From the Guidelines
Morning sickness during the first trimester can be effectively managed with a stepwise approach, starting with lifestyle modifications and progressing to medication if necessary, as recommended by the American College of Obstetricians and Gynecologists (ACOG) 1. The initial steps in managing morning sickness include diet and lifestyle modifications, such as reducing spicy, fatty, acidic, and fried foods, eating small, frequent, and bland meals, and avoiding specific triggers like strong odors or activities 1.
- Consuming ginger, either as tea, candies, or supplements of 250mg four times daily, can also be helpful in alleviating symptoms 1.
- Additionally, wearing acupressure wristbands and staying hydrated are recommended as part of the initial management strategy 1. If these measures do not provide relief, medication options can be considered, including:
- Vitamin B6 (pyridoxine) 10-25mg three times daily, which can be combined with doxylamine (Unisom) 12.5mg at night 1.
- For more severe cases, prescription medications like Diclegis (doxylamine/pyridoxine combination), ondansetron (Zofran) 4-8mg every 8 hours, or promethazine (Phenergan) 12.5-25mg every 4-6 hours may be recommended 1. These medications work by targeting different pathways involved in nausea and vomiting, such as neurotransmitter regulation, reduction of sensitivity in the vomiting center, and blockade of serotonin receptors 1. It is essential to seek medical attention if symptoms worsen or if there are signs of dehydration, severe vomiting, or weight loss exceeding 5% of pre-pregnancy weight, as these may indicate hyperemesis gravidarum requiring more intensive treatment 1.
From the Research
Treatment Options for Morning Sickness
The treatment options for morning sickness during the first trimester can be categorized into several approaches:
- Conservative measures: Dietary changes, emotional support, and alternative therapy such as ginger or acupressure can be effective in managing mild cases of morning sickness 2.
- Pharmacologic therapy: Medications like pyridoxine and doxylamine have been shown to be safe and effective treatments for nausea and vomiting of pregnancy 2, 3.
- Combination therapy: The combination of doxylamine and pyridoxine is considered a first-tier treatment option for nausea and vomiting of pregnancy 3.
Medications for Morning Sickness
Some medications that have been used to treat morning sickness include:
- Doxylamine succinate-pyridoxine hydrochloride (Diclegis): This is the only FDA-approved medication for the treatment of nausea and vomiting of pregnancy 3.
- Ondansetron: Although it has been used as a second-line treatment option, its use during the first trimester is now controversial due to potential risks of orofacial clefts and congenital heart defects 4.
- Metoclopramide: This medication has been used as a treatment option for nausea and vomiting of pregnancy, but its use should be individualized and monitored closely 4.
Preventing Recurrence of Severe Morning Sickness
Pre-emptive use of antinauseants, such as doxylamine-pyridoxine, before symptoms start can help prevent recurrence of severe morning sickness in subsequent pregnancies 5.