Morning Sickness

Nausea during pregnancy, commonly called “morning sickness”, is experienced by about four out of five women. Although called morning sickness, it may occur at any time during the day or night. The causes of morning sickness are not fully understood. This nausea and sometimes vomiting is believed to be related increased levels of a hormone produced by the placenta called human chorionic gonodatropin (HCG). You may take comfort in the fact that most nausea disappears by the 16-18th week.

The following recommendations may help you to cope with the symptoms of nausea during pregnancy. If your symptoms are severe ask us about taking medication to help manage your symptoms. If extremely severe (hyperemesis gravidarum) with major weight loss – you may require hospitalization.

ADVICE ABOUT DIET:
Eat small amounts every 2-3 hours.
EAT easily digested carbohydrates (fruits, fruit juices, breads, cereals, rice, pasta, potatoes).
Eat low-fat, high protein foods (lean meat, broiled or canned fish, poultry without skin, eggs, boiled beans)
FLUIDS:  Are better tolerated cold, clear, carbonated or sour (ginger-ale, lemonade, popsicles). Electrolyte replacement drinks (GatorAid) consume 30 minutes before or after food to minimize effect of full stomach.
Drink soups and other liquids between meals, rather than with meals, so as to not overly distend the stomach and trigger vomiting.
Avoid greasy, fried foods hard to digest and offending aroma.
Lightly season food, but salt to taste.
Snack (yogurt, milk, juice, bread, or sandwich) prior to bed or during the night.
Eat a piece of bread or crackers before getting out of bed in the morning.
Avoid brushing teeth immediately after eating.
Sit upright after meals to reduce gastric reflux (heartburn).
Try whatever appeals to you in an aroma free quiet environment including atypical food/beverages such as potato chips, lemonade, lemons (to smell) and Granny Smith apples.
AFTER RECOVERY (from SEVERE vomiting) as you restart oral feeding consider the BRAT diet consisting of bananas, rice, applesauce, and toast then advance diet as tolerated.  Getting protein intake is also key in helping reduce nausea.
Craved food should be eaten immediately or the window of opportunity may be lost. 

ADVICE ABOUT LIFESTYLE:
Avoid Triggers:  
stay away from situations, things, smells or events that trigger nausea.
Fresh air take walks or sleep with window open. Open windows or use exhaust fan to clear odors when cooking.
Avoid odors that aggravate your symptoms including perfume, cologne, workplace chemicals, breath, pets, gas stations, coffee pots, diapers, food and food preparation, magazines with perfume samples.
Stay in an air conditioned environment because heat and humidity concentrate pollutants and worsen nausea and vomiting.
Stay in quiet environment and remain relatively still because noise and motion have both been demonstrated to worsen nausea.
Avoid public travel (planes, bus etc) due to motion and smells.
Discontinue the prenatal vitamin until nausea lessens.
Avoid visual stimuli such as food commercials on television, poor quality computer screens and videos.
Fresh mouth rinses made from lemon juice and water may be helpful. Try lemon wedges, the citrus flavor counteracts nausea.
Vitamin B6 (Pyridoxine) 25 mg by mouth every 8 hours.
Use Ginger products (tart ginger ale, pickled ginger are ok ground ginger 250 mg by mouth four times a day.
Slowly sip a carbonated beverage when feeling nauseated.
Drink herbal tea (spearmint, raspberry, peppermint, chamomile, ginger root).
Dress warmly in cold weather but try to avoid artificial room heaters that can accelerate fluid loss worsening dehydration and constipation.
Dill pickles may have a calming effect and soothe the intestinal tract.
Fresh lemon juice mouth rinses may be helpful. Try lemon wedges, the citrus flavor counteracts nausea.
Sucking on Atomic Fireball or Cinnamon or Peppermint candies.
Chew one Milk of Magnesia tablet 2-3 times a day, soothe stomach and replenishes magnesium stores.
Sometimes it is necessary to receive IV fluids if you are unable to drink 10 cups of fluid/day.
Ginger one 250 mg capsule by mouth four times a day is sometimes helpful.
Reliefband –  Acupressure P6 Bands as needed are sometimes helpful (www.reliefband.com)

ELECTROLYTE REPLACEMENT:
Salting food helps replace chloride lost by vomiting.
Sport drinks (Gatorade, Power Burst, 10-K etc.) Balanced electrolyte solutions, easily absorbed.
Encourage potassium and magnesium rich foods. Potassium: Bananas, prunes, raisins, watermelon. Magnesium: Spinach, pumpkins seeds, sunflower seeds

MEDICATION OPTIONS:
DICLEGIS: is a new prescription that is usually effective and is very safe.  It is however, quite expensive. 
To pay as little as $30 for Diclegis click here
You can closely recreate Diclegis from its separate contents by taking:  

Pyridoxine: (Vitamin B6)  25mg by mouth three or four times a day – good safety profile, minimal side effects
Together with
Unisom SleepTabs: Doxylamine Succinate*   12.5 mg (1/2 a tablet)  every six hours as needed.  Should be taken on empty stomach with glass of water.  24 studies have shown no increased risk of birth defects. Most common side effects: sedation, dry mouth, light headedness, constipation.

IF DOXYLAMINE/PYRIDOXINE INEFFECTIVE, THEN:
Continue Pyridoxine and STOP Doxylamine, replace doxylamine with ONE of the following…
Diphenhydramine (Benadryl)  25-50mg orally every 4-6 hours
or
Meclizine 25mg orally every 4-6 hours.
or
Prochlorperazine (Compazine) 5-10mg orally, IM or IV
or
Zofran: (Ondansetron)  4- 8 mg by mouth (tablet) or IV, every eight hours as needed for nausea. Not associated with increased risk of anomalies according to UpToDate Service review of subject literature.

UNRESPONSIVE CASES:
Possible transfer to high risk specialists at EVMS
Initiate Home visits by specialized nurses for IV fluids and Medications
Hospitalization
Dietary/Nutritional Consultation
GI Consultation
for IV feeding
Prochlorperazine (Compazine)  5-10 mg by mouth or IV every 6-8 hours, or 25mg Per rectum every 12 hours.
Metaclopramide (Reglan) 10 mg IV/PO every 6-8 hours before meals.
Methylprednisolone regiman.

Chlorpromazine (Thorazine): 10-25 mg orally every 4-6 hours or 25-50 ng IV or IM every 4-6 hours..

Baby Center Summary on Nausea in Pregnancy

What to Expect Info on Nausea in Pregnancy

* Unisom SleepTabs  (Doxylamine Succinate) MUST be used.  Do NOT use Unisom SleepCaps or Unisom SleepGels.