Causes of Nausea and Vomiting in Pregnancy
During gestation, the body produces large amounts of human chorionic gonadotrophin (hGC). Once placenta is well established between 12 and 14 weeks, nausea often eases. Other hormones such as estrogen and thyroxine also play a part, and can create symptoms well beyond first trimester.
Hyperemesis gravidarum occurs very early, usually before 5 weeks, and causes excessive vomiting. This can lead to dehydration and nutritional deficiencies, and create a cycle that is difficult to break. IV fluids, nutrition and medications may be necessary.
Prenatal vitamins can cause nausea, as they are loaded with minerals, herbs and vitamins in large doses. The large horse pills often have a revolting smell and are difficult to swallow. A normal pregnancy and a well-balanced diet generally provide the RDA of all nutrients except elemental iron and folate, both of which must be supplemented. A standard prenatal vitamin formulation contains the following supplements:
- Iron – 30 mg
- Zinc – 15 mg
- Calcium – 250 mg
- Vitamin B-6 – 2 mg
- Folate – 0.4 mg
- Vitamin C – 50 mg
- Vitamin D – 5 mcg
Of course, contents vary by individual formulation, and nutrient supplementation should be chosen with attention to individual patient needs. If you choose to forgo a prenatal vitamin, do a thorough accounting of your diet. Most people think they eat well enough; most people are wrong.
Prenatal vitamins aren’t necessary, but they are prescribed to most patients for various reasons. A major reason is that a nutritionally compromised pregnancy can be difficult to identify, and the potential benefits of routine supplementation overshadow any risk that can be attributed. Also, the psychological impact of supplementation cannot be overlooked. Many patients are uncomfortable with the idea of foregoing prenatal vitamins and are reassured by their prescription.
Tips for Preventing Nausea When Taking Prenatal Vitamins
- Take your pills right before bedtime or naptime. Lack of body movement often helps reduce nausea.
- If you’re gagging on size of your pills, switch to a chewable or liquid supplement, or even a product with smaller pills.
- Not all prenatal vitamins are the same. Try a brand that doesn’t have a nauseating odor or aftertaste.
- Taking prenatal vitamins on an empty stomach is a recipe for queasiness. Eat your meal, let it sit for a few minutes, and then take your pills with lots of water.
- Wash your vitamins down with peppermint tea instead of water. The American Pregnancy Association recommends this soothing tea for easing nausea.
- Drink Teas, dried herbs and aromatherapies: fennel, ginger, thyme, peppermint, lavender.
- 1 gram of Ginger/day has been shown to reduce nausea during pregnancy.
- Eat stomach-settling foods: nuts and peanut butter, citrus fruit, fruits and vegetables, water and carbohydrate rich foods such as potatoes, bread, crackers and pasta.
- Use Drugs with caution: OTC antihistamines such as benedryl, and anti-nausea dimenhydrinate (Dramamine) can provide relief and are generally less risky than stronger prescriptive therapies. But when benefits outweigh the misery and nutritional deficiencies, Zofran, gabapentin and other options are available.
What to Eat for Prenatal Health
Iron (30 mg/day)
- Cook in cast iron. Each meal prepared will have approximately 1 mg of iron.
- Chicken Liver: 3 ounces contain 12 mg of iron
- Beef Liver: 3 oz of liver contain 7.5mg of iron, also high levels of vitamin A. Eat no more than once/week.
- Beef, chuck braised: 3 oz has 3 mg iron
- Prune juice: 1 cup of prune juice has 3 mg iron
- Oysters. 1 mg of iron per oyster
- Blackbeans: 1 cup cooked black beans = 3.6 mg of iron
- Lentils: 1 cup cooked lentils has 6.6mg of iron
- Spinach: ½ c boiled/drained has 3 mg of iron.
- Chicken: 3 oz chicken has 1 mg iron
- Turkey or ground beef: 3 oz of turkey or ground beef contain 2 mg of iron
- Molasses: 1 tbsp has 1 mg of iron
- Nuts and seeds: 1 cup cashews 8.22mg; sunflower seeds 4.24mg, pumpkin and squash seeds 11.38 mg; pine nuts (pesto!) 7.47mg; Hazelnuts 5.41mg; pistachios 4.96mg; almonds 5.29mg
- Pumpkin and squash seeds: 6.6mg per cup
- Cashews: 7.7mg per cup
- Spinach: 1.4 mg per cup cooke; 0.5mg per 100g raw
- Pork (lean shoulder) and chicken: 4.3mg per 3oz
- Dark Leafy Greens (water cress, curly kale): ~ 130 mg per 100 g raw
- Arugula, Collard greens ~55mg per 100 g raw
- Low fat Mozzarella: 269mg/1 oz; 1086mg/cup
- Fortified tofu: 434mg per ½ cup
- Almonds: 378mg/cup
- Sunflower seeds: 1.88mg/cup
- Pistachios: 1.38/cup
- Tuna: 0.88mg/3 oz
- Wild Salmon: 0.80 mg/3 oz
- Turkey and chicken (light meat): 0.69mg/3 oz
- Lean Pork: 0.67mg/3 oz
- Prunes: 0.98mg/cup
- Beef (sirloin steak, filet, rib eye): ~ .55 mg/3 oz
- Bananas: 0.43mg/fruit
- Avocados: 0.39mg/fruit
- Spinach: 0.44mg/cup cooked
Excellent sources of dietary folate include romaine lettuce, spinach, asparagus, turnip, collard and mustard greens, parsley, cauliflower, beets and lentils. Calf and chicken liver is excellent source. Folate from food has an average bioavailability of 65%.
Supplemental folate (Metfolin, Solgar, Designs for Health, Thorne, Metabolic Maintenance and Pure Encapsulations brands) is 5-methyltetrahydrofolate of 5-MTHF. Avoid folic acid supplements.
Juice Plus: Folate for pregnancy is 400mcg (0.4 mg) 2 capsules of Garden Blend contain .28 mgs and 2 capsules of Orchard Blend contain .14mg and Vineyard Blend .360mg. This is a total of 780 mcg per day!
Folic acid is the synthetic version of folate. Get as much natural folate as possible from food. High intake of supplements with folic acid can mask B12 deficiency.
Vitamin C (50mg/day)
- Red Bell Peppers: 210 mg per large pepper
- Yellow Bell Peppers: 342mg per large pepper
- Green Bell Peppers: 132 mg per large pepper
- Guavas: 377mg/cup. 126 mg/fruit
- Kale: 80mg per cup chopped
- Kiwi: 64 mg/fruit
- Broccoli: 81 mg/cup chopped
- Strawberries: 97mg/cup sliced
- Oranges: 96 mg/cup sectioned
- Tomatoes: 55mg/cup cooked
- Green Peas: 58mg/cup
- Pineapple: 78mg/ cup chunks
Vitamin D (5mcg/day) (Often measured in IUs instead of micrograms. Multiply IUs by 0.55 to convert to mg.)
- Cod liver oil: 1 tbsp 1400IU or 770 mcg. 1 tsp 500IU or 275 mcg.
- Oily fish: 3 oz trout 579 IU or 319 mcg; 3 oz Smoked Salmon 597 IU, 329 mcg; 3 oz swordfish 561 IU, 309 mcg; 3 oz salmon 448 IU, 247 mcg (Fish low in mercury and safe for 2-3 servings per week in pregnancy: farm raised rainbow trout, wild caught salmon and whitefish.)
- Portabello mushrooms: 1 cup diced 384 IU, 211 mcg
- Tofu (firm light): 3 oz 132 IU, 73 mcg