What helps reduce nausea in pregnancy?

Nausea typically starts between the sixth and eighth week of pregnancy and is gone by the end of 16 weeks. It lasts longer in some women, though. Nausea and vomiting become more of a problem if you feel extremely unwell and it becomes difficult to eat enough and follow a balanced diet. Severe nausea may also be a sign of other illnesses, such as gastroenteritis (stomach bugs), migraines, or gallbladder or pancreas disease.

It is not known why nausea is so common in pregnant women. Hormonal changes are believed to play an important role.

It hasn’t been proven that stress or other emotional issues can cause these problems or make then worse.

Many pregnant women try to manage their nausea without using medication. Many react to triggers like certain smells and foods, heat or noise. It can help to pay attention to when you start feeling nauseous and whether triggers are identifiable, so they can be avoided.

Eating smaller meals more frequently throughout the day, drinking a lot of fluids and eating a low-fat diet are strategies that help some pregnant women. There is no good research testing different diets, changes in lifestyle or psychological support to see whether they relieve nausea and vomiting in pregnancy.

If women vomit a lot as a result of severe pregnancy-related nausea, they are given infusions (a drip) at the hospital to replace the fluids lost. They then typically stop eating solid foods for several days.

Only very few studies have looked into the use of medication for nausea and vomiting in pregnancy. This is in part because hardly any clinical studies are done on pregnant women, as a precaution to prevent any harm to the child.

Common medications for nausea and vomiting:

• Vitamin B6 products (pyriodoxine) can relieve nausea somewhat. It is not clear whether they prevent vomiting too.
• Doxylamine is an older drug used to treat allergies (an antihistamine). Because it causes fatigue, it is mainly used as a sleeping pill. Studies have shown that it can relieve nausea and vomiting in pregnancy when combined with vitamin B6. Products that only contain doxylamine are also available. It is not clear whether they relieve these problems as well.

Other medications:

• Dimenhydrinate is also an allergy medication used to treat nausea and vomiting.
• Metoclopramide stimulates the movement of the stomach and bowel, and is commonly used for nausea and vomiting.
• Promethazine is mainly used to treat restlessness and agitation, but it's also approved for the treatment of nausea and vomiting.

Only the combination of Doxylamine and vitamin B6 has been explicitly approved in Germany for the treatment of nausea and vomiting in pregnancy. The other medication can be prescribed "off-label" by a doctor. It is then especially important to get professional advice about their effects, including possible side effects.

Only a few studies have looked into the effectiveness of medication when used specifically to treat hyperemesis gravidarum (especially severe pregnancy-related nausea and vomiting), so it’s difficult to say whether they can help.

Studies suggest that certain ginger products can help relieve nausea in pregnant women. These include ginger capsules or syrup (250 milligrams of ginger per dose) taken three or four times a day. It is not clear whether drinking ginger tea or getting a lot of ginger in your diet helps.

There is no evidence that herbal products relieve the nausea.

Some studies looked at whether drugs for nausea and vomiting increase the risk of miscarriages or malformations in children. To date there is no evidence for this, as long as the medications are taken only for a limited time and as prescribed.

Depending on the product or medication in question, various side effects can occur. Ginger may cause heartburn, but it is usually well tolerated. Older antihistamines like doxylamine make people feel very tired, and sometimes drowsy or dizzy. Metoclopramide affects the nervous system and might cause movement disorders. Vitamin B6 is usually well tolerated.

Many pregnant women also try alternative or complementary medicine. Acupressure is commonly recommended, for example using acupressure wristbands that are supposed to apply gentle pressure to certain areas. Research on acupressure has produced conflicting results – some studies see an effect, others do not. There is no evidence that acupuncture helps. This is also the case for homeopathic remedies. So the effects of alternative or complementary treatments for severe pregnancy-related nausea are not clear.