Most women who have ever been pregnant are familiar with that queasy, lingering nausea that comes with carrying a baby.
“Nausea during pregnancy is one of the most common and uncomfortable symptoms [of pregnancy],” says Janelle Luk, M.D., medical director and co-founder of Generation Next Fertility in New York City. “[It] impacts about 70% of pregnant women. … Nausea is linked to the pregnancy hormone (human chorionic gonadotropin hormone), which is released when the fertilized egg attaches to the uterine lining.”
It is usually most severe during the first trimester—but for some women, the nausea can last all nine months. You’ve probably heard the term “morning sickness,” but that’s a misnomer. It should really be called “all day sickness” because the truth is that it can strike at any time of the day or night. And it feels awful.
The good news is, it is unlikely to harm your baby. The vomiting only causes harm to your unborn child if it is so severe that you can’t keep any food or fluids down, which might affect the baby’s birth weight. But aside from this very rare scenario, nausea and vomiting of pregnancy is harmless. To the baby.
For the baby’s mama, it’s a relentless icky feeling that makes you want to hide in bed all day (as long as there’s a bathroom nearby). Here are the do’s and don’ts for treatment as you try to battle through.
Start with natural remedies
Outside of pregnancy, an upset stomach might have you running to the pharmacy for an over-the-counter solution. But drug choice requires more thought when you’re carrying a little one.
Often, pregnant women are able to manage their nausea on their own, according to Rebecca Berens, M.D., assistant professor of family and community medicine at Baylor College of Medicine in Houston.
“Home remedies with small, frequent bland snacks, such as saltine crackers, [may be enough],” Dr. Berens says. “Hard candies such as peppermints, sour candies, and commercial products such as ‘Preggie Pops’ can also be effective. Products containing ginger are known to be helpful, such as ginger candies and ginger teas.”
Family nurse practitioner and owner of Staunton Primary Care in Cincinnati, Ciara Staunton agrees. She also says that avoiding nausea triggers is important. “Examples of some triggers include stuffy rooms, odors (eg, perfume, chemicals, food, smoke), heat, humidity, noise, and visual or physical motion,” Staunton says. “Quickly changing positions and not getting enough rest/sleep may also aggravate symptoms. Lying down soon after eating and lying on the left side are additional potentially aggravating factors.” She explains that this could slow down digestion and keep food in your stomach for longer.
What about OTC treatments?
Our experts say if those interventions fail to calm your upset stomach, it’s time to talk to your provider. There are over-the-counter and prescription medications that may help—and some you should avoid.
The FDA recommends against using Pepto Bismol (Bismuth subsalicylate) during pregnancy. In fact, the agency has not assigned the drug to a pregnancy category, as there are not enough studies to show whether or not it is safe. According to a recent review in the Journal American Family Physician, pregnant women shouldn’t take this medicine in the second or third trimesters because of an increased risk of bleeding problems.
Nauzene, a popular upset stomach chew, is listed in the FDA’s pregnancy Category C. This means that controlled studies in animals have shown that the drug can harm the baby if taken during pregnancy, but doctors might still recommend it if the health benefits outweigh the risks.
If your upset stomach includes diarrhea, you might wonder if it’s safe for you to take an antidiarrheal such as Lotomil or Imodium. Like Nauzene, both of these OTC medications are a category C drug, so talk to your provider before picking some up at the pharmacy.
Tums, Rolaids, and other antacids are good, safe options if you have heartburn, but you should avoid taking magnesium in the last trimester as it could interfere with contractions during labor.
Your best bet for nausea, Staunton says, is vitamin B6: “Vitamin B6, 50–100 mg orally once daily, is nontoxic and may help some patients.”
Dr. Berens says that Unisom (doxylamine) is another drug that is safe and sometimes effective in treating nausea and vomiting during pregnancy. In fact, the FDA has approved a prescription medication for use during pregnancy that is a combination of Vitamin B6 and Unisom. It is called Diclegis.
“The same effect is possible, and much cheaper, by buying [Vitamin B6 and Unisom] over the counter,” Dr. Berens says. “Many physicians recommend trying Vitamin B6 alone first, then adding doxylamine, which is also a sleep aid, if Vitamin B6 alone is not effective. The sedating side effects of doxylamine may not be desired by a woman in her first trimester who is already exhausted!”
Researchers are not totally sure why the Unisom/B6 combination works to treat morning sickness. It might be because the drug combination blocks the neurotransmitters that send nausea signals in your brain. Or it could be that it simply disrupts your bodily processes that lead to vomiting.
Severe nausea and vomiting during pregnancy
Some women have severe nausea and vomiting that can’t be controlled with diet changes or over-the-counter medications. If this is the case for you, talk to your provider. There are other prescription medications that might help.
“This is especially important if your nausea is accompanied by vomiting and/or you are unable to keep down liquids,” Dr. Berens says. “Dehydration associated with hyperemesis gravidarum (a condition in which women suffer extreme nausea and vomiting during pregnancy) can be serious and requires urgent treatment.”
Some of the prescription medications that are available to treat extreme nausea and vomiting may have harmful side effects. It is important that you discuss the benefits and risks of any medications with your provider.