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Nausea/Vomiting of pregnancy (more!)

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FIRST WE EXPLAIN AND COMPLAIN, NOW WE WORK TO MAKE IT BETTER!

Part 1: It’s the Little Things. 

Morning sickness is a misnomer – women can feel sick at any time of the day, and most women feel sick throughout the day. But there are several small changes to make to your every day life style that can help tremendously. And prevention is key! The worse the symptoms the harder they are to control. Controlling mild symptoms can stop them from progressing to moderate or severe symptoms (click here for my top 11 ways to help with morning sickness).

Here are some more potential things to consider:

Diet changes:

  • Prenatal vitamin: Taking a prenatal vitamin before pregnancy can help. But prenatal vitamins, especially ones with iron, may make nausea worse once you are pregnant. Taking them at night, and never on an empty stomach may help.
  • Food: Small, frequent meals. Eat every 1-2 hours, but just a little bit. Avoid an empty stomach. Eat bland crackers first thing in the morning. High proteins are beneficial. Bland, dry food too. Spicy and fatty foods can exacerbate symptoms. Avoid foods with tastes, textures, and odors that are offensive
  • Drink: Cold, clear, carbonated, or sour beverages may be more tolerable. Have only a small amount of liquids between meals and snacks. Wait 20-30 minutes to drink after eating. Herbal teas and aromatics with mint and orange to aid digestion
  • If solid foods are intolerable, try meal replacement and / or electrolyte drinks.

Activity:

  • Walk in fresh air to avoid triggers or “reset” your odor trigger. 
  • Rest. Nap. Take it easy when possible. 
  • Avoid sensory stimuli like odors, heat, humidity, noise, and flickering lights.

Non-pharm therapies:

  • ginger can help – lollipops, drinks, candies, drops … whatever form you like. 
  • Acupressure. P6 is the spot – 3 fingerbreadths below the wrist, on the inside of the wrist between the 2 tendons. 

Part 2: A visit to the Pharm

Sometimes nausea and vomiting of pregnancy isn’t controllable with small lifestyle adjustments. There are many pharmacologic therapies that are safe in pregnancy and, more importantly, work. You need a prescription for some of the below, and it’s time to discuss your symptoms with your doctor when you’re at this stage. The two of you together can come up with the best options for you.  

Start simple – over the counter 

  • Vitamin B6. Doses of 25mg, taken 3X / day, have been shown to reduce nausea and vomiting of pregnancy. You don’t need a prescription to buy a vitamin but it’s also not easy to find this dose in over the counter (OTC) pills (and when you’re nauseous it’s often hard to swallow a ton of pills), so sometimes a prescription is still the best way to go. 
  • Benadryl / Unisom. These are OTC medications and for some women may help decrease nausea and vomiting. And if you’re having trouble trouble falling asleep or staying asleep because of the nausea, these can serve double duty. 

Prescription:

  • Diclegis. A combination of doxylamine (Unisom) and vitamin B6. The delayed release formula helps optimize the peak concentrations of these two which is why it can work better than taking OTC Unisom and vitamin B6 separately (and why it’s more expensive!). The down side is that it can make you sleepy because, if you’re paying attention, I literally just told you that doxylamine is a sleep aid. Your doctor can describe how to dose it, but the instructions are essentially to increase the dose until your symptoms are controlled (1 pill, 2 pills, 3 pills, then 4 pills a day. Up to 60% of women need 4 pills a day to control their symptoms). This is considered first line pharmacotherapy. 
  • Reglan. There’s some safety data but no conclusive evidence that it works. Anecdotally, I’ve seen some women respond wonderfully. 
  • Compazine. Same same as Reglan.
  • Zofran. The good: for some women, it works beautifully. The bad: extremely constipating. There were studies a few years ago that associated its use with cleft palate and cardiac defects in the offspring. Other studies didn’t show these associations. One conspiracy theory is that competing pharm companies were funding these studies to get Zofran’s popularity down. And it worked!  For all these reasons, I don’t prescribe this medication as first line, but I include it, along with the others listed above, in my discussions about second and third line options when it becomes necessary.  

Don’t take the use of medications in pregnancy lightly … but the safety of many of these options (especially Vitamin B6) is well documented, and take care of yourself. A frank discussion with your OB or midwife is critical to minimizing any unpleasant symptoms of pregnancy. 

Remember, this too shall pass. 

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Dec 18, 2020

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