Ease Nausea and Vomiting in Pregnant Women

Three out of every four pregnant women will have GI complaints.

Suggest small meals or wearing acupressure bands (Sea-Band, etc) for nausea and vomiting…elevating the head of the bed for heartburn…or adequate fluid and fibre intake or light exercise for constipation.

If symptoms persist after nondrug steps, it’s okay to try meds.

Nausea and vomiting. Suggest pyridoxine (vitamin B6) 10 to 25 mg TID to QID. Move to Rx Diclectin (pyridoxine/doxylamine) if needed…but keep in mind that even the generics can cost up to $85/month.

Suggest adding dimenhydrinate 50 mg every 4 to 6 hours when Diclectin is not enough. Caution about sedation since it’s common with both doxylamine/pyridoxine and dimenhydrinate.

If women want to try a ginger supplement, suggest using one with the root and taking 250 mg up to QID. Don’t rely on ginger-flavoured foods or beverages…most don’t have enough ginger to make a difference.

Be aware that overall evidence on ginger, pyridoxine, or doxylamine is mixed…but they’re unlikely to harm.

Suggest saving ondansetron for severe symptoms. It’s linked to cardiac malformations in the first trimester…and has QT prolongation risk in the mom, especially with electrolyte changes due to vomiting.

Heartburn. Suggest antacids first…such as calcium carbonate (Tums Extra Strength, etc) 2 to 3 tabs as needed, but no more than 10 tabs/day.

Consider an H2-blocker if heartburn continues. Explain that ranitidine has the most safety data in pregnancy.

Reserve PPIs for persistent symptoms…and stick with omeprazole.

Steer patients away from antacids with sodium bicarb (Alka-Seltzer Gold, etc)…due to risks of fluid retention and alkalosis.

Constipation. Suggest bulk laxatives (psyllium, etc) first…then adding polyethylene glycol (Lax-A-Day, etc) or lactulose if needed.

Reserve stimulant laxatives (senna, etc) for persistent symptoms.

Don’t rely on docusate. It’s found in some prenatals and is safe…but there’s not good evidence it helps prevent or treat constipation.