Morning sickness is a term given to nausea and vomiting in pregnancy. Nearly 80% women have nausea and vomiting when they are pregnant and it is a sick feeling that negatively affects their lives at homes, in jobs and in social gatherings too. The severity of symptoms varies from person to person and from one pregnancy to the other in the same person. No one is to be blamed for this feeling. The hormones, family history, evolutionary mechanism for protecting fetus, certain genes; there are a lot of hypothesis regarding its cause, but none have a definitive backing and research is still ongoing.
The best thing you can do is change your lifestyle and diet according to your body’s needs. Avoiding triggers, foods and smells can really help. So, it would not be far-fetched to say that “Really the best medicine is no medicine at all.” Every woman’s body works in a different pattern and the intricacies are beyond our understanding.
Some women still experience symptoms of morning sickness, despite making all the required changes in their diet; and this can be a cause for distress to them. Pregnant women and doctors, both prefer to avoid medications, until it is the only choice left.
What Is The Best Medicine For Morning Sickness?
It is important to discuss with your obstetrician before taking any medication, be it over the counter medication. The first line of treatment for morning sickness related to pregnancy is vitamin B6 alone or with antihistamine (doxylamine, meclizine, cyclizine, buclizine, diphenhydramine, dimenhydrinate), phenothiazine (promethazine, chlorpromazine), or metoclopramide. If the symptoms still persist then ondansetron should be considered. In cases where all the above medications fail and the patient is refractory to other medications, corticosteroid (methylprednisolone) should be the last resort.
Doxylamine and Vitamin B6 (pyridoxine) are prescribed as Diclegis in the US and Diclectin in Canada. Doxylamine is antihistamine and known to prevent morning sickness. Antihistamines are touted to block the receptors in brain that are responsible for morning sickness. Vitamin B6 deficiency can be found in pregnant women, so there is a combination of these two drugs. Both of these medications are available separately as over-the-counter medications. Although, it has been well established in the medical community for NVP and is a very popular drug and first line of treatment in Canada for pregnancy related morning sickness, in very recent study, this combination has come into spotlight as not being efficacious along with potential harmful effects of the drug during pregnancy. In light of these accusations, it is advisable to really consult your obstetrician about the efficacy and safety of the drug and its use during pregnancy or maybe consider taking an altogether different anti-emetic medication.
Antihistamines have been known to significantly alleviate NVP. They are also considered safe in pregnancy; however, first generation antihistamine have sedating effect, thus for some women that can be an issue. Diphenhydramine and dimenhydrinate should be avoided in third trimester due to their possible effect on contractions of uterus and early delivery.
Dopamine agonist phenothiazine and metoclopramide have been used in morning sickness related to pregnancy. Metoclopramide is widely used drug as it is both centrally acting as well as peripherally acting (by increasing gastric motility). Its side effect include extrapyramidal (tardive dyskinesia, dystonia) side effects.
Ondansetron is serotonin antagonist that is widely used for chemotherapy induced morning sickness. However, it has carved its passage in the refractory morning sickness related to pregnancy. It is also efficacious for hyperemesis gravidarum. Its safety in pregnant women is still questionable. FDA warns about the QT prolongation and cardiac arrhythmias with its use in patients with congenital cardiac abnormalities.
Corticosteroids are used in cases of hyperemesis gravidarum; however, its use in the first trimester should be avoided as it is associated with cleft palate and increased risk with higher doses.
All in all, it is best to avoid medications and should only be considered if needed after consulting your obstetrician.
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