Managing Nausea and Vomiting in Pregnancy

The American College of Obstetricians and Gynecologists (ACOG) recently published new clinical management guidelines for nausea and vomiting in pregnancy. The guidelines give options for both pharmacologic and non-pharmacologic treatment of these symptoms, which more than 50% of patients experience in pregnancy.

Over the past few years, it seems that patients have become more hesitant to use pharmacologic agents to treat nausea and vomiting in pregnancy due to reports of some medications possibly increasing the risk of congenital malformations.  As stated in ACOG’s guidelines though, there are very safe medications available.

Some things that patients can do to prevent and treat symptoms of nausea and vomiting in pregnancy include the following:

  • Start taking a prenatal vitamin at least 1 month before conceiving.  Some studies show that building up vitamin stores prior to pregnancy may actually reduce the incidence and severity of nausea and vomiting in pregnancy.
  • If you experience these symptoms in the first trimester, first line options for treatment include converting your prenatal vitamin to a folic acid supplement only, taking ginger capsules, and using acupressure wristbands.
  • If the above isn’t enough, Vitamin B6 (pyridoxine) supplements with or without the concurrent use of doxylamine (Unisom) would be the next thing to try.
  • If symptoms still persist after that, medications, such as dimenhydrinate (Dramamine) and diphenhydramine (Benadryl), are additional over-the-counter options that may help.  Other medications, such as prochlorperazine (Compazine) and promethazine (Phenergan), may be prescribed by your doctor.
  • After that, medications such as metoclopramide (Reglan) and ondansetron (Zofran), would be the next line of treatment.

There are some patients who won’t get relief from any of the above treatments and may need IV hydration, and even IV nutrition, for severe cases.

If you’re planning to conceive, start taking that prenatal vitamin now.  If you’re already pregnant and experiencing symptoms of nausea and vomiting, talk to your doctor before it gets worse.  Once nausea and vomiting progress, it can be more difficult to control symptoms. Early treatment may also prevent progression to more serious symptoms and possibly avoid hospitalization.  For most patients, early treatment will give them a chance to be able to focus on the more joyous parts of pregnancy.

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