Hypersalivation in pregnancy: understanding, preventing and relieving it

Pregnancy hypersalivation, also known as ptyalism gravidarum or hypersialorrhoea, is an excessive production of saliva in the mouth. A pregnant woman affected by this condition can produce 1 to 2 litres of saliva per day. This symptom affects some pregnant women, particularly during the first trimester. It can be unpleasant and may disrupt day-to-day quality of life.

Several factors explain this excess saliva production:

• Hormonal fluctuations, in particular human chorionic gonadotropin beta (b-HCG) and elevated oestrogen levels.
• Nausea and vomiting, which often prevent normal swallowing. This is all the more common in those who experiencehyperemesis gravidarum, a severe form of nausea and vomiting.
• Acid reflux during pregnancy. Heartburn irritates the oesophagus (due to stomach acid), which in turn stimulates the salivary glands to produce more saliva in order to neutralise the gastric acid. 

In general, pregnancy hypersalivation eases during the second trimester. An improvement is often observed towards the end of the third month (around 12 to 14 weeks of pregnancy). However, this symptom may persist throughout the entire pregnancy until delivery, and even into the early post-partum period. In these cases, it is important to speak to your doctor or midwife so that advice can be tailored to improve your daily comfort.

It is normal for saliva production to vary throughout the day, or even increase slightly during pregnancy. However, hypersalivation is distinguished by its intensity and persistence. Unlike an increased but occasional production by the salivary glands (for example when hungry or in response to olfactory stimulation), ptyalism gravidarum causes constant discomfort. Affected mothers often feel an irresistible urge to spit, sometimes several times a minute, which can affect their social, professional and emotional lives. You may also notice a thickening of the tongue.

This phenomenon should therefore not be trivialised, even if it is medically benign.

Pregnancy hypersalivation, although uncomfortable, does not endanger the baby's health. However, this pregnancy ailments can considerably impact the wellbeing of the expectant mother: 

• Increased fatigue due to constant discomfort.
• Pregnancy nausea worsened, particularly if saliva is swallowed, as it has a bitter taste.
• Sleep disruption in cases of excessive salivation at night. It is common for this phenomenon to ease at night, but unfortunately this is not always the case.
• Risk of mild dehydration, especially if saliva is consistently spat out.
• Difficulty eating, meaning the mother eats less and may even lose weight. You can take a food supplement for pregnant women to help ensure you meet your nutritional needs. 
• Unfortunately, this can also cause significant emotional distress and social difficulties for the pregnant mother.
   

Fortunately, hypersalivation has no direct effect on the foetus. However, if it is associated with severe vomiting (hyperemesis gravidarum), medical monitoring is necessary.

When faced with pregnancy hypersalivation, several approaches may therefore be considered. Natural remedies are a good place to start. These include in particular: 

• Ginger (as an infusion or lozenges) can be a great help.
• Regular hydration to thin the saliva. Drinking water regularly will indeed be beneficial. 
• Lemon (lemon water or lemon sweets) to neutralise the unpleasant taste.
• Small, frequent meals to reduce the feeling of a full mouth. Avoid large meals with heavy foods. A pregnancy snack is a good idea. Be mindful of foods that may upset your stomach and foods that are too fatty.
• Brushing your teeth several times a day. 
• You can also try chewing sugar-free gum. This will not reduce saliva production, but will make swallowing easier.

Mothers affected by this condition are often forced to use cups, tissues, and other means to manage excess saliva. Try to swallow the excess saliva if possible. 

When the discomfort becomes too significant, medical support may be considered. Certain medical treatments may be prescribed by a healthcare professional, always with caution during pregnancy. However, no treatment should be taken without prior medical advice.

The first point of contact remains the midwife or the obstetrician-gynaecologist following the pregnancy. This professional will be able to assess the severity of the symptoms and propose appropriate management. If in doubt, or if associated symptoms are present (frequent vomiting, severe reflux, pain), a referral to a gastroenterologist or an ENT specialist may be useful to rule out any organic cause unrelated to pregnancy. It is important not to minimise this condition and to discuss it openly during appointments.

Theacupuncture during pregnancy may also be considered to help reduce this symptom, as may homoeopathy. 

Excessive salivation, though unusual and often little understood, is one of the many changes the body can go through during pregnancy. While it is generally harmless, it can nonetheless become a significant source of daily discomfort. Understanding its origins, speaking openly about it with healthcare professionals, and trying natural remedies or appropriate medical treatments (acupuncture, homoeopathy, etc.) can often help you manage it better, or even ease it. Every pregnancy is unique, and this is just one illustration of that. With compassionate support and a few adjustments, it is entirely possible to get through this period more peacefully, while taking care of yourself and your wellbeing.

According to some beliefs: excessive salivation during pregnancy means you are expecting a boy. Nothing has been proven, but there is a one-in-two chance it could be true!