What do I do for Nausea and Vomiting?

If you do not get unbearably nauseous or vomit, great, if you do then here are some simple remedies:

• Small meals with some starchy foods, like crackers, will help absorb some of that stomach acid. Do not eat three meals a day, like the rest of your family. Instead, you should be snacking throughout the day.
• Drink liquids one-half hour after eating solid foods, distending your stomach makes you vomit.
• Do not eat anything within two to three hours of lying down.
• Eating or drinking stimulates stomach acid. The progesterone hormone your pregnancy makes, relaxes the smooth muscle valve separating your stomach and esophagus. Gastroesophageal reflux ensues and acid travels up to the throat, leading to nausea and vomiting.

If you do not get unbearably nauseous or vomit, great, if you do then here are some simple remedies:

• Small meals with some starchy foods, like crackers, will help absorb some of that stomach acid. Do not eat three meals a day, like the rest of your family. Instead, you should be snacking throughout the day.
• Drink liquids one-half hour after eating solid foods, distending your stomach makes you vomit.
• Do not eat anything within two to three hours of lying down.
• Eating or drinking stimulates stomach acid. The progesterone hormone your pregnancy makes, relaxes the smooth muscle valve separating your stomach and esophagus. Gastroesophageal reflux ensues and acid travels up to the throat, leading to nausea and vomiting.
• Non-pharmacologic treatments such as ginger can help. Ginger can be found in lollipop form and various pill forms at your local health food, Babies R US or drug store.
• Prescription prenatal vitamins (i.e. Citranatal B-Calm) that contain extra Vitamin B6 (pyridoxine) are available from your doctor and contain one larger pill followed by two smaller tablets with additional Vitamin B6 that can be taken throughout the day. You can often find coupons for these vitamins online. Generally, patients will take these during the first trimester than are switched to vitamins that contain more nutrients.
• Pharmacologic treatments for Nausea & Vomiting of Pregnancy (NVP) consist of first line therapies which include a combination of low dose Doxylamine (ingredient in Unisom) 10 mg with Pyridoxine (Vitamin B6) 10 mg, marketed in the US as Diclegis. This combination is considered to be safe in pregnancy and is one of the few pregnancy Category A drugs (Studies in pregnant women have shown that the medicine does not present an increased risk to the baby). Of note, splitting a Unisom dose and getting over the counter B6 is usually much less expensive than Diclegis.
• Additional pharmacologic therapies can be effective in controlling NVP but should be used with caution. Anti-nausea medications such as promethazine (Phenergan) have been used for years in pregnancy but have the sometimes significant side effect of severe drowsiness. Promethazine is FDA labelled as a Category C drug which is the most common classification for drugs that are used in pregnancy, from antibiotics to pain medication used in labor. Class C indicates that when given to laboratory rats in high enough doses it can cause birth defects or death but that no studies have shown such harm in humans.
• Zofran (Odansetron) has made headlines (and lawsuit ads) lately for its potential risk of birth defects, specifically cleft palate and possibly some cardiac defects. Odansetron is currently a pregnancy Category B drug, meaning animal studies have not revealed any increased risk of birth defects and no adequate human studies have demonstrated an increased risk to the baby. The best study to date in New England Journal of Medicine 2013 looked at 600,000 patients in Denmark and showed no association between Odansetron exposure and increased incidence of major birth defects, preterm delivery or low birth weight. This being said there have been some two smaller studies with less patients, one revealed a possible two-fold increase in cleft palate and another with a possible small increase in cardiac defects. Since these results have not been replicated in larger studies the FDA has not changed its pregnancy classification. The take away message, Odansetron (Zofran) should be used as a last resort until better studies have been completed. It should not be used prior to 7 weeks, to minimize any potential (however small) risk to your baby. This being said, if weight loss, dehydration and electrolyte disturbances are occurring then the benefits may outweigh the risks, as these problems can be more harmful to the mother and baby. Each case should be handled on an individual basis.
• Worst case scenario, we can arrange OB Home Health that can administer intravenous fluid hydration and even a subcutaneous Odansetron or Metoclopramide (Reglan) pump that can administer small, continuous dosing of medication that are usually very effective.