New Guidelines on Treating Pregnancy Morning Sickness
By Jennifer Lincoln, MD, IBCLC, Board Certified OB/GYN
Morning sickness is a side effect of pregnancy that no woman likes to experience, yet up to 85 percent of women do at some point. With this being such a common issue in pregnancy, expectant mothers should know some of the new guidelines about the treatment of this condition.
There are some natural remedies that you can try to treat your nausea and vomiting during pregnancy, but many women do eventually opt to ask their doctors or midwives for a prescription medication to help them feel better.
The American College of Obstetricians and Gynecologists (ACOG) released some updated guidelines regarding the management of morning sickness and hyperemesis gravidarum (the very severe form of morning sickness that about 2 percent of women experience) in September 2015. It’s likely that your obstetric provider has heard of this and may change what he or she is prescribing based on these recommendations.
Various drugs exist to treat nausea and vomiting in pregnancy, but a newer one on the market is a combination of two drugs: vitamin B6 (also known as pyridoxine) and doxylamine (a common sleep aid). This “new” drug is actually an old one, and was on the market in the United States from 1958 until 1983 when it was removed. During this time, about 30 percent of all pregnant women took this medication. Interestingly, when this drug was available the number of women who were hospitalized for nausea and vomiting dropped drastically. As soon as this drug was taken off the market, the rates of hospitalization went right back up.
We now know that the combination of vitamin B6 and doxylamine is safe in pregnancy — over 170,000 exposures have been followed — and because of this, it is again available to American women. One large study also showed that this medication led to a 70 percent decrease in nausea and vomiting. This drug is now available as a delayed release form where 10mg of each ingredient are in each tablet, and it is marketed under the brand name Diclegis.
ACOG now states that this drug combination should be the first therapy a woman tries to treat her nausea and vomiting during pregnancy, if she has already tried lifestyle and diet modifications, and they haven’t worked (these include smaller frequent meals, bland meals, etc). Options for taking this medication include getting a prescription from your doctor or midwife or taking vitamin B6 and pyridoxine separately (which you can get over the counter without a prescription, but they are not in the delayed release form that seems to be more effective in studies).
Other medications do exist for treating morning sickness during pregnancy, and many women have tried or will try some combination of them. One popular one is Ondansetron, also known as Zofran. This drug has made headlines recently for concerns over associated birth defects, including cleft palate and heart defects. However, ACOG states that studies are limited and the ones that we do have are conflicting, so more research is needed. With the overall risk likely being very low to the fetus, it is a drug that can be considered after the risks and benefits are reviewed with the patient, but it shouldn’t be the first drug a woman tries to feel better.
The American College of Obstetricians and Gynecologists
- Practice Bulletin #153: Nausea and vomiting of pregnancy
- September 2015.
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