Treatment of morning sickness

Nausea and vomiting are common in pregnancy, commonly known as morning sickness and can have a significant negative effect on women’s health. Approximately half of all pregnant women in the United States have nausea and vomiting in early pregnancy, and about 25% have nausea alone. Only about 25% of pregnant women are free of any such problem. The problem can vary in severity. The mildest form is often referred to as morning sickness and the most severe form is called hyperemesis gravidarum. 

Hyperemesis involves persistent vomiting, weight loss greater than 5%, abnormalities in various blood chemistries, and dehydration. Hyperemesis usually results in the need for hospitalization, treatment with intravenous fluids, and even intravenous feeding. Approximately 1% of pregnant women have vomiting severe enough to require hospitalization.

Persistent mild nausea, however, can also be a significant problem. It is not just “morning sickness” for many of these women. Approximately 35% of women with nausea during pregnancy lost time from work, and 25% cannot function well at home throughout the day.

Unfortunately, women who are suffering from nausea and vomiting in pregnancy frequently do not seek or receive effective treatments out of concern over safety of taking medications in early pregnancy. however, there are safe and effective options for women who suffer from this problem.

Triggers which cause morning sickness

It is unknown why some women experience nausea and vomiting of pregnancy and others do not. Some patients can identify the triggers of their nausea and thus can avoid aggravating odors or foods. These triggers are individualized so what works for one woman might not work for another. Often, a period of trail and error is needed to find the right combination of factors that will prevent or reduce nausea and vomiting.   Dietary modifications include:

  • eating frequent and small meals
  • drinking fluids between meals
  • eating primarily bland, dry, and high-protein foods
  • avoiding fatty or spicy foods
  • eating cold or frozen foods (like a popsicle) which may reduce the smell of a food which can be an aggravating factor
  • stopping the use of prenatal vitamin tablets with iron (iron can cause nausea)

 Vitamin B6 and Doxylamine

Vitamin B6, also known as pyridoxine)  is a good initial therapy for women whose nausea and vomiting cannot be managed with changes in diet. Studies using various doses (10 mg to 25 mg up to three times a day) of Vitamin B6 have shown considerable success at eliminating or reducing nausea and vomiting in early pregnancy. Using an extended release formulation may allow a woman to take just one tablet a day instead of multiple tablets. A Google search for “Vitamin B6” or “Vitamin B6 extended release” will turn up a variety of products.If vitamin B6 alone is not successful, the antihistamine doxylamine can be added. Doxylamine is easily available as Unisom SleepTabs, which contain 25 mg of doxylamine per tablet.  A regimen advocated by some experts is one full tablet of Unisom at night, along with a half tablet in the morning and a half-tablet in the afternoon if some nausea persists along with 25 mg of vitamin B6 at each of these times of the day.

A product containing both Vitamin B6 and doxylamine is available in the United States under the brand name Diclegis. Diclegis is the only FDA approved treatment for morning sickness. The FDA recommends a starting dose every day at bedtime and on an empty stomach. The dose can be boosted to a maximum of 4 doses per day — one in the morning, one in midafternoon, and 2 at bedtime — if need be.

Interestingly, some studies have suggested that women who have taken multivitamins containing vitamin B6 before pregnancy have less nausea and vomiting.

Other possible treatments

Ginger

Ginger ale has been a traditional remedy for nausea in various populations. There have been a few small studies which showed that ginger capsules were more effective than placebos (sugar pills)  and another few studies which showed ginger capsules worked as well as vitamin B6.

Acupuncture and acupressure

The data regarding the effectiveness of acupuncture is not as convincing as for Vitamin B6 or ginger. However, there appears to be little risk. Nerve stimulation of the P6 acupuncture point also appears to decrease the nausea and vomiting of pregnancy for some women. Acupressure with devices like the Sea-Band which stimulate an acupressure point at the wrists have also been used but with varying results.

Other medications Ginger and vitamin B6—alone or in combination with doxylamine—do not work for everyone. Other types of anti-histamines will sometimes be used by obstetricians to help control nausea and vomiting of pregnancy.

The serotonin antagonist ondansetron (Zofran) was used successfully for several years a treatment for nausea and vomiting of pregnancy. However, recent studies have suggested there may be an increase in the risk for birth defects associated with its use so it is no longer recommended.