From the Guidelines
For managing pregnancy-related nausea, start with lifestyle modifications before considering medications, and consider vitamin B6 and doxylamine as first-line therapy, as recommended by the American College of Obstetricians and Gynecologists (ACOG) 1.
Lifestyle Modifications
- Eat small, frequent meals throughout the day rather than three large ones
- Avoid spicy, greasy, or strong-smelling foods that may trigger nausea
- Keep plain crackers by your bedside to eat before getting up in the morning when nausea is often worst
- Stay hydrated by taking small sips of water or ginger tea throughout the day
First-Line Medication Therapy
- Ginger supplements (250mg four times daily) can be effective and are considered safe
- Vitamin B6 (pyridoxine) 25mg three times daily, either alone or combined with doxylamine (Unisom) 12.5mg at bedtime, is often recommended as first-line medication therapy
Severe Cases
- Prescription medications like Diclegis (doxylamine/pyridoxine combination) or antiemetics such as ondansetron (Zofran) may be prescribed by your healthcare provider
- These interventions work by addressing different aspects of nausea physiology - ginger has anti-inflammatory properties, B6 helps with neurotransmitter regulation, and antiemetics block signals in the brain's vomiting center
Important Considerations
- Most pregnancy nausea improves by the second trimester, but seek immediate medical attention if you cannot keep any fluids down or are losing weight rapidly
- Early treatment of nausea and vomiting of pregnancy may reduce progression to hyperemesis gravidarum, as stated in the AGA clinical practice update on pregnancy-related gastrointestinal and liver disease: expert review 1
From the Research
Nausea and Vomiting of Pregnancy
- Nausea and vomiting of pregnancy is a common condition that affects the health of a pregnant woman and her fetus, diminishing the woman's quality of life and contributing to health care costs and time lost from work 2, 3.
- The cause of nausea and vomiting in pregnancy is unknown, but may be due to the rise in human chorionic gonadotrophin concentration 4, 5, 6.
- More than half of pregnant women suffer from nausea and vomiting, which typically begins by the fourth week and disappears by the 16th week of pregnancy 4, 5, 6.
Treatment and Management
- Mild cases of nausea and vomiting of pregnancy may be resolved with lifestyle and dietary changes, and safe and effective treatments are available for more severe cases 2, 3.
- Treatment in the early stages may prevent more serious complications, including hospitalization 2, 3.
- The woman's perception of the severity of her symptoms plays a critical role in the decision of whether, when, and how to treat nausea and vomiting of pregnancy 2, 3.
- Various interventions have been studied for their effectiveness and safety in managing nausea and vomiting of pregnancy, including: