose in blood plasma are determined. Liver tests are indicated for suspected damage to the liver and biliary system. If necessary, an analysis of the main hormones is prescribed.
All women must undergo a standard gynecological examination, which is necessary to control the development of the fetus and helps to detect specific diseases of pregnancy. With severe emotional instability, a neurological examination of the pregnant woman and a psychologist's consultation may be required to exclude functional disorders of the digestive system.
Citrus fruits may reduce nausea during pregnancy
Symptomatic therapy
Episodic nausea that occurs with mild toxicosis or due to physiological causes does not require medical correction. To reduce painful sensations, pregnant women are recommended to eat in small portions up to 5-6 times throughout the day. Easily digestible foods should prevail in the diet. After eating, it is undesirable to be in a horizontal position so as not to provoke the reflux of contents from the stomach into the esophagus.
If nausea during pregnancy is observed constantly, significantly complicates eating or is accompanied by headaches, repeated vomiting, severe pain in the stomach and intestines, you should contact a specialist as soon as possible. Before establishing a clinical diagnosis, prokinetics, antacids, and sedatives can be used to alleviate the condition. With functional digestive disorders, psychotherapy methods are effective.