Intended for healthcare professionals

Rapid response to:

Clinical Review Interactive case report

Treatment of nausea and vomiting during pregnancy: presentation

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7434.276 (Published 29 January 2004) Cite this as: BMJ 2004;328:276

Rapid Response:

Monitored nutritional repletion

1. What would you say to the patient about the safety of treatments
(both conventional and complementary) in pregnancy?

I do not give pharmaceutical drugs for hyperemesis gravidarium
because all drugs are potentially dangerous to the developing foetus. I
seldom find women who have been given good preconception care need to take
any medications. Ideally this includes avoiding smoking, alcohol,
exogenous hormones and starting a high protein low allergy diet 3-4 months
before conception. I also use monitored essential nutrient repletion. I do
not regard essential nutritional supplementation as either complementary
or alternative but necessary to correct common important maternal
physiological defects. This is necessary to minimise the risk of
congenital abnormalities, learning or behaviour problems or illnesses in
children.

2. What study design might provide evidence for their relative
efficacy in an individual patient?

The investigations and treatments must be tailored for each
individual woman. Studies can be designed to look at each individual
problem such as smokers versus non-smokers, iron or folate deficient or
not. Usually stopping smoking and iron and folic acid tablets are advised
in pregnancy, but this will not prevent sickness if the woman is zinc,
magnesium or copper deficient and therefore inevitably has impaired immune
responses to pregnancy and will have adverse reactions to more foods and
chemicals. Avoiding cheese, chocolate and red wine does not prevent
migraine if a woman has masked, but strong, reactions to wheat or cow/s
milk. I use a four day rotation diet of different meats, fish, vegetables
and fruit which, in my 30 years experience, in is equally effective in
preventing migraine, hypertension, pregnancy sickness, and pre-eclampsia.

3. How would you rate the relevance of such evidence to another
patient?

A properly structured programme is effective for all women.

4. How many of your patients are using complementary therapies, and
what percentage of pregnant women do you think use complementary therapies
such as herbal treatments or supplements during pregnancy?

All my patients are given monitored nutritional supplementation
before or during pregnancy. Very few women are nutritionally replete in
the most important trace minerals and as the blood levels of zinc and
magnesium fall and copper levels rise during pregnancy, deficiencies of
these key nutrients should be prevented.
I do not practise alternative or herbal medicine, only evidence based nutritional medicine.

Competing interests:
None declared

Competing interests: No competing interests

30 January 2004
Ellen C G Grant
Physician and Medical Gynaecologist
20 Coombe Ridings, Kingston-upon-Thames, Surrey, KT2 7JU