CONTACT: BECKY SOGLIN
Iowa City IA 52242
(319) 335-6660; fax (319) 384-4638
Release: Aug. 21, 2002
UI obstetrician discusses ways to avoid nausea, vomiting during pregnancy
pregnant women have nausea and vomiting severe enough to make it difficult
for them to go through their daily routine. For some women, it can severely
affect their nutrition. At the same time, they may avoid using treatments
out of concern for otherwise adversely affecting their pregnancy.
An estimated 35 percent of pregnant women experience morning sickness that
significantly affects their daily lives but hesitate to seek treatment. In
addition, nearly 1 percent of pregnant women need to be hospitalized for severe
Efforts by physician-scientists like Jennifer Niebyl, M.D., University of
Iowa professor and head of obstetrics and gynecology, aim to lessen the discomfort
many pregnant women experience, by helping them find safe and effective remedies.
"Patients are just clamoring for information. Nausea and vomiting during
pregnancy significantly impact women's lives in terms of missing work and
affecting their personal relationships and responsibilities at home,"
In addition, some women with severe vomiting may be unable to retain sufficient
amounts of folic acid, which has been shown to prevent birth defects.
Niebyl and T. Murphy Goodwin, M.D., associate professor of obstetrics and
gynecology at the Keck School of Medicine of the University of Southern California,
published in the May supplement of the American Journal of Obstetrics and
Gynecology an overview article and the proceedings of a conference they helped
organize on the medical and societal costs of nausea and vomiting during pregnancy
as well as its causes and different ways to treat it -- with drugs and without
drugs. The meeting was the first to bring together researchers from a range
of disciplines to explore the problem in such depth.
"Some physicians still are reluctant to treat patients for nausea and
vomiting because of fear of causing birth defects in the first trimester;
yet you can treat this problem with very safe, over-the-counter medications,"
While supplement and drug options exist, physicians first check for other
causes such as gallbladder disease, hepatitis or the presence of twins or
other multiples. Next, the first line of treatment is to try dietary modifications.
"Frequent small feedings -- not letting your stomach get empty -- can
be helpful," Niebyl said. "Women can keep crackers by the bedside
to eat something right away in the morning, save part of lunch for the middle
of the afternoon and have a protein snack at night."
Niebyl added that it is helpful for women to identify the odors and spices
that are a problem. Certain things "trip people's trigger" and vary
from person to person, she said.
However, up to 10 percent of women have nausea and vomiting that do not
respond to these methods and require a supplement or medication. Niebyl recommends
starting with vitamin B6, although she added that any new use of vitamins
or medication, or change in health care routine, should first be approved
by a woman's health care provider.
In the past decade, several studies, including one led by Niebyl, have found
that treatments with vitamin B6 are safe and effective for pregnancy-related
"We don't know exactly how vitamin B6 works, but for nearly half the
women who take it, vomiting stops and nausea is reduced from severe to mild
or moderate," Niebyl said.
Other researchers have studied the use of ginger to control nausea and vomiting.
However, while findings show effectiveness, they do not fully address safety
"Ginger ale has been a home remedy for years for nausea and vomiting
but the regular use of ginger by expectant women has not been scientifically
studied," she said. For cases that do not respond to vitamin B6 alone,
Niebyl would instead recommend doxylamine, an over-the-counter antihistamine,
in combination with the vitamin.
Doxylamine, along with vitamin B6, was a component of an anti-nausea pregnancy
drug called Bendectin. The manufacturer stopped selling Bendectin in the United
States in the 1980s because the company was targeted for lawsuits claiming
birth defects. Yet the scientific evidence consistently showed no such negative
effects -- the manufacturer won all the cases -- and the Food and Drug Administration
(FDA) never removed approval for Bendectin. An equivalent drug (Diclectin)
has remained available in Canada, and the company that makes it is seeking
FDA approval to market the drug in the United Sates.
"When Bendectin was no longer available in the United States, the hospitalization
rate dramatically increased for nausea and vomiting but stayed down in Canada,"
Doxylamine is available without a prescription in Unisom Sleep Tabs. The
manufacturer does not market the drug as a pregnancy-related aid, but doxylamine
has been studied in more than 6,000 patients and found not to cause birth
defects, Niebyl said.
"It has to be the tabs, not the gel form, which is a different form
of antihistamine," Niebyl emphasized. "The combination of vitamin
B6 and the doxylamine in the Unisom sleep tab is almost identical to the combination
of active ingredients the FDA had approved for Bendectin.
"Again, the FDA never removed approval for Bendectin; the company stopped
manufacturing it for financial reasons. Women who want to try doxylamine,
in the form of Unisom Sleep Tabs, and vitamin B6 should first consult their
personal physician," she added.
A relatively new prescription item called Premesis contains a controlled
release form of vitamin B6, vitamin B12, folic acid and calcium carbonate.
Because of the large amount of folic acid in the medication, it is available
only by prescription.
"This medication provides a way to give a woman vitamin B6 and folic
acid," Niebyl said. "All women in early pregnancy are supposed to
be on folic acid to prevent birth defects but if they're vomiting, a multi-vitamin
can't do its job. The advantage of this medication is that it gives you the
essential part of the multi-vitamin, to help prevent birth defects, and the
B6 helps control nausea."
Niebyl said women sometimes try acupuncture or wristbands. However, studies
have revealed conflicting data, and she does not know whether these treatments
As with all medical conditions, it is best to consult your personal physician
before making any changes to your health care routine, Niebyl said.
University of Iowa Health Care describes the partnership between
the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and
Clinics and the patient care, medical education and research programs and
services they provide. Visit UI Health Care online at www.uihealthcare.com.