If morning sickness—and worry over treating it—overshadows the thrill of being pregnant, you may be happy to learn that a popular nausea medication appears to be safe for both mom and baby. A major study, published in this week’s Journal of the American Medical Association, reinforces the safety of metoclopramide (also known by its brand name, Reglan), which is often prescribed when other treatments don’t ease severe symptoms.
High-risk pregnancy expert Dr. Loralei Thornburg says the study brings great news. Reviewing more than 1.2 million pregnancies, researchers compared outcomes for women who used metoclopramide to those who didn’t. Their analysis showed no association between the medication and pregnancy loss or any of 20 common birth defects.
While most women have some nausea and vomiting during pregnancy, for some, it can be severe. Researchers estimate that 50,000 women with extreme morning sickness require hospitalization each year and they lose just over 200 hours of time at work during a pregnancy. And that doesn’t count the emotional toll of feeling horrible during what is supposed to be one of the happiest times of their lives.
Women who have significant symptoms often hesitate to take medications, fearful they may harm the baby. Those who do take medications often feel guilty about it and limit their use to minimize any potential exposure to the baby. As a result, some women become very ill, even requiring hospitalization or potentially dangerous interventions. This study reinforces what we’ve long thought—this medication is safe in pregnancy and should be used when needed.
When you need it
When nausea and vomiting interfere with daily life, it’s time to seek help. It’s not uncommon for pregnant women to experience some morning sickness in the first few weeks. Sometimes it’s the first sign of a pregnancy. But when it doesn’t subside—no matter what you do—and you’re unable to keep any food down, losing weight and feeling debilitated, that’s extreme.
Your provider will check for weight loss and signs of dehydration, which may indicate hyperemesis (severe morning sickness). These two symptoms separate hyperemesis from more common mild nausea and vomiting during pregnancy.
Up to 15 percent of women may need prescription medication to relieve their nausea and vomiting. If you’re among them, you should feel reassured regarding the potential for effects of this medication on your baby. This study looked at both early and late pregnancy loss and well as birth defects. Women experiencing these events often blame themselves for these outcomes because they used medications during pregnancy.
When you don’t
If you’re among the larger group with less severe—yet still troubling—symptoms, here are some tips for coping:
- One-a-night: Consider taking your prenatal vitamin at night, finding one without iron in it for a few weeks, or trying other forms of prenatal vitamin such as a chewable or gummy vitamin.
- Sip and sleep: Stay hydrated and get plenty of rest. Frozen juice bars or popsicles can be helpful and provide water, sugar, and electrolytes. Take small, frequent sips of fluids to avoid overwhelming a sensitive tummy.
- Spice it up: Try ginger; some evidence shows that ginger may help to subdue symptoms.
- Get to the point: Consider the use of pressure-point wrist bands (sea bands) to provide relief.
- “B” yourself: Vitamin B6 is available over the counter, and when taken routinely can help reduce mild nausea symptoms.
- Munch mini meals: Eat smaller meals five to six times a day. Try carbohydrate-rich foods, like bread or saltines, before getting out of bed in the morning. Avoid spicy or acidic foods that can worsen heartburn and increase nausea. Sour and salty are often flavors that are tolerated well in nausea, but eat what sounds good to you. Typically a low-residue diet (like pasta, potatoes, bread, and other simple foods) is better tolerated than foods with heavy sauces or strong flavors.
Loralei L. Thornburg, MD, is an assistant professor in URMC’s Department of Obstetrics and Gynecology and is board certified in both Ob/Gyn and Maternal Fetal Medicine.