7 morning sickness prevention and treatment suggestions

A medical journal commentary raises questions about what to prescribe for morning sickness.

It’s estimated over half of all pregnant women experience nausea and vomiting during pregnancy, according to the Society of Obstetricians and Gynaecologists of Canada (SOGC). The society’s webpage notes there are many ways of easing nausea and vomiting.

"Morning sickness" may occur more often in the morning when awakening with an empty stomach, but can happen at any time of day.

Kate Middleton’s hospitalization in 2012 for a severe form of morning sickness known as hyperemesis gravidarum drew attention to the treatable condition that occurs in an estimated 0.3 per cent to 2.3 per cent of pregnancies. 

The April issue of the Journal of Obstetrics and Gynaecology Canada includes a commentary by family physician Dr. Nav Persaud of St. Michael’s Hospital in Toronto and his co-authors on Diclectin, a combination of doxylamine, an antihistamine, and pyridoxine, or vitamin B6.

The prescription rate for Diclectin was 503 per 1,000 live births in 2010, according to data from seven provinces, which the authors said represents a 2.4-fold increase since 2001.

"The role of doxylamine-pyidoxine as the first-line pharmacological treatment for nausea and vomiting of pregnancy in Canada should be reconsidered," the commentary concluded.

Dr. Jennifer Blake, chief executive officer of the SOGC, said the flaws Persaud identified in a key 1997 paper do not change that organization's position on Diclectin.

Last April, the U.S. Food and Drug Administration approved the combination to treat nausea and vomiting due to pregnancy. The FDA said the drug is intended for women who haven’t adequately responded to diet and lifestyle changes to manage nausea and vomiting.

To prevent and treat morning sickness, doctors, midwives and researchers recommend:

• Snack on a few crackers in the morning and rest for a few minutes before getting up from bed.
• Get up slowly from bed and avoid lying down just after eating.
• Eat several small meals throughout the day instead of large meals. 
• Prepare cold foods if the smell of cooking foods bothers you.
• Sniff, eat or drink ginger tea by steeping ginger in hot water.
• Acupuncture from a licensed and experienced acupuncturist can help some women.
• Enjoy fresh air and avoid warm places since feeling hot can add to nausea.

In March, a Cochrane review of randomized control trials of drugs, vitamin B6, acupressure, acupuncture and other treatments for nausea, vomiting and retching in early pregnancy concluded there’s a "lack of high-quality evidence to support any particular intervention. This is not the same as saying that the interventions studied are ineffective, but that there is insufficient strong evidence for any one intervention."