Drugs, ginger and acupuncture 'best for morning sickness'

“Hundreds of thousands of pregnant women with morning sickness should be given drugs to ease their symptoms,” the Daily Mirror reports.

The recommendation comes from a set of new guidelines that also say ginger and acupuncture can play a useful role in treating nausea and vomiting in pregnancy, better known as morning sickness.

Health professionals prefer to call it nausea and vomiting in pregnancy as it can occur at any time, not just in the morning.

The new guidelines (PDF, 545kb) were produced by the Royal College of Obstetricians and Gynaecologists, a UK professional body of clinicians that seeks to improve healthcare for women.

Nausea and vomiting in pregnancy

Nausea and vomiting in pregnancy is very common in early pregnancy, affecting the majority of women in their first trimester.

It’s unpleasant, but doesn’t place the pregnancy at any increased risk and usually clears up by weeks 16 to 20 of pregnancy.

Hyperemesis gravidarum

The guidelines also discuss hyperemesis gravidarum, where women experience excessive nausea and vomiting.

They might be sick many times a day – some women report being sick up to 50 times a day – and be unable to keep food or drink down.

This is far less common than nausea and vomiting in pregnancy, affecting around 1 in every 100 women.

The Duchess of Cambridge, née Kate Middleton, reportedly suffered from hyperemesis gravidarum during her first pregnancy.

What are the main recommendations?

The main recommendations of the guidelines are outlined below.

Self care

Most women with nausea and vomiting in pregnancy can manage their symptoms themselves using self care techniques.

These include:

• eating small amounts of food often, rather than having several large meals – but don’t stop eating
• eating cold meals, rather than hot ones, as they don’t give off the smell that hot meals often do, which may make you feel sick
• avoiding foods or smells that make you feel sick

Complementary therapies

The guidelines mention there is some evidence that ginger supplements may help reduce nausea and vomiting.

To date, there have not been any reports of adverse effects being caused by taking ginger during pregnancy.

However, ginger products are unlicensed in the UK, so buy them from a reputable source, such as a pharmacy or supermarket. Check with your pharmacist before you use ginger supplements.

Similarly, acupressure on the wrist may also be effective in reducing symptoms of nausea in pregnancy.

Acupressure, similar to acupuncture, involves wearing a special band or bracelet on your forearm.

The guidelines do not recommend the use of hypnotherapy, as there is no evidence it is effective.

Medication

If symptoms fail to respond to these approaches, medication is recommended, which can be prescribed by your GP.

Anti-sickness medications (antiemetics) known to be safe during pregnancy, such as cyclizine, are usually recommended.

Some antihistamines, often used to treat allergies such as hay fever, also work as antiemetics.

Admission to hospital

Admission to hospital may be recommended if you:

• are dehydrated
• have severe vomiting and are unable to tolerate any fluids
• have abnormal blood tests
• have lost weight
• have a medical condition, such as a heart or kidney problem, or diabetes

What happens in hospital?

You will be given the fluids you need though a drip in your arm. This will be continued until you are able to drink fluids without vomiting.

You should be offered anti-sickness medication and a B vitamin called thiamine. Both of these can be given through the drip in your arm if you are unable to keep tablets down.

Compression stockings and medications may be used to help prevent blood clots. Being dehydrated and not being mobile increases blood clot risks.

You should be discharged from hospital once your symptoms improve.

Links To The Headlines

Pregnant women with morning sickness should be given drugs to ease symptoms, say doctors. Daily Mirror, June 22 2016

Ginger and acupressure ‘options for morning sickness’. BBC News, June 22 2016

All pregnant women suffering morning sickness to be offered drugs rather than ‘suffer in silence’. Daily Mail, June 22 2016

Use drugs to help women beat morning sickness, GPs urged. The Times, June 22 2016 (subscription required)

Links To Science

Royal College of Obstetricians and Gynaecologists. The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No.69). June 2016