OVERVIEW AND SUMMARY OF TREATMENTS/STRATEGIES 1. Lifestyle Get extra sleep Avoid stress Wear loose-fitting clothes Speak up when someone brings an offensive smell into your range Get someone else to empty the kitty litter/do the dishes, whatever triggers a bout of nausea Use freshly-sliced lemons on your desk, around your neck, to keep your nose under control Experiment to see if pre-natal vitamins make it worse 2. Diet SMALL, FREQUENT MEALS--never let your stomach get empty Experiment to see if pre-natal vitamins make it worse Eat what you can tolerate (wait until later to worry about balanced nutrition Try popsicles, crushed ice, jello, fruit, bland starches Eating rotein before bedtime takes longer to digest Cola drinks help some people--and others are helped by cola drinks in which the carbonation has dissipated Papaya juice has enzymes that aid digestion Lemons--sucking on them, or in a lemon ice Ginger--either capsules, tea, sticks, or crystalized Rasberry tea--not rasberry leaf tea, which could cause premature labor Herbal remedies 3. Over-the-counter remedies Emetrol is a phosphated carbohydrate solution, is a sweet syrup which reduces smooth muscle contractions. Vitamin B6 has been shown to be effective. Recommended dosages seem to range from 25 mg, twice a day, to 50 mg, twice a day. One caution: your body becomes accustomed to a certain level of this vitamin, so you need to maintain a constant level by taking it every day, whether you are sick that day or not. If you miss a dose, you may find yourself very sick from the withdrawal effect. It works best to divide your daily intake into two or more evenly- spaced doses, and be consistent about the time of day you take it. As you start to feel better, wean yourself gradually by cutting down the daily dosage, cutting pills in half if necessary. (effectiveness: Sahakian V, Rouse D, Sipes S, Rose N, Niebyl J. Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study. Obstetrics and Gynecology 1991; 78:33-6). Vitamin B12 and E were recommended by people, but no studies were found. Acupressure wrist bands, often marketed for seasickness and available in many drug stores, have been shown to be effective (De Aloysio D, Penacchioni, P. Morning sickness control in early pregnancy by Neiguan Point Acupressure. Obstetrics and Gynecology 1992; 80:852-4.) 4. Prescription Medications What about the safety of medications? All of the drugs in this section are classified as FDA pregnancy category B, which means that "Animal studies have not demonstrated a risk to the fetus but there are no adequate studies in pregnant women *or* animal studies have shown an adverse effect, but adequate stin pregnant women hae not demonstrated a risk to the fetus during the first timester of pregnancy and there is no evidence of risk in later trimesters." So they are not without risk (no drug is) but chances are baby will be okay. Remember, mom's health is also essential to baby's health, and you wouldn't even be considering such a drastic measure as medication unless you were really ill. Intravenous Therapy--If you are sick enough to need intervention, but leery of drugs, see if your health care team can just rehydrate you without using medication Phenergan (Promethazine) seems to be commonly prescribed for nausea and omiting of pregnancy nowadays. It is available as either a suppository or pill, and the supporsitory is particularly useful in stopping a cycle of vomiting, since it can be administered at home yet does not require the medication to stay down in the stomach. The side effects include drowsiness that may preclude driving, and it becomes ineffective after extended use. Small women find the adudose may be too much for them, and adjust the dosage by cuttin it in half. There have been some studies as to the safety; see Niebyl JR, Maxwell KD. Treatment of the nausea and vomiting of pregnancy. In: Niebyl JR, ed. Drug use in pregnancy. 2nd ed. Philadelphia: Lea & Febiger, 1988. Bendectin (Debendox in the UK) was a combination of doxylamine succinate (10mg) and Vitamin B6 (pyridoxine hydrocholride, 10 mg) that has not been marketed in the U.S. since June 1983 because of the cost of defending lawsuits, but has recently become available in Canada under the name Diclectin. Published studies have linked it to correctable birth defects such as pyloric stenosis, but not the limb deformities for which lawsuits had been filed. The antihistimine in this drug is also found in the over-the-counter sleep aid Unisom, so anyone who is interested could mix their own by taking half a Unisom and a Vitamin B6 tab together. (Bendectin also had an antibiotic in the original formula, but that was dropped in 1976.) Reglan (Metaclopramide Hydrochloride) This drug is generally thought of for people with stomach problems, but it was shown to be effective in treating nausea and vomiting of pregnancy as well. (Leatham, Anne M. Safety and Efficacy of antiemetics used to treat nausea and vomiting in pregnancy. Clinical Pharmacy, 5, 1986, 660-668.)