When Linda Hasadsri, M.D., Ph.D. (they/them/she/her), began a Mayo Clinic fellowship in Clinical Molecular Genetics immediately after completing their training in Clinical Biochemical Genetics, they never imagined the genetic tests they were helping develop would be the very same tests that guided their life’s journey. But just after starting that fellowship, Dr. Hasadsri’s personal and professional worlds collided, giving them a dual role as both patient and physician.

Now the director of the Molecular Technologies Laboratory in the Department of Laboratory Medicine and Pathology and proud mom to two sons, Dr. Hasadsri’s experiences provide a unique perspective on the quality of Mayo Clinic Laboratories testing, the importance of timing, and the implications of test results for the future.

“WHEN I SAY A GENETIC TEST IS THE BEST TEST OUT THERE YOU COULD GET FROM THE BEST PEOPLE, I KNOW IT FROM MY OWN EXPERIENCE — I’M NOT JUST HYPING IT UP BASED ON SOME PERFORMANCE METRICS,” DR. HASADSRI SAYS. “I ACTUALLY WENT THROUGH THE PROCESS AND COULD TELL YOU ALL THE THINGS A TEST DOES WELL AND WHAT INFORMATION IT CAN YIELD FOR YOU.”

Back in 2012, Dr. Hasadsri was working through an intense laboratory fellowship. Newly married and pregnant, their life took an unexpected turn when they miscarried the pregnancy. The devastating event triggered a sequence of medical discoveries that saved Dr. Hasadsri’s life and placed them on a genetic testing track that enabled the family of their dreams.

“If that pregnancy and pregnancy loss had not happened, I would not have gotten my cancer diagnosis, I would not have been stage 3 — I would’ve been stage 4. Literally, that baby that never was saved my life.”

Up close and personal with genetic testing

Despite their young age and having no known family history of cancer, Dr. Hasadsri was found to have stage 3 colorectal cancer.  A sample of the tumor tissue underwent somatic testing (current Mayo ID: MCCRC). Much to Dr. Hasadsri’s surprise, the results came back suggestive of Lynch syndrome, a hereditary cancer predisposition syndrome, and a blood sample was submitted for follow-up hereditary testing (current Mayo ID: LYNCP). Advanced sequencing to detect gene variants related to Lynch syndrome, which increases the risk of colon, endometrial, uterine, and other cancers, yielded no pathogenic variants.

The negative test result was the first of many Dr. Hasadsri has received in the past decade. Each result informing their choices and providing reassurance that nothing has been missed. Moreover, the ability to experience each existing and newly implemented oncology test in the lab has provided unique insight into what answers mean to patients.

“IT WAS AN UNREAL EXPERIENCE TO BE TRAINED ON THE TESTS THAT I MYSELF WAS EXPERIENCING — IT REALLY LEVELS UP YOUR LEARNING,” DR. HASADSRI SAYS. “WITH EACH NEW TEST OR TECHNOLOGY THAT WAS LAUNCHED, I WOULD HAVE IT BECAUSE WE WERE TRYING TO SEE WHETHER I HAVE A MOLECULAR EXPLANATION FOR THIS CANCER, EITHER HEREDITARY OR ACQUIRED, BECAUSE EITHER WAY I WOULD HAVE AN ANSWER THAT COULD HELP ME PREPARE OR PLAN MY LIFE ACCORDINGLY.”

Navigating health challenges

For Dr. Hasadsri, the miscarriage marked the beginning of an ongoing testing journey. Just after the loss, blood testing revealed a hemoglobin level of five grams per deciliter (g/dL) of blood. The average hemoglobin in adult females is 12–15 g/dL.

“(My primary care physicians) were like, ‘This is not conducive to a successful pregnancy, and we need to get to the bottom of this,’” explains Dr. Hasadsri.

Due to a known family history of alpha-thalassemia, Dr. Hasadsri was sent to hematology to determine whether an underlying anemia was at play. While suspected hematologic culprits were being discussed, the hematology-oncology fellow performing the physical exam found an abdominal mass.

“The whole time I was feeling exhausted from what turned out to be anemia and having some abdominal pain after eating meals, I'd never even thought to examine myself,” Dr. Hasadsri says. “And then once I actually felt that area of my abdomen, I could definitely palpate it as well. I could push around it and feel my lymph nodes were enlarged too. And so that got me worried.”

Although cancer was within the differential diagnosis, it was not something Dr. Hasadsri easily accepted. “I’m like, ‘maybe I just have really bad inflammatory bowel disease and my colon is just really angry and hardened from that.’”

CT imaging revealed the mass had penetrated two sections of the colon, causing internal bleeding and a low hemoglobin level. Neighboring lymph nodes were also enlarged. During a follow-up colonoscopy, part of the mass was removed and biopsied. Somatic tumor testing revealed features of Lynch syndrome, an inherited cancer predisposition syndrome, but germline testing did not identify any causative genetic variants.

Female colon cancer patients who test positive for Lynch syndrome are at an increased risk of developing uterine, endometrial, endothelial, and gastric cancers, among others.

“If an individual with Lynch syndrome is diagnosed with colon cancer and has a uterus in place, we typically remove the uterus (hysterectomy), fallopian tubes, and ovaries at the time of colon cancer surgery, unless the individual has not completed childbearing,” says Myra Wick, M.D. Ph.D., Dr. Hasadsri’s OB/GYN and medical geneticist. “This reduces cancer risk and the need for additional surgeries in the future.”

The pending nature of Dr. Hasadsri ’s molecular test result at the time they were scheduled to undergo a hemicolectomy, combined with their knowledge that Lynch syndrome diagnosis can only be cemented through molecular genetic testing, empowered them to push back against the recommended surgical approach.

“I remember during the consent process before going into surgery, they were saying, ‘You have Lynch syndrome — we should remove your uterus and ovaries too,’’’ Dr. Hasadsri says. “And I was like ‘WAIT! I still want those, I’m not done with those yet.’”

So the uterus and ovaries stayed. But 75% of Dr. Hasadsri’s colon and more than 30 lymph nodes were removed.

Defying the odds to build a family

After the surgery, Dr. Hasadsri and their spouse, Vincent Pureza, M.D., Ph.D., faced another decision. Because the chemotherapy needed to target any lingering cancer cells would push Dr. Hasadsri into premature menopause and limit their ability to bear genetic offspring, did they want to undergo in vitro fertilization and preserve embryos so they could one day try for the family they still hoped for?

In the end, the answer was yes. Thanks to a grant from the Livestrong Foundation, the couple successfully created and froze five embryos.

Immediately after the egg retrieval, Dr. Hasadsri began chemotherapy. Over the course of six months — all while still training as a Mayo Clinic fellow — they received 12 rounds of treatment.

“I was told that after chemo, you should probably wait at least a year before trying to get pregnant, because all of those harmful chemicals are still in your body. We don't know what effect they're going to have on the eggs, on a potential embryo, or pregnancy,” Dr. Hasadsri says. “And chemo definitely put me in menopause. But just to be safe I also went on birth control afterwards too, because I was like, I’m not going to take any chances.”

But just one month after chemotherapy ended, the unimaginable happened: Dr. Hasadsri conceived naturally.

“My OB/GYN, who is also a medical geneticist, was happy but also a little freaked out. It was too soon,” Dr. Hasadsri says.

“It is always concerning when women become pregnant in the midst of cancer treatment,” Dr. Wick says. “We're not always sure if there will be implications for the pregnancy,” Dr. Wick says. “We don’t know if some of the treatment the patient is on currently or previously might affect fetal growth or be associated with congenital problems. So, Dr. Hasadsri’s pregnancy soon after chemotherapy placed them into a high-risk pregnancy category, where we monitor things more carefully, including the baby's growth.”

The pregnancy, however, was successful, and so was the delivery.

“And that's how my 7-year-old came into being,” Dr. Hasadsri says.

Three years later, after using the frozen embryos and enduring three pregnancy losses, Dr. Hasadsri had accepted their fate.

“It was like, OK, I guess one child’s enough, I’m perfectly happy to have this one miracle baby that I didn’t even think I would have,” they say. “But then I got naturally pregnant with my second at age 40. I feel very lucky.”

Proactively managing diagnosis

Throughout their medical journey, Dr. Hasadsri has followed the screening and testing recommendations for individuals with Lynch syndrome, despite lacking a genetic diagnosis.

“Even though I still carry a Lynch syndrome diagnosis in my chart, it’s because they would rather err on the conservative side and make sure I am managed appropriately, which I am totally on board with,” Dr. Hasadsri says. “I’d rather be screened more often than less since, even if I were eventually found not to have Lynch, I still worry about my risk of a cancer recurrence.”

That translates into annual colonoscopies. Before having their second son, Dr. Hasadsri also received annual endometrial biopsies. Not long after the baby was born, Dr. Hasadsri underwent a hysterectomy and oophorectomy.

“I’M GETTING TO NOT JUST WITNESS THE PROGRESS BEING MADE IN GENETIC TESTING OF TUMORS AND FOR HEREDITARY CANCER PREDISPOSITION SYNDROMES BUT GETTING TO PERSONALLY EXPERIENCE IT AT THE SAME TIME, WHICH IS INCREDIBLE,” DR. HASADSRI SAYS. “BY HAVING TESTING DONE, I GOT TO ACTUALLY SEE HOW IT PERFORMED AND WHEN THOSE TESTS BECAME CLINICALLY LIVE AND AVAILABLE TO ALL PATIENTS, I KNEW FROM TRULY PERSONAL EXPERIENCE HOW FANTASTIC THOSE TESTS WERE.”

As the sensitivity and specificity of genetic sequencing have increased and genetic targets become more defined, it is possible that a genetic association with Lynch syndrome will eventually be discovered for Dr. Hasadsri. But to date, each new test has yielded negative results.

“I am definitely an example of how sometimes a negative result is just as powerful and just as relieving as a positive one,” Dr. Hasadsri says. “Or that it inches you a bit more toward closure. It's still very, very gratifying and satisfying because you're like, ‘OK, that's just one more piece of evidence that it's probably not something that I inherited or that my kids could inherit from me.’”

Translating experience into action

While Dr. Hasadsri’s interest in genetic testing evolved long before their personal journey intersected with hereditary cancer testing, the experience has fueled their passion.

“Just recently we had an example of a potentially difficult diagnosis with a pregnant patient, it was a condition that is tested for in our laboratory, and Dr. Hasadsri really went the extra mile to test additional family members and send tests kits out,” Dr. Wick says. “I think that is just part of their personality and how they function, and illustrated meeting the needs of the patients and going all out to make sure that happens.”

Having felt the many emotions that correspond with cancer testing, Dr. Hasadsri understands deeply what is at stake for patients seeking answers.

“EVERY PATIENT DOES HAVE A LAB TEST AT SOME POINT, AND SO I THINK THAT LABORATORY MEDICINE AND PATHOLOGY IS ESPECIALLY RELATABLE FOR THE PEOPLE WHO WORK IN THE FIELD,” DR. HASADSRI SAYS. “BUT IN MY CASE, I FEEL LIKE IT WAS EXTRA REAL BECAUSE I WAS THAT PATIENT GOING THROUGH THAT PROCESS ANXIOUSLY WAITING. IF IT’S AT THE END OF THE DAY AND YOU’VE GOT AN EXTRA CASE, FOR INSTANCE, YOU WANT TO TAKE THE TIME TO GET THE CASE OUT, EVEN THOUGH IT’S STILL WITHIN TURNAROUND TIME AND COULD WAIT UNTIL THE NEXT DAY, YOU DON’T BECAUSE YOU KNOW WHAT IT MEANS TO BE THAT PATIENT. BECAUSE YOU WERE THAT PATIENT.”

This article first appeared on the Mayo Clinic Laboratories blog.

The post Personal journey shapes unique perspective appeared first on Mayo Clinic News Network.

Getting vaccinated for COVID-19 during pregnancy might protect not only the pregnant woman, but also the baby after birth. That's what a recent Center for Disease Control and Prevention (CDC) study suggests.

Data show that being vaccinated, even before pregnancy, can prevent COVID-19 hospitalizations among infants 6 months and younger.

Dr. Myra Wick, a Mayo Clinic OB-GYN, explains why the findings are significant.

Watch: Dr. Myra Wick discusses COVID-19 vaccination during pregnancy.

Journalists: Broadcast-quality video is available in the downloads at the end of the post. Please "Courtesy: Mayo Clinic News Network." Name super/CG: Myra Wick, M.D., Ph.D., Obstetrics and Gynecology.

The study looked at two groups of infants 6 months and younger who had been admitted to the hospital. One group was admitted for COVID-19 infection. The second was admitted for various other reasons.

Researchers then looked at the vaccination statuses of the mothers during pregnancy to see if being vaccinated provided some protection after delivery for the infants. The babies whose mothers were vaccinated during pregnancy were found to be protected for up to six months after birth.

How do babies gain this protection?

"When the mom is vaccinated, she produces antibodies, and these antibodies can be transferred through the cord blood to the baby and provide what we call 'passive immunization.' The antibodies transferred from the mom protect the infant against COVID infection."

Dr. Wick says one of the best examples of this, prior to COVID, is the tetanus diphtheria and acellular pertussis booster, or Tdap.

"We vaccinate all women who are pregnant with Tdap, regardless of when they were vaccinated previously," says Dr. Wick. "Mom produces an increased number of antibodies in response to the vaccination. These are transferred to the fetus and provide protection against pertussis (whooping cough)."

Why are these findings significant?

"It just gives us another reason to encourage moms to vaccinate during pregnancy. We know that moms who are pregnant and get COVID-19 are at increased risk for needing hospitalization, ICU care, ventilation, even death. And that data has been pretty well established. Those are all reasons to be vaccinated, and now knowing that there could be protection for the baby, as well, is very exciting. And seeing that protection up to six months ― that's wonderful."

Guidance for those who have not been vaccinated for COVID-19, and are pregnant or plan to become pregnant

"Vaccinate. We know that there aren't any adverse effects. There are over 185,000 women enrolled in the V-Safe Program, which is a tracking program through the CDC after COVID vaccination, who have reported that they were pregnant at the time of receiving the COVID vaccine. There haven't been any increased number of adverse events or effects in women who have received the vaccine. We also know that there aren't any issues with fertility. There aren't any issues with miscarriage associated with the vaccine."

COVID-19 vaccination during pregnancy is recommended to prevent severe illness and death in women who are pregnant. Infants are also at risk for COVID-19 associated complications, including respiratory failure and other life-threatening complications.

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For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.

Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date. 

For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

Learn more about tracking COVID-19 and COVID-19 trends.

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On the next Mayo Clinic Radio program, Dr. Minetta Liu, a medical oncologist at Mayo Clinic, will break down the latest results of the Mayo Clinic National Health Check Up. Also on the program, Dr. Myra Wick, a medical geneticist at Mayo Clinic, will explain the latest advances in prenatal screening. And Dr. Karthik Balakrishnan, an otolaryngologist at Mayo Clinic, will discuss treatment for pediatric ear, nose and throat problems.

Here's your Mayo Clinic Radio podcast.

The post National Health Checkup / advances in prenatal screening / pediatric ear, nose and throat problems: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Minetta Liu, a medical oncologist at Mayo Clinic, will break down the latest results of the Mayo Clinic National Health Check Up. Also on the program, Dr. Myra Wick, a medical geneticist at Mayo Clinic, will explain the latest advances in prenatal screening. And Dr. Karthik Balakrishnan, an otolaryngologist at Mayo Clinic, will discuss treatment for pediatric ear, nose and throat problems.

To hear the program, find an affiliate in your area.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: National Health Checkup appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Minetta Liu, a medical oncologist at Mayo Clinic, will break down the latest results of the Mayo Clinic National Health Check Up. Also on the program, Dr. Myra Wick, a medical geneticist at Mayo Clinic, will explain the latest advances in prenatal screening. And Dr. Karthik Balakrishnan, an otolaryngologist at Mayo Clinic, will discuss treatment for pediatric ear, nose and throat problems.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: National Health Checkup / advances in prenatal screening / pediatric ear, nose and throat problems appeared first on Mayo Clinic News Network.

New genomic technology is reshaping perinatal screening, which is testing before and during pregnancy to assess the health of a baby. Now pregnant women can have their baby initially screened for genetic disorders, such as Down syndrome, through the use of a newer blood test that evaluates DNA from the placenta present in the mother’s blood stream. Another test for couples planning a family uses a single blood sample to assess whether future children might be at risk for developing a genetic disease.

“It’s an exciting time in perinatal testing,” explains Myra Wick, M.D., Ph.D. “DNA sequencing and molecular technology has improved and become more cost effective. These tests are important for family planning prior to pregnancy as well as planning for the care of a child who is found to have a genetic disorder during pregnancy. ”

Three state-of-the-art perinatal genetic tests are highlighted below. Researchers from the Center for Individualized Medicine have helped implement several of these tests, which use a personalized medicine approach in perinatal screening.

1. Cell free DNA testing

Mayo Medical Laboratories recently launched a blood test to screen for the most common chromosome disorders diagnosed in pregnancy, such as Down syndrome. It’s known as a cell-free DNA test. It screens the mother’s blood that contains DNA from the baby, looking for genetic disorders in the fetus. The new test generally has a higher detection rate and fewer false positives than traditional screening tests.

“Prior to this new test, mothers had the option of traditional first trimester screening, which is a blood test and ultrasound, or second trimester screening, which is a blood test. In general, the cell free DNA blood test can be used in place of the traditional first and second trimester screening,” explains Dr. Wick. It is important to remember that the cell free DNA testing is a screening test, and abnormal results should be followed up with additional testing. Read the rest of the article on Advancing the Science.

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Other Mayo Clinic medical research websites:

• Advancing the Science
• Discovery’s Edge
• Forefront
• Mayo Clinic Center for Individualized Medicine
• Mayo Clinic Center for Innovation
• Mayo Clinic Center for Regenerative Medicine
• Research at Mayo Clinic

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Recently, the U.S. Food and Drug Administration published recommendations that women, especially those at high risk,  should not rely on screening blood tests to check for ovarian cancer, because the tests are unreliable.

Mayo Clinic experts say all women who have ovaries are at risk of ovarian cancer. But, the risk increases for women with a family history of ovarian cancer and those who have certain genetic mutations.

In this Mayo Clinic Minute, reporter Vivien Williams talks to Dr. Myra Wick about the connections between genetics and ovarian cancer.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:10) is in the downloads. Read the script.

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According to the Centers for Disease Control and Prevention, 20,000 women in the U.S. are diagnosed with ovarian cancer every year. Most cases happen spontaneously, but a small percentage of women diagnosed with ovarian cancer have a genetic mutation that increases their risk of the disease.

In this Mayo Clinic Minute, reporter Vivien Williams talks to Dr. Myra Wick about genetics and ovarian cancer.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:10) is in the downloads. Read the script.

The post Mayo Clinic Minute: Ovarian Cancer Genes appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC:

ANSWER: For a woman carrying a BRCA mutation without a personal history of cancer, hormone replacement therapy, or HT, is usually recommended from the time your ovaries are removed until you turn 50. Beyond that age, the risks of continuing HT for a BRCA mutation carrier are not fully known. So HT is usually stopped around age 50. Going without any hormone therapy after prophylactic oophorectomy may increase the likelihood of some significant health risks, including problems that could affect your bones, heart and brain.

A mutation in the BRCA1 gene significantly raises your risk of breast and ovarian cancer. Surgery done in an effort to prevent cancer by removing the breasts, called prophylactic mastectomy, and removing the ovaries, called prophylactic oophorectomy, often can dramatically lower those cancer risks.

The surgeries, however, pose their own health risks. Because your ovaries make most of your body’s estrogen — one of the hormones that regulates your menstrual cycles — removing your ovaries triggers menopause. That means after your surgery, you are likely to have menopause symptoms, such as hot flashes, night sweats and vaginal dryness.

When menopause happens before age 50, which is considered the average age for it, research suggests the risk goes up for bone thinning, heart disease, parkinsonism, anxiety, depression and dementia. After your ovaries are removed, HT during your 40s may provide some protection against these health risks.

Hormone replacement therapy involves taking medications containing female hormones to replace the ones your body no longer makes after menopause. Estrogen typically is prescribed along with the hormone progesterone or a medication similar to progesterone called progestin. This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the uterine lining, increasing the risk of uterine cancer. If you have your uterus removed, you won’t need progesterone.

To get the best protective effect, you will likely need systemic HT. That means the hormones are delivered to your entire body. Along with reducing your risk for heart, bone and brain problems, systemic HT often effectively decreases hot flashes, night sweats and vaginal symptoms of menopause. Hormone replacement therapy comes in a variety of forms, including pills, skin patches, gels, creams, sprays and a vaginal ring. Talk to your doctor about which is best for you.

It is important to note that if you have already had breast cancer, HT is not appropriate for you at any age. That’s because HT can increase the risk that certain kinds of breast cancer could come back.

Research is currently underway to see if surgically removing only the fallopian tubes, a procedure called salpingectomy, could be a viable alternative to prophylactic oophorectomy for women who have a BRCA gene mutation. Studies have found that a relatively high percentage of ovarian cancers begin in the fallopian tubes. Removing the fallopian tubes before cancer begins may be an effective way to prevent ovarian cancer while avoiding the side effects of ovary removal. This is still under investigation and is not standard care at this time. However, talk to your surgeon about your options before you have surgery.

Hormone replacement therapy can be a complicated topic. It is important that you fully understand the risks and benefits in your situation before you move forward. Talk with your doctor about his or her recommendations based on your medical history, as well as your individual circumstances. Ask questions and get the information you need to feel comfortable making a well-informed decision. — Myra Wick, M.D., Ph.D., Obstetrics and Gynecology, and Mary Marnach, M.D., Women’s Health Clinic, Mayo Clinic, Rochester, Minn.

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ANSWER: It is not clear what causes morning sickness — the nausea and vomiting many women have during pregnancy. There are home remedies you can try that may help. If you start to lose weight, if you can’t keep liquids down or if vomiting becomes severe, see your doctor right away.  

Although it is called morning sickness, that term is not accurate, as the symptoms can happen any time and, in some women, may last all day. Morning sickness is most common during the first trimester. But when it starts and how long it lasts can vary quite a bit. In a small number of cases, morning sickness can be an issue throughout pregnancy.  

Doctors don’t know exactly why women get morning sickness. The hormone changes that happen during pregnancy are thought to play a role. When pregnancy begins, a woman’s body starts making a hormone called human chorionic gonadotropin (hCG). Morning sickness often kicks in when production of hCG begins. The production of hCG tends to be higher in twin pregnancies. The fact that morning sickness is more common in women carrying twins seems to reinforce the theory that hCG is connected to morning sickness.  

Whatever the cause, morning sickness can be hard to prevent. There are ways you may be able to make it less bothersome, though. For example, nausea tends to be worse when your stomach is completely full or empty. So rather than eating three large meals a day, eat smaller amounts more often. Many women find that snacking on soda crackers or dry toast can quell feelings of queasiness. Drink plenty of fluids throughout the day, too. But don’t drink too much at one time. Water and ginger ale are often good choices.  

Limit the amount of greasy, spicy or fatty foods you eat, as they are more likely to cause nausea and vomiting. The smell of certain foods, especially during cooking, can be a problem for some women with morning sickness. Try to avoid using problematic foods if you are preparing meals, and enlist someone else to help make meals if cooking triggers nausea.  

Also, pay attention to when and how you take your prenatal vitamins. Some women find that taking them in the morning makes nausea worse. If that’s the case for you, try taking them at night. Having a snack, chewing gum or sucking on hard candy after you take your vitamins also may help. Taking a children’s chewable multivitamin in place of prenatal vitamins may be an option, too.  

If nausea and occasional vomiting continue, your doctor may suggest over-the-counter medications. A combination of doxylamine succinate, a sleep aid, and vitamin B6 often decreases symptoms. Both of these medications are safe in pregnancy. If that doesn’t work, a prescription medication, such as promethazine or ondansetron, may be useful.  

For most women, morning sickness is a nuisance that fades as pregnancy progresses. However, a small percentage of women develop serious nausea and vomiting, called hyperemesis gravidarum, which could threaten their health and possibly the health of the baby.  

Women who have hyperemesis gravidarum often become dehydrated and lose weight. If it isn’t treated quickly, hyperemesis gravidarum can lead to hospitalization. In the hospital, intravenous fluids and nutrition may be used to treat severe morning sickness. Rarely, hyperemesis gravidarum may result in premature birth or low birth weight. Fortunately, morning sickness often can be successfully managed — even in more serious cases — without long-term health risks to the mother or baby. — Myra Wick, M.D., Ph.D. , Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.

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