Manage nausea and vomiting in pregnancy with first-line strategies like hydration, 400–800 μg/day folic acid supplementation, ginger capsules (250 mg four times daily), and P6 acupressure wristbands. Second-line options include vitamin B6 tablets, taken throughout the day, with or without doxylamine. If symptoms persist, third-line treatments like dimenhydrinate or prescription medications such as doxylamine-pyridoxine (Diclegis), promethazine, or ondansetron may be necessary.
January 10, 2025

Morning Sickness: 3 Lines of Defense

Evidence-Based Over-the-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Common in the first trimester due to hormonal changes, occurring in up to 90% of pregnancies, typically at 5-6 weeks gestation, peaking 9 weeks, and resolving by 16-20 weeks.

The American College of Obstetricians and Gynecologists 2018 Practice Bulletin No. 189 recommends the following approach:

Before conception:

First-line recommendations:

Second-line recommendations:

  • Vitamin B6: A recent systematic review of RCTs and non-RCTs found that vitamin B6 (pyridoxine) was associated with improvement in mild nausea and vomiting symptoms. Take 1 tablet before bedtime, with or without doxylamine sleep aid and 2 more throughout the rest of the day. Vitamin B-6 25 Mg Tablets.

Third-line recommendations:

  • Dimenhydrinate: Antihistamines (such as dimenhydrinate and diphenhydramine) have been shown to be effective in controlling nausea and vomiting symptoms of pregnancy and are frequently used. 50mg every 4-6 hours as needed. If also taking doxylamine sleep aid, do not exceed 200mg per day. Dramamine original nausea relief.

Prescription medications:

  • Doxylamine-Pyridoxine (Diclegis or Bonjesta): Combination of an antihistamine (doxylamine) and vitamin B6 (pyridoxine) used as a second-line alternative.

  • Promethazine (Phenergan) and Prochlorperazine (Compazine): Antihistamines with anti-nausea properties. Effective but may cause drowsiness and other side effects.

  • Ondansetron (Zofran) and Metoclopramide (Reglan): Neurotransmitter blockers for severe nausea when other medications fail.

Citation:

Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy. Obstet Gynecol. 2018; 131(1): p.e15-e30. doi: 10.1097/AOG.0000000000002456

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