Nausea and Vomiting in Pregnancy

Neither I nor any member of my family has any financial connections with the pharmaceutical industry.

A Fairly Common Condition

Nausea and vomiting in pregnancy are fairly common conditions. By themselves, they are neither life threatening nor threatening to the pregnancy, but they are nevertheless terribly uncomfortable, displeasing, and sometimes disabling.

Nausea and vomiting can often interfere with a patient's ability to perform household or workplace duties and can be destabilizing to a patient's life at a time when there otherwise is joy and happiness. Sometimes, nausea and vomiting can be so severe that they result in hospitalization and intravenous feeding.

For all these reasons, they cannot be overlooked.

Unfortunately, they are also mysterious. Nausea and vomiting in pregnancy are relatively uncommon in the populations of certain continents, such as Africa and Asia, but relatively common among North American women. They occur for varying lengths of time in some North American women and not at all in others. The causation, in short, is unclear and likely complicated. A number of hypotheses have been advanced, but none has been proved.

Despite the uncertainties, the frequency and effects of nausea and vomiting in pregnancy demand our attention. It therefore seems important to present a Master Class on the subject and to review the various treatments that have been tried and are available for patients who struggle with the condition.

Some of these approaches will work for our patients, and some will not. With these options before us, however, we can offer our patients the very best care.

Here to address the issue is Dr. Jennifer R. Niebyl, professor and chair of the department of obstetrics and gynecology at the University of Iowa Hospitals and Clinics, Iowa City.

Dr. Niebyl is an expert in the area of drugs and pregnancy and an expert in maternal-fetal medicine, with a special interest in nausea and vomiting in pregnancy.

Key Points

▸ Vitamin B6 and doxylamine should be first-line therapy for nausea and vomiting in pregnancy.

▸ No antiemetic has been found to have any teratogenic risk.

▸ Some alternative remedies, such as ginger and acupuncture, have been shown to be effective.

Treatments for Nausea/Vomiting

Vitamin B6

PremesisRx

Antihistamines

Doxylamine (Unisom)

Dimenhydrinate (Dramamine)

Diphenhydramine (Benadryl)

Meclizine (Antivert)

Hydroxyzine (Vistaril, Atarax)

Cetirizine (Zyrtec)

Phenothiazines

Promethazine (Phenergan)

Prochlorperazine (Compazine)

Chlorpromazine (Thorazine)

Prokinetic Agent

Metoclopramide (Reglan)

5-HT3 Receptor Antagonists

Ondansetron (Zofran)

Dolasetron (Anzemet)

Granisetron (Kytril)

Corticosteroids

Acupuncture

Ginger