From the Guidelines
Nausea during pregnancy can be effectively managed with a stepwise approach, starting with dietary changes and lifestyle modifications, followed by medication therapy with vitamin B6 and doxylamine, as recommended by the American College of Obstetricians and Gynecologists (ACOG) 1. The initial step in managing nausea during pregnancy involves dietary changes, such as eating small, frequent meals, avoiding spicy or fatty foods, and consuming ginger in various forms (tea, candies, or capsules of 250mg four times daily) 1.
- Staying hydrated by consuming cold, clear beverages is also essential.
- Identifying and avoiding specific triggers, such as certain foods with strong odors or activities, can help alleviate symptoms. If symptoms persist or are severe, therapeutic options include:
- Vitamin B6 (pyridoxine) at 10-25mg every 8 hours, as recommended by ACOG 1.
- Doxylamine, an antihistamine, which is US Food and Drug Administration–approved and recommended by ACOG for persistent nausea and vomiting of pregnancy (NVP) refractory to non-pharmacologic therapy 1.
- Combination therapy with doxylamine and pyridoxine, available in 10 mg/10 mg and 20 mg/20 mg combinations, which is safe and well-tolerated 1. For more severe cases, prescription antiemetics may be necessary, including:
- Ondansetron, metoclopramide, and promethazine, which may be required in moderate to severe cases, as stated in the AGA clinical practice update on pregnancy-related gastrointestinal and liver disease: expert review 1. Early treatment of nausea and vomiting of pregnancy may reduce progression to hyperemesis gravidarum, emphasizing the importance of prompt intervention 1.
From the FDA Drug Label
Pregnancy Category A—The requirement for pyridoxine appears to be increased during pregnancy Pyridoxine is sometimes of value in the treatment of nausea and vomiting of pregnancy.
- Treatment options for nausea during pregnancy may include pyridoxine, as it is sometimes of value in treating nausea and vomiting of pregnancy 2.
- The requirement for pyridoxine appears to be increased during pregnancy, indicating a potential benefit of supplementation.
From the Research
Treatment Options for Nausea during Pregnancy
- Doxylamine-pyridoxine is recommended as a first-line treatment for nausea and vomiting during pregnancy, as shown in a study published in 2018 3.
- The combination of doxylamine and pyridoxine has been found to have a trend towards efficacy for nausea and vomiting symptoms compared to placebo, although the statistical significance of the difference depends on the method of handling missing data 3.
- Pyridoxine (Vitamin B6) supplementation has been widely used to treat nausea and vomiting during pregnancy, and a systematic review and meta-analysis published in 2023 found that it significantly improved symptoms of nausea 4.
- Lifestyle and dietary changes are also important components in managing nausea and vomiting during pregnancy, with a study published in 2003 finding that all 500 women surveyed reported that dietary and lifestyle changes helped to improve their symptoms 5.
- The American College of Obstetricians and Gynecologists (ACOG) recommends that nausea and vomiting of pregnancy be distinguished from nausea and vomiting related to other causes, and that treatment be individualized based on the severity of symptoms and the woman's perception of their severity 6.
- Safe and effective treatments are available for more severe cases of nausea and vomiting during pregnancy, and mild cases may be resolved with lifestyle and dietary changes 7, 6.
Pharmacological Treatments
- Doxylamine succinate-pyridoxine hydrochloride (Diclegis) is currently the only medication approved by the US Food and Drug Administration (FDA) for the treatment of nausea and vomiting during pregnancy 7.
- The combination of doxylamine and pyridoxine has been found to be safe and effective for the management of nausea and vomiting during pregnancy, with a substantial amount of safety data accumulated over the years 7.
Non-Pharmacological Treatments
- Lifestyle and dietary changes, such as validation, supportive counseling, and dietary adjustments, are important components in managing nausea and vomiting during pregnancy 5.
- A study published in 2003 found that all 500 women surveyed reported that dietary and lifestyle changes helped to improve their symptoms of nausea and vomiting during pregnancy 5.