Any-Time-of-Day Sickness and Your Pregnancy

By Joanne Stone, Keith Eddleman, Mary Duenwald

For some women, the nausea that can strike during the first trimester is worse in the mornings, maybe because the stomach is empty at that time of day. But ask anyone who’s had morning sickness, also known as nausea and vomiting of pregnancy (NVP), and she’ll tell you it can hit any time.

It often starts during the fifth or sixth week (that is, three to four weeks after you miss your period) and goes away, or at least becomes much less severe, by the end of the 11th or 12th week. It can last longer, and in fact about 10 percent of women have symptoms up to 16 weeks!

If you are carrying twins or more, don’t be surprised if the NVP is worse than expected, because the higher hormone levels make the nausea even more extreme. Fortunately, there are things you can do to ameliorate your symptoms.

Even when nausea doesn’t actually cause you to vomit, it can be extremely uncomfortable and truly debilitating. Certain odors — from foods, perfumes, or musty places — can make it worse. If your queasiness gets out of control — if you experience weight loss, if you find that you can’t keep down food or liquids, or if you feel dizzy or faint — call your doctor.

If you’re really bothered by the nausea, talk to your doctor about over-the-counter or prescription medications. Your doctor may suggest or prescribe one of the following:

  • Vitamin B6: Some evidence suggests that 50 milligrams of vitamin B6 three times a day can reduce nausea.

    A combination of vitamin B6 and the antihistamine doxylamine (Unisom — one pill at nighttime; check before you buy because some generics substitute a different medication) may also be helpful. This combination is similar to the medication Benedictin, which was removed from the market due to completely unsubstantiated claims of an increase in birth defects.

    Although Benedictin still isn’t available, scientists no longer believe it’s teratogenic (causes birth defects). Talk to your doctor about trying vitamin B6, with or without doxylamine. Remember that doxylamine is marketed as a sleep aid, so it will most likely make you drowsy.

  • Diclegis: A new FDA-approved prescription medicine (pregnancy category A), Diclegis (doxylamine succinate, 10 mg, and pyridoxine hydrochloride, 10mg) can help provide relief from NVP. It is basically the old Benedictin, but revamped with improved benefits.

    It has a delayed-release formulation and a dosing schedule that helps you control symptoms throughout the day. Diclegis should be taken on a regular basis and not “as needed.” The combination of ingredients in Diclegis has been commercially available as the active ingredients in another medication called Diclectin for more than 30 years in Canada, so it has an excellent safety record.

    The main side effect of this medication is drowsiness, so avoid taking it while operating heavy machinery, driving, or other situations in which drowsiness can cause a problem. Taking it with some pain medications like oxycodone, which we already know causes central nervous depression and respiratory depression, can make these problems even worse than they are with the oxycodone alone.

  • Ondansetron (Zofran): Some women find relief for extreme nausea with or without vomiting from this prescription medication. Although ondansetron hasn’t been extensively studied in pregnancy, there are no reports of an increase in birth defects associated with this medication.

  • Metoclopramide (Reglan): Your doctor can actually administer this drug by continuous infusion under the skin through a device known as a subcutaneous pump. This is advantageous for those women who can’t even swallow a pill because they’re so nauseous.

Occasionally, the nausea and vomiting are so severe that you develop a condition called hyperemesis gravidarum. The symptoms include dehydration and weight loss. If you develop hyperemesis gravidarum, you may need to be given fluids and medications intravenously.

If you’re less than six weeks pregnant and experiencing NVP, you can take folic acid alone instead of your prenatal vitamin. Folic acid is the main supplement that you need early in your pregnancy, and it’s much less likely to upset your stomach than the multivitamin you normally take during pregnancy. Check with your doctor for the correct dose for you.

You may hear some women say that morning sickness is a sign that you’re experiencing a “normal” pregnancy, but that claim is a myth — and so is the reverse. If you’re not having morning sickness, or if it suddenly disappears, don’t worry that your pregnancy isn’t normal; just enjoy your good fortune.

Similarly, you may hear that the severity of your queasiness indicates whether you’re having a girl or a boy. But that’s also a myth, so don’t buy those pink or blue outfits just yet.

Above all, don’t compound the problem by worrying about it. The nausea is harmless — to you and the baby. Your optimal weight gain for the first three months is only 2 pounds. Even losing weight probably isn’t a big problem.