Anti-nausea medications used during pregnancy in the past have led to serious consequences, but more strict drug regulations have led to the development of safe medications. Understanding the history of these medications will help you make informed decisions when managing nausea during pregnancy.
Beginning in 1957, Thalidomide was given to pregnant women for treatment of morning sickness. Very quickly, it became clear that Thalidomide caused fetal deaths, dramatic limb defects and other harms, but it still took 5 years before doctors and pharmacists were told to destroy their remaining stock of the medication in 1962 (today the drug is used for leprosy and multiple myeloma). After that, the U.S. FDA required drugs to be tested for their ability to harm developing fetuses, called “teratogenicity.” There lingered a distrust amongst the public, which still persists.
Manufacturers of Bendectin, a safe and effective drug for treatment of morning sickness, burdened by the scrutiny and costs of defending its product, voluntarily removed it from the market in 1983. In the 30+ years since, women have not had a good option for medical treatment. Recently Bendectin has returned to the market as Diclegis, and although the FDA has given it the best safety rating of Category A, it is expensive and often not covered by insurance.
Looking for an over-the-counter solution for morning sickness?
A simple non-prescription drug combination can greatly diminish morning sickness experienced during pregnancy: doxylamine succinate (an antihistamine used as a sleep aid) and pyridoxine hydrochloride (Vitamin B6). These are the ingredients in Bendectin (and Diclegis), and they are available cheaply over the counter.
Note: Unisom brand doxylamine succinate is available, but read the label carefully: Unisom brand diphenhydramine (also sold under the Benedryl brand) is not the same thing. Typical dosing is 25 mg of Vitamin B6 3-4 times during the day and 12.5 mg of doxylamine succinate at bedtime only. Do not drive while under the effect of doxylamine succinate. Do not take this combination if you are breastfeeding.
When to call your health care provider
If you are unable to keep any food or water down for 24 hours, it is time to seek medical help. Nausea is worsened by dehydration, electrolyte imbalance, and presence of ketones in your blood from the breakdown of fat. IV fluids and Vitamin B6 can work wonders, temporarily.
If you are making frequent trips to the ER, your health care provider will do further testing to rule out other conditions and to assess your need for ongoing therapy. I have seen women in OB triage who waited too long to come in, have had damaged kidneys and other end-organ disruptions and required admission to the ICU. In countries without sufficient resources, women do indeed die from this. When nausea of pregnancy crosses over to abnormal, it is called “Hyperemesis gravidarum.”
Zofran (ondansetron) is a medication not FDA approved for pregnancy, but often prescribed. Use of Zofran was rising in recent years, but concerns have been raised regarding prolonged QT intervals (heart beat irregularities), interactions with SSRIs used for depression in pregnancy, and perhaps some congenital defects. Reglan is another drug sometimes used for nausea, but in very rare cases of long term use, women can develop involuntary muscle twitches called “tardive dyskinesia,” which can be permanent and devastating. Now we hold Reglan, Zofran and other medications until other things have failed.
Avoid a completely empty stomach. Eat small, frequent snacks. Remember to eat, even if you don’t feel like it. Carry nut butter on crackers or some other snack when you go out.
Eat high protein foods like deli turkey or bologna (heated to sizzling to kill bacteria), which can be dipped in salsa or mustard, or chicken soup with bits of chicken. Don’t shy away from strong flavors if they appeal. Many women find lemon juice helpful. Try to track what works for you and what doesn’t.
Avoid fast carbohydrates like sweet cereals and doughnuts, because the sugar roller-coaster will make it worse. As you blood sugar falls, your nausea increases, so you will benefit from keeping those falls less steep. Protein, although it does not appeal, will prevent the roller coaster.
Ask others to prepare food for you. The process of thinking about food and working with it may take away any appetite you have. Avoid cooking odors, especially fish. This is a way family members can truly help.
Some women find it helpful to spit out their saliva instead of swallowing it. During pregnancy, you make more saliva, and this worsens nausea when swallowed.
Getting enough sleep will help. Fatigue worsens the nausea.
If you think you are having heartburn, try an antacid such as chewable Maalox. Separating liquids and solid food can help. Avoid lying down soon after eating.
For mild nausea, ginger in all forms can be helpful. Fresh ginger steeped in hot water is a personal favorite.
There is a point on the inside of the wrist, 3 of your fingerbreadths up from your wrist crease, where the application of pressure may help. An acupuncturist can assist you with this. “Seabands” can be purchased to press this point, or you can use your thumb.
Nausea in pregnancy usually is worst from weeks 8-12. The toll this takes on your spiritual health and the dynamics of your family can be high. I told my husband he should try imagining having the flu for a month!