Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting of pregnancy (NVP) that can significantly impact a pregnant woman's health and well-being. It is characterized by persistent and intractable vomiting, leading to dehydration, electrolyte imbalances, weight loss, and metabolic disturbances. While every pregnant woman reacts to food differently, dietary modifications play a crucial role in managing HG symptoms. This article provides comprehensive dietary recommendations based on research and expert opinions to help alleviate nausea and vomiting associated with HG.
Understanding Hyperemesis Gravidarum
Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting of pregnancy (NVP) that persists beyond the first trimester. It was estimated that HG affects 0.3% to 10.8% of pregnancies. Studies have shown that HG is associated with an increased risk of maternal morbidity (e.g., anemia, eclampsia, venous thromboembolism, gestational hypertension) and adverse birth outcomes (e.g., preterm birth and low birth weight). Clinical treatment for HG is usually symptomatic and ineffective.
HG is defined as the presence of nausea and intractable vomiting sufficient to cause dehydration and metabolic disturbance of a severity to require hospitalization, occurring early in pregnancy. It is essential to exclude other potential causes of vomiting, such as gastrointestinal or urinary tract infections, viral hepatitis, or pre-existing medical conditions prior to diagnosing HG.
General Dietary Strategies
The primary goal when experiencing nausea and/or vomiting is to consume anything tolerable while implementing food strategies. This may involve eating foods that are not particularly healthy; however, the aim is to avoid weight loss and consume the most nutritional version of appealing foods.
Frequent, Small Meals
Eat a small meal or snack every 2 hours rather than 3 large meals every day. This helps maintain stable blood sugar levels and minimize nausea. Eating a small snack before going to sleep at night can also be beneficial.
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Hydration is Key
Drink most of your liquids between meals, or small amounts of liquids with your meals. Stay hydrated by regularly sipping water, clear fluids, herbal teas, and electrolyte-enhanced drinks. Consider freezing unsweetened fruit juice to create nutrient-rich ice cubes.
Identify and Avoid Nausea Triggers
Avoid foods and smells that worsen your symptoms, which can include spicy foods, fatty foods, and strong odors. Common culprits are those that are pungent, such as fish, vinegar, garlic and onions.
Consider Food Textures and Temperatures
Fluids are better tolerated cold, clear, carbonated and sour (e.g., ginger ale and lemonade) and taken in small amounts with a straw. Imagined consumption of crunchy-textured and sweet foods was least likely to evoke a nauseous or vomit response.
Specific Food Recommendations
Foods That May Help
- Apples: Sweet apple had the highest agreeability score, the lowest nausea severity and intolerance-emesis response rate when tasted by women with HG. Fewer were likely to feel nauseated or want to vomit when they considered eating apples (16%, which topped the tolerated list).
- Watermelon: Watermelon ranked high in agreeability.
- Crackers: Substituting snacks or meals that are protein-dominant, salty, low-fat, bland and dry (e.g., crackers, cereal and toast) may help in HG.
- Ginger: Adding ginger to your diet can help reduce feelings of nausea. Try ginger tea, candies, or fresh ginger in cooking.
- Bananas: Bananas are useful because they have nutritional benefits and they actually stimulate mucus production from your stomach’s lining.
- Rice, Applesauce, and Toast: Nothing quite settles the stomach like bland toast and crackers.
Foods to Avoid
- Coffee: There are opinions that eliminating coffee and spicy, odorous, high-fat, very sweet foods may help in HG.
- Spicy Foods: There are opinions that eliminating coffee and spicy, odorous, high-fat, very sweet foods may help in HG.
- Fatty Foods: There are opinions that eliminating coffee and spicy, odorous, high-fat, very sweet foods may help in HG.
- Caffeine: Avoid drinks containing caffeine.
High-Protein and Low-Glycemic Foods
Incorporate lean meats, fish, tofu, eggs, and low-glycemic carbohydrates such as whole grains and vegetables to keep your energy levels stable. Protein-predominant snacks are associated with decreased nausea in one study.
Taste Study Findings
A study recruited 72 women within 24-hour of first admission for HG who were 18 years or above, with confirmed clinical pregnancy of less than 16 weeks’ gestation were recruited and analyzed. The study evaluated the feasibility of a food taste trial design in women with HG and the empiric response towards four common foods including two, apple and watermelon, that topped a questionnaire for tolerability and to crackers and bread, which were often touted as tolerated foods in HG.
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On agreeability scoring, apple (mean±SD 7.2±2.4) ranked highest followed by watermelon (7.0±2.7) and crackers (6.5±2.6), with white bread ranked lowest (6.0±2.7); Kruskal-Wallis H test, p=0.019. Apple had the lowest mean nausea score and mean rank score, while white bread had the highest at both 2 and 10 min; the Kruskal-Wallis H test showed a significant difference only at 10 min (p=0.019) but not at 2 min (p=0.29) in the ranking analyses.
This study showed a broadly consistent trend that the two fruits tested were more agreeable and better tolerated compared with bread and crackers in women hospitalized with HG. The sweet apple performed consistently well and white bread consistently poorly in a tasting trial in women with HG.
Dietary Patterns and HG Risk
A cross-sectional study conducted in Xi’an, China from April 2021 to September 2022, explored the relationship between dietary patterns and the risk of HG. The study involved 2515 pregnant women and identified five dietary patterns:
- Prudent: Included a variety of foods beneficial to human health.
- Fish, Shrimp, and Meat: Featured fish and shrimp meat, non-processed poultry and livestock meat, nuts, and yogurt products.
- Sweet and Processed Meats: Consisted mainly of processed meats, baked goods, and confectionery.
- Beverages: Consisted mainly of sugar-free colas, sugary drinks, and coffee drinks.
- Egg, Milk, and Water Drinking: Consisted mainly of milk and dairy products, eggs, water, and yogurt.
The study found that a diet rich in eggs, milk, seafood, and unprocessed poultry and animal meat may be a protective factor against HG, while a diet high in beverages may be detrimental to HG. The highest quartile of the “fish, shrimp and meat” and “egg, milk and water drinking” patterns was associated with a 37% and 58% lower risk of HG compared with the lowest quartile, respectively. Conversely, the highest quartile of the “beverage” pattern was associated with a 64% higher risk of HG compared with the lowest quartile.
Practical Tips and Meal Ideas
- Keep food close by: Keep food close by or in a cooler for quick snacks. Motion and preparing food worsen nausea and thus may decrease your ability to eat.
- Liquid meals: Liquid meals if tolerated can be easier to digest and may decrease nausea. Try protein powders in a milk shake or smoothie.
- Consider digestive enzymes: Consider taking digestive enzymes when you eat to get the most from your food and speed digestion. This is especially helpful if you are on acid blocking drugs.
- Collect menus from local take-out and delivery restaurants: If you have a craving, see what sounds good and call it in.
Nutritious Recipes for Hyperemesis Gravidarum
- Baked Salmon with Lemon and Herbs: Season salmon fillets with lemon and herbs, bake, and serve with steamed vegetables and quinoa.
- Egg Muffins: Combine whisked eggs with diced vegetables and cheese, bake in muffin tins.
- Turkey and Vegetable Stir-Fry: Stir-fry turkey strips with vegetables, season with ginger, and serve over brown rice.
- Greek Yogurt Parfait: Layer Greek yogurt with berries, nuts, and a drizzle of honey.
- Chicken and Vegetable Soup: Simmer chicken with vegetables and herbs in a low-sodium broth.
- Quinoa Salad with Roasted Vegetables: Mix roasted vegetables with quinoa and a lemon-olive oil dressing.
- Tofu and Vegetable Stir-Fry: Stir-fry tofu with vegetables and a low-sodium sauce.
- Spinach and Feta Omelette: Cook eggs with spinach and feta, serve with whole grain toast.
- Lentil Soup: Simmer lentils with vegetables and spices until tender.
- Grilled Chicken Caesar Salad: Grill chicken, mix with lettuce, tomatoes, and a light dressing.
The Importance of Professional Guidance
Dietary guidelines also suggested dry, starchy food in patients with HG, with crackers, being a commonly suggested food. Always consult with your healthcare provider or a registered dietitian to tailor these recommendations to your specific needs during pregnancy.
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