A Variety Of Ways To Avoid Nausea And Vomiting During Pregnancy
"Patients are just clamoring for information. Nausea and vomiting during pregnancy significantly impact women's lives in terms of missing work and affecting their personal relationships and responsibilities at home," Niebyl said. In addition, some women with severe vomiting may be unable to retain sufficient amounts of folic acid, which has been shown to prevent birth defects.
Niebyl and T Murphy Goodwin, MD, associate professor of obstetrics and gynecology at the Keck School of Medicine of the University of Southern California, published in the May supplement of the American Journal of Obstetrics and Gynecology an overview article and the proceedings of a conference they helped organize on the medical and societal costs of nausea and vomiting during pregnancy as well as its causes and different ways to treat it -- with drugs and without drugs. The meeting was the first to bring together researchers from a range of disciplines to explore the problem in such depth. "Some physicians still are reluctant to treat patients for nausea and vomiting because of fear of causing birth defects in the first trimester; yet you can treat this problem with very safe, over-the-counter medications," Niebyl said.
Where to begin?
While supplement and drug options exist, physicians first check for other causes such as gallbladder disease, hepatitis or the presence of twins or other multiples. Next, the first line of treatment is to try dietary modifications. "Frequent small feedings -- not letting your stomach get empty -- can be helpful," Niebyl said. "Women can keep crackers by the bedside to eat something right away in the morning, save part of lunch for the middle of the afternoon and have a protein snack at night."
Niebyl added that it is helpful for women to identify the odors and spices that are a problem. Certain things "trip people's trigger" and vary from person to person, she said.
Possible remedies and medications
However, up to 10 percent of women have nausea and vomiting that do not respond to these methods and require a supplement or medication. Niebyl recommends starting with vitamin B6, although she added that any new use of vitamins or medication, or change in health care routine, should first be approved by a woman's health care provider.
In the past decade, several studies, including one led by Niebyl, have found that treatments with vitamin B6 are safe and effective for pregnancy-related nausea. "We don't know exactly how vitamin B6 works, but for nearly half the women who take it, vomiting stops and nausea is reduced from severe to mild or moderate," Niebyl said.
Other researchers have studied the use of ginger to control nausea and vomiting. However, while findings show effectiveness, they do not fully address safety issues. "Ginger ale has been a home remedy for years for nausea and vomiting but the regular use of ginger by expectant women has not been scientifically studied," she said. For cases that do not respond to vitamin B6 alone, Niebyl would instead recommend doxylamine, an over-the-counter antihistamine, in combination with the vitamin.
Doxylamine, along with vitamin B6, was a component of an anti-nausea pregnancy drug called Bendectin. The manufacturer stopped selling Bendectin in the United States in the 1980s because the company was targeted for lawsuits claiming birth defects. Yet the scientific evidence consistently showed no such negative effects -- the manufacturer won all the cases -- and the Food and Drug Administration (FDA) never removed approval for Bendectin. An equivalent drug (Diclectin) has remained available in Canada, and the company that makes it is seeking FDA approval to market the drug in the United States. "When Bendectin was no longer available in the United States, the hospitalization rate dramatically increased for nausea and vomiting, but stayed down in Canada," Niebyl said.
Doxylamine is available without a prescription in Unisom Sleep Tabs, notes Niebyl. The manufacturer does not market the drug as a pregnancy-related aid, but doxylamine has been studied in more than 6,000 patients and found not to cause birth defects, Niebyl said. "It has to be the tabs, not the gel form, which is a different form of antihistamine," Niebyl emphasized. "The combination of vitamin B6 and the doxylamine in the Unisom sleep tab is almost identical to the combination of active ingredients the FDA had approved for Bendectin. "Again, the FDA never removed approval for Bendectin; the company stopped manufacturing it for financial reasons. Women who want to try doxylamine, in the form of Unisom Sleep Tabs, and vitamin B6 should first consult their personal physician," she added.
New on the horizon
A relatively new prescription item called Premesis contains a controlled release form of vitamin B6, vitamin B12, folic acid and calcium carbonate. Because of the large amount of folic acid in the medication, it is available only by prescription. "This medication provides a way to give a woman vitamin B6 and folic acid," Niebyl said. "All women in early pregnancy are supposed to be on folic acid to prevent birth defects -- but if they're vomiting, a multi-vitamin can't do its job. The advantage of this medication is that it gives you the essential part of the multi-vitamin, to help prevent birth defects, and the B6 helps control nausea."
Niebyl said women sometimes try acupuncture or wristbands. However, studies have revealed conflicting data, and she does not know whether these treatments actually work. And as with all medical conditions, it is best to consult your personal caregiver before making any changes to your health care routine, Niebyl said.