June 2008
Medical Treatments
If you can tolerate your morning sickness without the use of medications, this is ideal. Many medications normally used to stop nausea and vomiting in people who are not pregnant are generally not proven to be safe during the first 12 weeks of pregnancy. Debendox ('Bendectin' in the USA) was prescribed from about 1964 for morning sickness but was withdrawn from sale in 1983 due to the claim it caused birth defects. This was despite many research studies that failed to confirm a definite link between human birth defects and the use of Debendox. However, the pharmaceutical company could not definitely prove that it didn't cause birth defects and animal tests showed an increase in limb deformities. Since this time there has been a reluctance to prescribe new medications to women during early pregnancy for morning sickness.
One group of medications that may be prescribed by doctors for severe cases of morning sickness are antihistamines such as meclozine, promethazine or prochlorperazine. So far there appears to be no adverse effects on the baby by the small amount of research carried out. Antihistamines may be prescribed as a tablet or administered as an injection if you are vomiting excessively. Antihistamines do cause drowsiness and some women will experience blurred vision.
Another commonly prescribed medication is metoclopramide. As with antihistamines, this is usually prescribed for severe cases of morning sickness. Research to date suggests that there are no adverse effects on foetal development. Metoclopramide may be prescribed as a tablet or administered as an injection if you are vomiting excessively, with possible side effects including drowsiness, diarrhoea, and/or an increase in prolactin production (hormone for breast milk production). Other side effects may include dizziness, headache and a dry mouth.
Depending on what reference books you use, both metoclopramide and antihistamines may be listed as Category A or Category B drugs. As with any medication, their use during pregnancy needs to weigh up the possible benefits against any small possible risks.
Excessive vomiting ('Hyperemesis Gravidarum')
Less than 1% of pregnant women with morning sickness will experience excessive vomiting to the point that they become dehydrated. The medical term for this is 'Hyperemesis Gravidarum' and for some reason it is more common for women during their first pregnancy (but can still be experienced by women during subsequent pregnancies).
If you are vomiting several times a day and are unable to keep food or fluids down for a couple of days or more, you may need to be admitted to hospital to have a drip placed in your vein to administer fluids. You may also be prescribed an antihistamine or metoclopramide (usually as an injection) for the vomiting (see above). These can make you feel drowsy. You may just stay in hospital overnight or for a few days, depending on how unwell you are and how quickly the vomiting settles. Often resting in hospital is a remedy in itself. A few women find they are in and out of hospital over a period of several weeks during early pregnancy, whenever the vomiting becomes severe.
It is important to note that not all cases of excessive vomiting are caused by severe morning sickness during early pregnancy. You may have a virus or food poisoning, meaning it could be caused by a health condition or illness totally unrelated to the pregnancy. If your doctor is concerned they will probably perform a range of blood tests and other investigations to make sure the vomiting isn't being caused by something else. In very rare circumstances, excessive vomiting may be caused by a pregnancy variation called a molar pregnancy (an abnormal of pregnancy, characterized by the presence of an anomalous growth containing a nonviable embryo which implants and proliferates within the uterus).
Jewell D, Young G Interventions for nausea and vomiting in early pregnancy (Cochrane Review). In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software.
Kizior RJ and Hodgson BB. Saunders drug handbook for health professionals. 2nd ed. 2002 W B Saunders, Philadelphia.
Seto A, Einarson T, Koren G. Pregnancy outcome following first trimester exposure to antihistamines: meta-analysis. American Journal of Perinatology. 1997. 14(3). 119-124. Steele NM, French J, Gatherer-Boyles J, Newman S, Leclaire S. Effect of acupressure by Sea-Bands on nausea and vomiting of pregnancy. J Obstet Gynecol Neonatal Nurs 2001, Jan-Feb;30(1): 61-70.
Vickers A J. Can acupuncture have specific effects on health: a systematic review of acupuncture antiemesis trials. Journal of the Royal Society of Medicine. 1996. 89. 303-311.
Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstetrics and Gynecology. 2001 Apr;97(4):577-82.
Flaxman SM, Sherman PW. Morning sickness: a mechanism for protecting mother and embryo Q Rev Biol 2000; 75:2:113-48
Eliakim R, Abulafia O, Sherer DM. Hyperemesis gravidarum: a current review Am J Perinatol 2000; 17:207-218
Davis M. Nausea and vomiting of pregnancy: An evidence based review J Perinat Neonat Nurs 2004; 18:4:312-328
American College of Obstetricians and Gynecologists. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists: nausea and vomiting of pregnancy Obst Gynecol 2004;103:803-11
Sahakian V et al. Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study Obstet Gynecol 1991; 78:33-6
Bryer E. A literature review of the effectiveness of ginger in alleviating mild to moderate nausea and vomiting of pregnancy J Midwifery Womens Health 2005; 50:1:e1-3
Tiran D. Nausea and vomiting in pregnancy: safety and efficacy of self-administered complementary therapies Complement Ther Nurs Midwifery 2002; 8:191-196
Davis M. Ibid
MIMS
Koren G, Maltepe C. J Obstet Gynaecol 2004; 24:5:530-3
Davis M. Ibid
