For some women, unfortunately, nausea elevates with pregnancy to the next level (figuratively and literally). Waking moments are riddled with waves of nausea and vomiting. It may be cyclic or occurring at particular times during the day or with particular triggers. The goal would be to reduce these environmental triggers (smells, visuals.. etc).
If the doxylamine-pyridoxine (Diclegs, discussed in previous blogs) is ineffective, then another class of drugs may be added to the regimen. For women who experience side effects, yet another class of drugs can be substituted in this place. These medications can include diphenhydramine (Benadryl), meclinize and or prochlorperazine. These medications should be used with a care provider aware of the symptoms present.
Sometimes, fluid replacement (IV-fluids) and IV anti-emetic meds may be enough to turn the tide and restore electrolyte balance and hydration. Constant vomiting and signs of dehydration (decreased urine output) weight loss and sallow eyes, should be followed by a physician.
In pregnant women refractory to all the above and with frequent ER visits for hydration, ondansetron (Zofran) has been a mainstay. However, the use of this medication in pregnancy has been controversial. In limited studies, there was a small risk of cardiovascular anomalies. However, like most aspects of life, the benefits must outweigh the risks and for many women who suffer from this relentless cycle, it does.
In women less than 10 weeks pregnant, the risk-benefit profile must be considered. After cardiac formation (after 10 weeks), it may be used more readily.
Fortunately, there are no long term effects on cognitive development of the fetus from nausea and vomiting of pregnancy. There are questions as to whether the early metabolic issues experienced my by the mother affect fetal metabolic profiles or even the metabolic profiles of the resultant child.
Because heartburn (acid reflux) has been associated with nausea and vomiting, treating it prior to conception may afford a reduction in symptoms.
It is always best to consult your doctor. We are here to help answer any questions you may have!