Effective Diets for Pregnancy Sickness
Vomiting in early pregnancy, often after wakening, is very common (70-80 per cent) and usually self-limiting. The etiology is unknown. Rarely (approximately 2 per 1000), the symptoms are very severe and protracted with complications that may include Wernicke's encephalopathy and death. A desire to avoid or delay antiemetic treatment during early pregnancy may cause severe dehydration and ketoacidosis. Past reports show associations between hyperemesis gravidarum and fetal growth retardation, congenital abnormalities, and prematurity. In recent reports no effect has been found on the outcome of pregnancy, perhaps because of improved patient management.
Dietary factors, insulin adjustments and blood glucose values are so interdependent in women with Type 1 diabetes that one should not consider any one in isolation. Women with Type 1 diabetes have an absolute deficiency of insulin and their glycaemic control is totally dependent on exogenous insulin and dietary intake. The metabolic and physiological changes occurring in early pregnancy make these women especially vulnerable to hypoglycaemia, and this is further compounded if food intake falls due to pregnancy-induced nausea or vomiting. In later pregnancy, due to the increase in maternal lipolysis during the post-absorbative and fasting periods, ketoacidosis may develop rapidly. To minimise metabolic complications one needs to continually match and adjust the insulin doses to the carbohydrate intake. Maternal ketosis, as assessed by urine strips, is usually an indication for an increase in both dietary carbohydrate and insulin treatment. Diets need to be individual and flexible...
Unexpected or polypharmacology in a structure can occasionally lead to additional benefits in drugs. In the same way polypharmacology can have dramatic consequences in toxicity. Thalidomide was used as an anti-nausea drug to control morning sickness. Its use in pregnant women had terrible consequences due to the teratogenic nature of the drug.
Occasionally beta-HCG levels may be sufficiently elevated to react with the TSH receptor and result in elevated free T4 and free T3 levels. This situation can be seen in an otherwise uncomplicated pregnancy, in hyperemesis gravidarum, in hydatidiform moles and in choriocarciomas. In these conditions, the radionuclide scan demonstrates a diffuse homogenous uptake, similar to that seen with Graves' disease. The thyrotoxic state usually is not severe. Thyrotoxicosis in association with greatly elevated beta-HCG levels in the appropriate clinical situation establishes the diagnosis.
Thyroid function should be assessed in women with hyperemesis gravidarum. Women known to have Graves' disease may decide on definitive treatment of their condition prior to becoming pregnant. If Graves' disease is diagnosed during pregnancy, it is important to use the smallest dose of antithyroid drugs by reviewing regularly to maintain maternal concentrations of free thyroid hormone and thyroid-stimulating hormone within their respective normal ranges. This is to avoid fetal hypothyroidism and goiter. Most recommend that carbimazole should be discontinued 4 weeks before the expected date of delivery to avoid any possibility of fetal hypothyroidism at the time of maximum brain development. If subtotal thyroidectomy is necessary because of poor drug compliance or hypersensitivity, it is most safely performed in the middle trimester. Radio-iodine is contraindicated because it invariably induces fetal hypothyroidism. If antithyroid agents are given postdelivery, breast feeding is not...
Pyridoxine is extremely important in the development of the nervous system. It helps process amino acids and is involved in the production of serotonin, melatonin, and dopamine. The vitamin has been used to reduce morning sickness during pregnancy. A hormonal shift leading to PMS (premenstrual syndrome) in women, and nerve compression injuries such as carpal tunnel syndrome, These vitamins have been isolated in foods and their chemical structures identified as part of the B group, although the activity of para amino benzoic acid (PABA) is quite different from other B vitamins. Biotin acts as a coenzyme in the metabolism of fats, carbohydrates, and protein. Prolonged use of antibiotics and antiseizure medicines interfere with its production. It is destroyed by raw egg white. The vitamin strengthens brittle nails and lowers blood glucose levels preventing diabetic neuropathy. Deficiency symptoms include fatigue, lack of appetite, dermatitis, hair loss, anemia, nausea, and depression....
In the 1960s, the drug thalidomide was prescribed to pregnant women to treat morning sickness. However, thalidomide caused severe limb defects in the children of some women who took the drug, and its use for morning sickness was discontinued. It is now known that thalidomide was administered as a mixture of two stereoisomeric compounds, one of which relieved morning sickness and the other of which was responsible for the birth defects. What are stereoisomers Why might two such closely related compounds have such different physiologic effects
Risk factors for post-operative nausea and vomiting. Anaesthesia, 49 (Supplement), 6-10. Mitchelson, F. (1992). Pharmacological agents affecting emesis a review (Part 1). Drugs, 42, 295-315. Morrow, G.R., Hickok, J.T., and Rosenthal, S.N. (1995). Progress in reducing nausea and emesis. Comparisons of ondansetron (Zofran), granisetron (Kytril) and tropisetron (Navoban). Cancer, 76, van de Ven, C.J.M. (1997). Nasogastric enteral feeding in hyperemesis gravidarum. Lancet, 349, 445-6.
Interestingly, the desire for salt in the food, which can indirectly affect one's state of hydration, may be induced prenatally by maternal dehydration. Crystal and Bernstein found that infants whose mothers experienced moderate to severe morning sickness along with moderate to severe vomiting during pregnancy craved salt more than infants whose mothers had not experienced morning sickness.1 Although the explanation for this phenomenon was not clear, it was hypothesized that the fluctuations in fluid and electrolyte balance resulting from the dehydration could be related to the activation of hormones that triggered the salt cravings. In any case, this study reinforces the concept that the mechanisms of thirst and dehydration are not as straightforward as we may think. Fur
Serum concentrations of thyroid-stimulating hormone fall in the first trimester as concentrations of human chorionic gonadotrophin, to which it is structurally similar, increase. Hyperemesis gravidarum may be associated with a biochemical thyrotoxicosis with high levels of free thryoxine and suppressed thyroid-stimulating hormone. In the third trimester thyroid-stimulating hormone levels increase, and so the upper limit of the reference range is raised compared with the non-pregnant state. Similarly, the normal ranges for free thyroxine and T3 are reduced.
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