What can be done for relief from morning sickness?

Management of Morning Sickness in Pregnancy

Diet and lifestyle modifications should be the first-line approach for managing morning sickness, followed by vitamin B6 (pyridoxine) alone or combined with doxylamine if symptoms persist. 1

Initial Management: Non-Pharmacological Approaches

Dietary Modifications

• Eat small, frequent meals (every 2-3 hours) to avoid an empty stomach
• Choose bland, low-fat, high-protein foods
• Try the BRAT diet (bananas, rice, applesauce, toast) 1
• Avoid spicy, fatty, acidic, and fried foods that can trigger symptoms
• Identify and avoid personal food triggers with strong odors

Lifestyle Adjustments

• Separate liquid and solid food intake by at least 30 minutes
• Get out of bed slowly in the morning
• Avoid lying down immediately after eating
• Stay well-hydrated, taking small sips of fluids throughout the day
• Rest in a cool, well-ventilated environment

Pharmacological Management

First-Line Medications

1. Vitamin B6 (Pyridoxine)

   • 10-25 mg every 8 hours 1
   • Safe and effective for mild to moderate symptoms
   • Can be used alone initially

2. Doxylamine + Pyridoxine Combination

   • Available in 10 mg/10 mg or 20 mg/20 mg combinations 1
   • FDA-approved and recommended by ACOG for persistent NVP
   • Take at bedtime to minimize daytime drowsiness

Second-Line Medications

1. H1-Receptor Antagonists

   • Promethazine or dimenhydrinate 1
   • Consider when first-line treatments are ineffective
   • May cause drowsiness

2. Ginger Supplements

   • 250 mg capsules 4 times daily 1
   • Evidence supports efficacy for mild symptoms
   • Available in various forms (capsules, tea, candies)

Severe Cases (Hyperemesis Gravidarum)

For severe, persistent vomiting with weight loss >5% of pre-pregnancy weight or dehydration:

• IV fluid rehydration and electrolyte correction
• Thiamine supplementation to prevent Wernicke's encephalopathy
• Consider hospitalization for severe cases
• Ondansetron may be considered, though safety data in pregnancy is still being collected 2

Monitoring Severity

Use the Motherisk Pregnancy-Unique Quantification of Emesis (PUQE) score to assess severity:

• Score ≤6: Mild
• Score 7-12: Moderate
• Score ≥13: Severe 1

Prevention Strategies

• For women with history of severe morning sickness, pre-emptive use of doxylamine-pyridoxine before symptoms start may prevent recurrence 3
• Consider smaller prenatal vitamins or those with lower iron content, as large tablets and high iron content can worsen nausea 4

Important Considerations

• Morning sickness typically begins at 4-6 weeks, peaks at 8-12 weeks, and resolves by week 20 1
• Early intervention may prevent progression to hyperemesis gravidarum
• Untreated severe nausea and vomiting can lead to dehydration, electrolyte imbalances, and weight loss
• Reassure patients that most anti-nausea medications recommended for pregnancy do not increase risk of birth defects

Morning sickness affects 70-80% of pregnant women 2, and appropriate management can significantly improve quality of life during pregnancy. Starting with dietary and lifestyle modifications before progressing to medications offers the safest approach while effectively managing symptoms for most women.