From the Guidelines
Treatment options for nausea during pregnancy should start with lifestyle modifications and non-medication approaches, with vitamin B6 and doxylamine being considered first-line medication therapy. The most recent and highest quality study, published in 2024 in the journal Gastroenterology 1, recommends diet and lifestyle modification as the initial steps in managing nausea and vomiting during pregnancy. This includes reducing spicy, fatty, acidic, and fried foods, eating small, frequent, and bland meals, and identifying and avoiding specific triggers.
For mild to moderate symptoms, consuming ginger products (tea, candies, or capsules containing 250mg four times daily) and wearing acupressure wristbands can be helpful. Vitamin B6 (pyridoxine) at 10-25mg every 8 hours is considered first-line medication therapy and can be combined with doxylamine (an antihistamine) for more severe symptoms.
- Key considerations for treatment include:
- Assessing the severity of nausea and vomiting using a scoring system such as the Motherisk Pregnancy Unique Quantification of Emesis score
- Identifying and avoiding specific triggers
- Staying hydrated and eating small, frequent meals
- Considering prescription medications such as promethazine, metoclopramide, or ondansetron for refractory cases, as recommended by studies published in 2023 in the Annals of Oncology 1
- Ensuring safe use of medications during pregnancy, with ondansetron being considered safe for use in pregnancy, as noted in a 2021 study published in Hepatology 1
It is essential to consult with a healthcare provider before starting any medication during pregnancy to ensure appropriate treatment for the specific situation. Severe cases of nausea and vomiting may require IV fluids and hospitalization, and early intervention and treatment can help prevent progression to hyperemesis gravidarum.
From the FDA Drug Label
8.1 Pregnancy
The FDA drug label does not answer the question.
From the Research
Treatment Options for Nausea During Pregnancy
- The treatment options for nausea during pregnancy include vitamin B6, anti-emetic medication, ginger, and acupressure 2, 3, 4, 5.
- Vitamin B6 is officially recommended in the USA, Canada, and Australia for the treatment of mild to moderate pregnancy sickness and vomiting, and its harmlessness has been established for doses up to 40-60mg/day 2.
- Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy, with some evidence of adverse effects, but limited information on effects on fetal outcomes 3, 4.
- Ginger may be of benefit in reducing nausea, but the evidence is weak 3, 4, 5.
- Pyridoxine-doxylamine combination and ondansetron have been associated with improved symptoms compared to placebo, especially for moderate symptoms 5.
- Corticosteroids may be associated with benefit in severe cases of hyperemesis gravidarum 5.
Medication-Specific Treatment Options
- Vitamin B6 can be taken orally, 10mg four times a day, alone or in combination with doxylamine 2.
- Ondansetron has been associated with improvement for a range of symptom severity, but its safety during pregnancy has been a topic of debate 5, 6.
- Metoclopramide and promethazine have been compared in clinical trials, with no significant difference in reducing nausea and vomiting after 24 hours 5.