New guidelines released for managing nausea, vomiting during pregnancy

The Society of Obstetricians and Gynaecologists of Canada has released new guidelines to help pregnant women suffering from nausea and vomiting including, among them, a recommendation that they can eat whatever pregnancy-safe foods they want.

The new guideline titled, “The Management of Nausea and Vomiting of Pregnancy” has been published in the December edition of the SOGC’s peer-reviewed Journal of Obstetrics and Gynaecology Canada (JOGC). The medical society says that nausea and vomiting of pregnancy (NVP) affects 50 to 80 per cent of all pregnant women. The SOGC says the cases can range from mild to severe.

The publication lists 13 recommendations that cover diet and lifestyle changes, non-pharmacological therapies and pharmacological therapies to combat the stomach-churning symptoms, which can range from mild nausea to throwing up multiple times per day.

Many women suffer through the gut-wrenching condition without treatment because they worry about the potential risks medications pose to the developing fetus, said Dr. Jennifer Blake, CEO of the professional medical organization.

However, managing the condition "can have a profound effect on improving women's health and their quality of life during pregnancy," Blake said in a statement to The Canadian Press following Thursday's release of the guidelines.

Kim Campbell, the guidelines’ principal author and a registered midwife from B.C., said the SOGC document is the summary of the most recent scientific and clinical research available.

"There are some new medications on the market, but there isn't necessarily a magic bullet," she said. "What we have now is more information about some natural approaches that are accessible to everybody.”

Fill up on potato chips if you want

The SOGC says women were told in the past to eat small, bland meals and to avoid fatty foods, such as potato chips, to prevent NVP. However, new guidelines suggest there is little evidence to support the idea that dietary changes will relieve symptoms. Instead, the new recommendations encourage women to eat whatever pregnancy-safe food they want.

Campbell notes that it is important for women to be wary of foods that have a higher likelihood of carrying infections like Listeria. Vegetables should be thoroughly washed. Deli meats, uncooked meats, unpasteurized dairy products and soft cheeses should be avoided.

Prenatal vitamins

The statement also says there is new evidence that pregnant women experiencing nausea and vomiting, who don’t have an iron deficiency, can stop taking prenatal vitamins containing iron in their first trimester. Instead, they can substitute iron prenatal vitamins with folic acid or vitamins that are low in iron.

The medical society also reported other safe options to relieve symptoms include taking ginger (particularly pharmaceutical-grade ginger), pyridoxine (Vitamin B6) and self-administered acupressure.

Forget medical marijuana

While the stomach-settling properties of medical marijuana have long been touted by cancer patients undergoing chemotherapy, taking a puff during pregnancy is not recommended.

Campbell said the SOGC committee that wrote the guidelines did discuss marijuana, but decided not to include it in the new guidelines.

Recommendations:

1) Women may discontinue iron-containing prenatal vitamins during the first trimester and substitute them with folic acid or vitamins low in iron.

2) Women should eat whatever pregnancy-safe food appeals to them.

3) Ginger may help alleviate NVP symptoms.

4) Acupressure may help some women manage their NVP.

5) Mindfulness-based cognitive therapy may be beneficial.

6) Pyridoxine monotherapy or doxylamine/pyridoxine combination therapy is recommended.

7) Pre-emptive doxylamine/pyridoxine treatment at the beginning of pregnancy may be beneficial for women with a high risk for nausea and vomiting.

8) H1 receptor antagonists should be considered in the management of acute or chronic episodes of NVP.

9) Metoclopramide can be safely used as an adjuvant therapy.

10) Phenothiazines are safe and effective as an adjunctive therapy for severe NVP.

11) Ondansetron can be safely used as an adjunctive therapy when other antiemetic combinations have failed.

12) Corticosteroids should be avoided during the first trimester.

13) When NVP is resistant to initial pharmacotherapy, doctors should investigate other potential causes.

With files from The Canadian Press