Hyperemesis and Malnutrition

“Don’t worry the baby will get all it needs from you.”

There is a strange phenomenon that happens when you are pregnant; people love to give you advice. Most of the times these people aren’t medical professionals or people who work with pregnant women or people who have studied pregnancy and yet they appear to know a lot about the science of it.

How many times have you heard the following statement? “You are eating for two now”….well guess what Mrs Higgs from No. 32 that’s a myth and in fact, I don’t need to increase my calories at all in the first trimester and by my third trimester I only need to increase these by 350-450 a day.

So what happens when you aren’t eating anything in your first trimester and your calories are reduced to maybe a couple of hundred? Well then you can rely on the same people telling you “Don’t worry the baby will take everything from your reserves!” (Actual quote from a “friend of mine).”

But what is the truth around this, and what impact can malnutrition have on not only the mother but the baby?…..

Here are some facts that you might find helpful to know about Hyperemesis and malnutrition.

  1. A calorie is a calorie – whilst it is difficult to imagine 9 months of consuming only french fries, lucozade and on occasion the odd piece of cucumber – a calorie is a calorie. Put simply, do not feel guilty about what you are eating as long as you attempt to fuel your body with some type of food. Yes in the ideal situation a pregnant woman would only eat fibrous, protein rich, essential fatty oil foods full of vitamins such as D and B – but this is not an ideal situation and that is not your fault. Eat what you can keep down and don’t add anymore guilt to your plate.
  2. You will not harm your baby if you cannot “eat healthily”. But Hyperemesis could. It is the job of a nutritionist to support you to make sure you are getting the bare essentials to get you through.
  3. Weight loss is important to keep an eye on. This isn’t to diagnose Hyperemesis but to monitor your reduction in weight to see whether other interventions might be needed. Research has shown that there is an association with women who lose 15% or more of their pre-pregnancy weight and adverse fetal outcomes. If this is you then you must advocate for more nutritional care and support if this is not already being offered.
  4. Adverse Fetal Outcomes – These include premature/preterm delivery and low birth weight. Another suggestion is that a link between Hyperemesis and Fetal programming (prolonged stress, malnutrition and dehydration in the mother which can potentially put an unborn child at risk for chronic disease) is likely – but this area of study is relatively new and no link as of yet has been made. More research in this field is vital.
  5. Wernicke’s Encephalopathy (WE) is a neurological disorder that occurs due to a depletion in vitamins, particularly B1 Thaimine (commonly found in whole grains, meats, nuts, beans and peas). Signs of WE include visual changes to the eyesight, confusion, difficult in speaking, slurred speech, weakness, inability to stand and seizures. If left untreated WE can be fatal in 20% of cases and it can cause spontaneous abortion. Sadly, it is often missed in Hyperemesis sufferers as they might not meet all the criteria for symptoms, but prolonged vomiting, rapid weight loss and confusion should be seen as signs of an increased risk of WE and if you are concerned about experiencing any of these symptoms please speak to your Doctor. The good news is that if caught early it is easily treatable by administering the vitamin direct to a woman via an IV.

In my own experience I was able to return to normal eating (albeit still having to avoid certain foods due to triggers) in my second trimester and I didn’t have rapid weight loss (I lost around 5% of my pre-pregnancy weight).

In other words, don’t stress or worry if you are not currently able to eat much. The key here is “prolonged” and “15% or more” so be mindful of how long you have not been able to eat and if you can, try and keep a food diary of amounts as well as types of foods, so you can share this with your Doctor. As a caveat though if you ever feel that something isn’t right (whatever is with Hyperemesis!?!) and you don’t fit into these sometimes strict parameters, always ask and always seek an opinion, it is better to ask than not to.

Here are some tips on food choices that might help with your nutritional intake.

  • Make nutritious choices. If you can stomach bread then try wholemeal over white. If you can eat cereals or cereal bars try ones that have a higher fibre content or include nuts and berries. Try full fat milk if you can and full fat yoghurts.
  • Try to eat protein. I struggled with this one – but a higher protein diet can help with nausea so see if you can experiment with ways to add even just a little in your diet.
  • Keep odourless snacks close by. Can your partner make up small snacks and leave them in your room? Things like cucumber, carrots, raisins or breadsticks? Having them close by will mean that you don’t have to get up and prepare them yourself, which can trigger a nausea and vomiting episode.
  • Try and mix up oral vitamins to take with your food instead of gulping down water. Drinking water used to make me vomit so I used to hide my vitamins in my food and break them down a little, which seemed to help.
  • Go to a liquid diet. If whole foods are just not staying down but liquid is then try a liquid diet until you can stomach whole foods again. Things like protein powders, smoothies, soups, broth’s and again the higher the calories the better.

However, if you are unable to manage this by yourself, and again if this has not been offered to you, please speak to your Doctor and ask to see a nutritionist or make a plan on how best you can take in and keep down the vitamins you need to give you and your baby the best outcome.

AND – please do not feel guilty if you cannot. It can take time to see a nutritionist and get an appointment, it can take time to pluck up the courage to try different foods and experiment and it can be heartbreaking when another food choice just won’t stay down. Just remember don’t put any more guilt on your plate, just eat what you can and plan to try again the next day.

*If you have had prolonged vomiting with little to no food and have experienced rapid weight loss please do reach out to your Doctor or call/speak to your national Hyperemesis support group or charity.

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