Q: My daughter is two months pregnant and has morning sickness all day. She has tried ginger tablets, saltines and gingerale, nothing seems to help. Do you have any suggestions?
A: Morning sickness is unfortunately a fairly common problem, and in its most severe form, given the fancy name of hyperemesis gravidarum, requires hospitalization and intravenous fluids to maintain hydration. Many women do feel queasy during the first few months of pregnancy. We really do not know the cause – some researchers think it’s due to higher levels of estrogen seen during pregnancy, or high levels of the hormone that gives us the positive pregnancy test, namely human chorionic gonadotropin, or HCG. Indeed, in pregnancies where we see high levels of HCG, such as twins or pregnancies with placental tumors called moles, we often see bad morning sickness.
The good news is that most morning sickness resolves by the end of the first trimester of pregnancy – we just have to get your daughter to that point. One trick that I find helpful is vitamin B6. I know women taking up to 200 mg per day, and that often helps. The midwives taught me to give it intravenously in doses of 100 mg at a time, and that often works well. Many patients come in for B6 injections once or twice a week, with good results. Of course, rest tends to help too. If a woman is working 12 hours a day without a break, just getting her off her feet for several hours a day may help.
Sometimes one needs to resort to medicines to help with the nausea and vomiting. Fortunately, there are several medications that do the trick. An antihistamine known as phenergan is widely used during pregnancy, and is available not only in pill but also in rectal suppository form for women too sick to swallow a pill. And for very recalcitrant nausea, a medication known as ondansetron or Zofran, which is commonly prescribed for nausea of chemotherapy can be helpful. It is very expensive, but it’s worth it if it helps keep an unfortunate woman out of the hospital. These medicines seem to be safe during pregnancy, so if someone is very sick, she should not hesitate to seek help.