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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Nausea and Vomiting in Pregnancy
Sponsored by The Indian Health Service Clinical Support Center
10. What about natural products and lifestyle changes?
The first steps in managing nausea and vomiting in pregnancy should be diet and lifestyle changes.
Avoidance of triggers
The cornerstone of nonpharmacologic therapy of hyperemesis gravidarum is avoidance of environmental triggers. Examples of some triggers include: stuffy rooms, odors (e. g., perfume, chemicals, food, smoke), heat, humidity, noise, and visual or physical motion (e. g., flickering lights, driving). Brushing teeth after eating, quickly changing position, and not getting enough rest may also aggravate symptoms. Supplements containing iron should be avoided until symptoms resolve.
Diet
Advise your patient to make dietary adjustments, such as small, frequent, high carbohydrate, low fat meals. Other dietary manipulations, such as eliminating foods high in fat or spicy foods or eating salty or high protein snacks/meals appear to help some women. Fluids are better tolerated if cold, clear, and carbonated or sour (e.g., ginger ale, lemonade) and if taken in small amounts between meals.
Aromatic therapies involving lemon (lemonade), mint (tea), or orange have also been described as useful. Women with hyperemesis should eat before or as soon as they feel hungry in order to avoid an empty stomach that may aggravate nausea.
Davis 2004 provides an evidence based review of nausea and vomiting in pregnancy with helpful tables on Dietary Instructions, Lifestyle Changes, and Stressors in Women with Nausea and Vomiting
Herbal or Natural alternatives
Other patients may want to pursue herbal or natural alternatives. These agents are not regulated by the FDA, hence one can never be certain what dose, potency, or contaminants are actually present in these preparations. Caution should be exercised when using any unregulated products like those listed below.
Here are some examples
Name |
Category |
Plant Part |
Dose |
Comments |
|---|---|---|---|---|
Ginger
|
Herb |
Root |
Oral: 250 mg 3 -4 times/day with food, standardized to contain 4% volatile oils or 5% total pungent compounds (most prominently 6-gingerol and 6-shogaol) per dose |
Ginger has been used extensively as both a culinary herb and an agent in traditional medicine. In the US, it has been popularized for motion sickness, dyspepsia, and nausea. Its lack of sedative effects may be an advantage over other antiemetic agents. Ginger is beneficial as an antiemetic, for both nausea and vomiting, in women |
Herb |
Flower |
Oral: 400-1600 mg/day in divided doses, standardized to contain 1.2% apigenin and 0.5% essential oil per dose Tea: 1 heaping teaspoonful of dried flowers in hot water; steep for 10 minutes, drink up to 3 times/day |
Chamomile has been used for centuries as a mild sedative and anxiolytic. In contrast to many anxiolytic agents, it does not generally cause drowsiness or motor impairment. Chamomile also has spasmolytic and anti-inflammatory properties which may contribute to its apparent value in relieving a number of gastrointestinal complaints. |
|
Peppermint
|
Herb |
Leaf, oil |
Oral: One tablet (enteric coated),
2-3 times/day, containing 0.2 mL oil per tablet |
Peppermint oil is used for digestive complaints as a carminative and spasmolytic. It is also used in Irritable Bowel Syndrome (IBS). |
17
weeks gestation. In one study, subjects took ginger at doses up to 1 g daily
for a maximum of 4 days. Follow-up and assessment took place for 7 days following
the treatment period. No side effects were reported during this study and evaluation
period
4.5%
w/v and 
10%
w/w of esters calculated as menthyl acetate
44%
w/v of free alcohols calculated as menthol
15%
w/v and 
32%
w/v ketones calculated as menthone
