Pregnancy can cause all kinds of minor maladies.
MANY pregnant women suffer from minor ailments which may or may not cause discomfort. It is advisable to consult the doctor or pharmacist before taking any medicine during pregnancy.
Symptoms of nausea and vomiting are common during early pregnancy. Although termed morning sickness, it can occur at any time of the day.
About half of all pregnant women will experience nausea and vomiting; about a quarter experience nausea without vomiting. The exact cause of this ailment is unknown.
There are several measures that can help reduce these symptoms. They include drinking in small but frequent amounts which may help reduce vomiting; eating small but frequent meals high in carbohydrates but low in fats; avoiding factors that trigger the symptoms such as food, smell; and getting plenty of rest as tiredness can aggravate the nausea.
The doctor should be consulted if: none of the above measures work; there is persistent vomiting (more than three to four times a day), the vomitus contains blood or looks like coffee; there are symptoms of dehydration including thirst, dizziness, passing small amount of urine, dark coloured urine or none at all; there is weight loss; or there is any concern about the symptoms.
The doctor will check for features of dehydration. A urine test for ketones provides helpful information about the severity of the dehydration. The doctor will prescribe a sort course of medicine that will reduce the severity of the symptoms (anti-emetic). The medicine prescribed will be one that is safe for use in pregnancy.
Sometimes, hospitalisation may be advised for correction of severe dehydration with intravenous fluids.
There are reports that taking ginger and acupressure, a form of acupuncture, may be helpful in reducing symptoms in some women.
This term is frequently used to describe a number of symptoms which include heartburn, food coming back from the stomach (regurgitation), discomfort or pain in the upper abdomen and bloating. About half of pregnant women experience it at some time during the pregnancy, with an increased likelihood as pregnancy advances.
Indigestion is primarily due to pregnancy-related body changes such as increasing hormones and abdominal pressure resulting in acid reflux, which is the backflow of acid from the stomach into the gullet (oesophagus) causing an irritation of its lining.
A simple measure like avoiding food that triggers indigestion may be all that is needed to control the symptoms, especially if the symptoms are mild. However, if the symptoms are more severe, the doctor may prescribe some medicines for symptom relief such as antacids and alginates. It is important to check with the doctor or pharmacist before taking any medicine that has not been prescribed.
Antacids provide rapid symptom relief by neutralising the acid in the stomach so that its irritation of the digestive system is reduced. Sometimes the antacid is combined with an alginate which forms a foam barrier on top of the surface of the stomach contents, thereby confining the acid within the stomach. Antacid and alginates are safe as long as the recommended dose is adhered to.
Iron supplements should not be taken at the same time as antacids as the latter can affect the absorption of iron. The antacid should be taken about two hours before or after the iron.
If antacids and alginates do not provide symptom relief, a medicine that suppresses acid production may be prescribed. Both are safe for use in pregnancy. It is important to adhere to the dose prescribed.
Many pregnant women have problems opening their bowels. Dietary measures like eating food with more fibre (vegetables and fruits), and drinking more fluids are helpful. If the measures are ineffective, bulking agents (bran, ispaghula, methylcellulose) can be used. Stimulant laxatives (cascara and senna) can be used if the bulking agents are unhelpful. However, it is best not to depend on medicines to treat constipation.
Many pregnant women get the occasional episode of diarrhoea, particularly those who eat out often. A short episode of diarrhoea does not harm the foetus. However, diarrhoea that lasts more than a few days can lead to dehydration. This can be prevented by taking rehydration salts which are safe in pregnancy.
Loperamide should be avoided because of insufficient information available to make a decision on its safety in pregnancy.
Coughs and colds
These are very common. Most medicines for cough and cold contain more than one compound, which may include antihistamines, decongestants and painkillers. It is vital to ensure that it is safe to use each compound in pregnancy. As such, it is advisable to consult the doctor or pharmacist before taking any medicine during pregnancy.
Everyone gets pain from time to time. Pregnant women are no different. They can be prone to backache, especially in the latter stages of pregnancy. It is advisable to try measures that do not involve consumption of medicines, such as gentle exercises, to relieve backache.
Paracetamol is considered safe for short term use in all three trimesters and is often used for pain relief and when there is fever. Non-steroidal anti-inflammatory drugs (NSAIDS) and aspirin are usually not recommended during pregnancy as it can delay labour and affect the newborn baby. The risk of bleeding is increased in mothers and their newborn if aspirin is taken in the third trimester of pregnancy.
Opioid analgesics like codeine and dihydrocodeine should be avoided in the third trimester as they can affect the newborn’s breathing. However, it can be prescribed in the first two trimesters for pain relief if the dose is small and the duration of intake is short. As some over-the-counter painkillers contain codeine and dihydrocodeine, it is important to consult your doctor or pharmacist before consuming them.
Stretch marks (striae) appear whenever there is stretching of the skin because of sudden growth. Sometimes, it may be due to medical conditions like Cushing’s syndrome. The body parts that are commonly affected by striae are the abdomen, thighs and buttocks.
Pregnant women are prone to striae, especially after the second trimester. One reason is that the hormones produced in pregnancy soften not only the pelvic ligaments to facilitate childbirth but also the fibres in skin, thereby increasing the likelihood of striae formation. Another reason is that as the foetus grows, the abdominal skin is stretched more and more. Striae can also appear on breasts and thighs as they in-crease in size during pregnancy.
Most striae become thinner and fade in the course of time. If the striae are prominent or affect a large part of the body, it is advisable to consult the doctor who may make a referral to a specialist. Some treatments for striae may reduce it but does not make it disappear. In this respect, it is essential to be realistic about what can be achieved.
■ Dr Milton Lum is member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.