Dear Doctor,

I am pregnant with my first child but after my first antenatal visit last week, I was told that I am anaemic. I was given medicine and also advised to eat more vegetables. The problem is, even the sight of them makes me want to throw up. I tried eating some broccoli yesterday and I couldn’t stomach it. Is there anything else that I can try or perhaps medication that can stop the nauseating feeling I get when I see vegetables?

Worried Lisa

Dear Lisa,

Congratulations on your first pregnancy. What you are suffering from is called morning sickness of pregnancy or hyperemesis gravidarum. About 50 per cent of women world over suffer from this condition. The duration and severity of this sickness is variable. Some women have nausea and or vomiting during the first trimester and then it subsides spontaneously, whereas some may suffer till later and even for the full duration of the pregnancy. In some, there is just mild sickness, but some have severe sickness needing rest and even intravenous perfusions sometimes. Actually nausea and vomiting can occur at any time of the day, including evening. At times it may last throughout the day.

The exact cause of morning sickness is not known. It is postulated that it can be due to high levels of hormones like estrogen and HCG (human chorionic gonadotropin) during early pregnancy. Another theory is that it could be due to increased sensitivity of the digestive system to increased levels of hormones. One may develop increased sensitivity to smells, causing nausea and or vomiting, when exposed to that smell. The use of hormonal contraceptives prior to becoming pregnant, morning sickness in a previous pregnancy, functional dyspepsia are other risk factors that predispose one to morning sickness. Genetic factor also increases susceptibility. A woman with a female blood relative having morning sickness is more prone to develop nausea and vomiting during pregnancy.

Morning sickness leads to weight loss and malnutrition in the affected woman.  The requirement of iron and calcium is increased during this period, if not met with, it results in anaemia and joint and bone pains in the lady during pregnancy and after delivery. The baby delivered is born underweight and may be malnourished.

Therefore it is important to keep the body well hydrated and well fed during pregnancy. As such, there are no dietary restrictions during pregnancy, but it is advised to take a balanced, nutritious diet. Frequent small meals are a better option than taking one or two heavy meals. If the sight of vegetables makes you throw up, try taking vegetables in another form like soups, baked vegetables, salads with different flavours, juice as of beetroot, pumpkin, and etcetera. Fruits like passion fruit, pomegranate, among others, are a rich source of iron.  Vitamin C rich fruits like orange and guava are useful as vitamin C helps in absorption of iron.  Supplements of iron and folic acid are useful to correct the anaemia. In fact folic acid can be started from beginning of pregnancy.

If nausea and or vomiting are mild, one can ignore it.  If nausea is severe or one is unable to tolerate it, antiemetic tablets can be used to help cure the vomiting. Other things which can cause gastric irritation like alcohol, excess tea, coffee, hot pepper, drugs like aspirin, and non-steroidal anti-inflammatory drugs (NSAIDS), should be avoided as they can aggravate the nausea and or vomiting.

Dr. Rachna Pande is a  specialist in internal medicine.

E-mail- rachna212002@yahoo.