Gyno Groupie

Nausea in pregnancy is very common, affecting more than 50% of pregnant women.  Though commonly called ‘Morning Sickness’, the symptoms can occur at any time of the day.  Nausea of pregnancy usually improves by 14-16 weeks, but can continue throughout the pregnancy for some women.  Nausea in pregnancy is usually not harmful to your developing baby, but may become more problematic when associated with consistent vomiting and weight loss.

The cause of Nausea in Pregnancy is not well understood.  It may be caused by the elevated hormone levels of pregnancy and their effect on slowing overall gut motility.  The GI tract is normally constantly moving food and stomach acid from the stomach, though the GI tract.  The effect of slower gut motility can result in a feeling a nausea after eating a large (your standard sized) meal, where food isn’t moving out of the stomach at the same rate.  With slower gut motility, stomach acids aren’t moving out of the area at a normal rate either, potentially also causing a feeling nausea when we go 3-4 hours without eating.

In modern obstetrics, there is a growing trend in expecting mothers’ request for ‘elective’ Cesarean section (‘Cesarean Section on Maternal Request’.)  This ‘elective’ cesarean delivery, is a maternal request for Cesarean section delivery, in the absence of any maternal or fetal need (nor medical indication) for Cesarean section birth.  (This particular ‘request’ for Cesarean section refers to a maternal request for a first-time Cesarean delivery… not a request for a repeat Cesarean birth, as in the case of a mother with previous Cesarean Section deliveries.)  In the U.S. 2.5% of births are performed by Cesarean section for this request.  In my experience, concern and anxiety regarding pain in labor seem to represent the most common reason for this request.

50%-90% of pregnant women experience symptoms of ‘morning sickness’ in the early months of pregnancy.  These symptoms can range from mild intolerance to certain odors or food, to more significant, daily nausea and vomiting (N/V).  Studies suggest that up to 25% of pregnant women experience nausea, 50% experience both nausea and vomiting, leaving only 25% of pregnant women unaffected.  In those affected, the symptoms usually manifest by the 9^th week of pregnancy.

Much is written and discussed about home/medical remedies for morning sickness, but much less is written/discussed about the (possible) causes for nausea and vomiting in pregnancy (NVP).  Though the cause of NVP has not been proven, it has been postulated that NVP is an innate mechanism, presenting as a ‘protection’ for the developing fetus (an inherent ‘aversion’ to substances that could be harmful to the fetus.)  Leading medical theories consider the adverse reaction of the ‘hormones of pregnancy’ as potentially causative (in the absence of other intestinal or medical problems that could present with N/V.)

If anyone should know the concerns of choosing pregnancy and childbirth later in life, as an Ob-Gyn physician, having given birth to my first child at 39 yo, I should think I’d be one of them.   With my training and experience as an Ob-Gyn physician, I was fully aware of my risks in deciding on childbirth…as a woman of ‘advanced maternal age’.  I counsel women on their risks nearly every day.

I already knew that at my age, it may take longer for me to get pregnant. I knew that advancing age is associated with subfertility (prolongation in time to achieve conception,) and I knew this to be related to altered/changing hormonal patterns as we age, leading to suboptimal ovulation.  I already knew that there is decreased ovarian reserve (fewer fertilizable eggs remaining in our ovaries) as we age.  I also knew that advancing age was associated with a higher risk of miscarriage, most likely related to the poorer quality of aging eggs, and the increased chances of fertilizing an egg containing abnormal chromosomal material...

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Suzanne Hall, MD  (@drsuzyyhall)