What to do when nauseated during pregnancy- a 2019 update

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

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.

Consider dimenhydrinate 50 mg (Gravol® OTC) every 4 to 6 hours when Diclectin® (this is a prescription product) (Diglegin® in the USA) is not enough. Caution about sedation since it’s common with both doxylamine/pyridoxine and dimenhydrinate.

If you 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.

Save ondansetron (a prescription products also known as Zofran®) 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. Try 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. Ranitidine (Zantac®) has the most safety data in pregnancy.

Reserve PPIs (like Prilosec®) for persistent symptoms…and stick with omeprazole.

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

Constipation. Try 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.