What are Safe Treatments for Morning Sickness?

What are the common symptoms of morning sickness?

If you experience nausea, vomiting, or both during your pregnancy, you are not alone. Nausea and vomiting occur in more than half of all pregnancies. Often referred to as morning sickness, these uncomfortable symptoms frequently last throughout the day and can have a negative impact on quality of life during pregnancy. Nausea and vomiting most commonly start around week 6 of the pregnancy, peaking between 8 and 10 weeks. For some, these symptoms may be present well into the second trimester.

What causes morning sickness? Is there a cure?

The exact cause of nausea and vomiting in pregnancy is unknown, and there is no absolute cure for this condition. Instead, treatments are used to prevent or reduce the symptoms. 

What are safe natural treatments for morning sickness?

Non-drug treatments for morning sickness include eating small amounts of food several times a day instead of consuming larger meals, as well as eating foods with a high protein content. Acupressure wrist bands may also provide some relief.

Ginger is an herbal product commonly used in pregnancy to treat nausea and vomiting. It is an aromatic spice native to Asia and other tropical climates and has been used as an herbal medicine since at least 400 BC. Ginger can decrease esophageal pressure, increase stomach emptying, and decrease gas production. It is available in multiple forms, including teas, candies, and pills. The use of ginger as a treatment for pregnancy-induced nausea and vomiting has been studied for decades. Multiple studies have demonstrated its safety and effectiveness. The American College of Obstetricians and Gynecologists (ACOG) recommends ginger as a first-line non-drug option, at a dosage of 250 mg 4 times a day.

While these non-drug treatments are effective for many, medications are required in at least 10% of pregnancies to provide more effective control of nausea and vomiting.

What are safe drug treatments for morning sickness?

Doxylamine (an antihistamine) and pyridoxine (vitamin B6) are effective drug treatments for pregnancy-induced nausea and vomiting. Each of these drugs is available individually over-the-counter. They were combined in a prescription medication named Bendectin that was marketed in the 1950s as a treatment for pregnancy-induced nausea and vomiting. Bendectin was withdrawn from the US market in 1983 because of concerns about a potential association with birth defects. Ultimately, multiple large human and animal studies failed to show a relationship between Bendectin and birth defects. 

In 2013, Bendectin was reintroduced in the US as the prescription medication Diclegis. Diclegis is classified by the FDA as Pregnancy Category A, meaning that multiple well-controlled investigations have failed to show evidence of fetal risk and the drug is safe to take during all trimesters of pregnancy. Diclegis contains doxylamine 10 mg and pyridoxine 10 mg and is commonly prescribed as 1 tablet in the morning, 1 in the mid-afternoon, and 2 at bedtime. Since Diclegis contains an antihistamine, it can cause drowsiness. The use of pyridoxine, alone or in combination with doxylamine, is recommended by ACOG as a first-line drug treatment for nausea and vomiting of pregnancy.

If nausea and vomiting persist despite use of the therapies discussed above, there are several other prescription drugs available, including promethazine (Phenergan), metoclopramide (Reglan), and ondansetron (Zofran). These medications can be administered by mouth, as well as rectally or by injection if the patient has difficulty taking pills due to persistent nausea and vomiting. However, these medications have significant side effects, including excessive sleepiness and abnormal heart rhythms. In addition, some studies have shown an increased risk of birth defects related to use of these drugs. Because of the side effects and risks of fetal harm associated with the use of these drugs, ACOG only recommends these medications as second-line therapies for nausea and vomiting in pregnancy.

In up to 3% of pregnancies, nausea and vomiting are severe enough to cause weight loss and electrolyte changes. This condition is called hyperemesis gravidarum and often requires hospitalization. Intravenous fluids, and in some cases, even artificial nutrition through a feeding tube, may be required to prevent or treat dehydration or nutritional deficiencies.

If you have nausea and vomiting during pregnancy, remember that this condition is usually temporary. In addition, many studies show that those who experience nausea and vomiting during pregnancy have a decreased risk of miscarriage, premature birth, and birth defects.

What should you do if you had an adverse reaction to a morning sickness treatment?

If you have questions about morning sickness or suspect an adverse event or poisoning related to a treatment for morning sickness, you can get 24/7 free and confidential help from Poison Control at 1-800-222-1222.

Kelly Johnson-Arbor, MD
Medical Toxicologist

Revised William G. Troutman, PharmD
Professor of Pharmacy Emeritus 

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