Common Treatments for Hyperemesis Gravidarum
By Peggy O'Mara
Nausea and vomiting, the most common conditions of pregnancy, affect up to 80 percent of all pregnant women. Commonly called “morning sickness,” nausea and vomiting can occur throughout the day. Rarely does this cause problems for mother or baby, and most often it resolves itself around the 12th week of pregnancy, when levels of the pregnancy hormone Human Chorionic Gonadotropin (hCG) plateau. Ninety percent of nausea and vomiting is relieved by the 22nd week of pregnancy.
For a small percentage of pregnant women, however, there is no relief. For these women, the severe nausea and vomiting, in such cases called hyperemesis gravidarum, never abate, and sometimes require hospitalization with intravenous (IV) fluids and medications. In many cases, a home health nurse can administer IV fluids, so that the pregnant woman can stay at home.
Hyperemesis gravidarum can be related to hyperthyroidism, gall-bladder disease, pregnancy-induced hypertension, appendicitis, or irritable bowel syndrome. Smaller, more frequent meals that are low in fat and sugar and contain plenty of vegetables and fruits can help. Caffeine should be avoided.
Acupressure has proven successful in relieving the nausea of pregnancy. The NeiGuan Pressure Point (P6) is located about two inches below the wrist crease dividing the wrist from the hand, on the underside of the wrist, between the two tendons. Apply direct pressure either with fingers or with a wristband. Ginger root has been used for centuries for nausea; it can be taken raw or in the form of tea, tinctures, capsules, or candy. It is often suggested that the intake of foods containing B vitamins be increased. These include whole grains, leafy greens, dried beans, almonds, peanuts, broccoli, and cabbage.
Antiemetic drugs are prescribed for some women who suffer from pernicious nausea and vomiting. Medications are taken rectally, orally, or through an IV line, and may include pyridoxine (vitamin B6). These drugs include Promethazine (phenergan), Compazine, Haloperidol, and even Thorazine (chlorpromazine). Newer antinausea drugs, such as Zofran (ondansetron), were designed for cancer patients and are expensive. Nor are they always covered by insurance, as they are not labeled as approved for use by pregnant women.
In one study, two thirds of the women surveyed believed that drug use was more likely to increase their baby’s risk for birth defects.1 These fears are fueled by memories of such drugs as thalidomide, which was prescribed to pregnant women for nausea in the 1950s. Thalidomide was withdrawn from the market in 1961, when it was discovered that the drug was a human teratogen; i.e., a substance that would cause developmental malformations in the fetus. Approximately 5,000 to 7,000 malformed infants were born to women who ingested thalidomide during pregnancy.
Bendectin, a combination of vitamin B6 (pyridoxine) and the antihistamine Doxylamine, was commonly prescribed for nausea in pregnancy. Because of repeated accusations that Bendectin caused fetal malformations, its manufacturer, Merrell Dow Pharmaceuticals, voluntarily removed the drug from the market in 1983. According to its supporters, Bendectin was never proven to be teratogenic. It is still marketed in Canada, under the name Diclectin.
Hyperemesis is a serious condition—the dehydration that results from repeated nausea and vomiting can put both baby and mother at risk. However, the drugs commonly prescribed for severe nausea and vomiting have never been tested on pregnant women. In some cases, the results of animal trials are available, but there simply have been no tests on pregnant women. Although no animal or human teratogenicity has been reported regarding Zofran (ondansetron), arguably the most effective drug for nausea and vomiting, Zofran’s package insert cautions: “There are, however, no adequate or well-controlled studies in pregnant women. Because animal reproductive studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.”
For some women, nothing seems to work. One mother reported vomiting 10 to 30 times a day, sometimes every 15 minutes. Steroids are used to control the vomiting. In addition, the antiemetic drug Zofran is prescribed, as well as the antipsychotic Zyprexa. These drugs can be taken as tablets dissolved under the tongue, or by IV. In one study of 267 pregnancies, preliminary survey data reported that medical marijuana was 34 to 40 percent effective in relieving the symptoms of hyperemesis gravidarum—at least as effective as Antivert (meclizine), corticosteroids, and Diclectin.
1. Paolo Mazzotta, MSc, et al., “The Perception of Teratogenic Risk by Women with Nausea and Vomiting of Pregnancy,” Reproductive Toxicology 13, no. 4 (Jul-Aug 1999): 313–319.