A Mother's Day Memo: "Please Excuse Me if I Hurl"

By Lynn Martinez, Teratogen Information Specialist, MotherToBaby Utah

BXP68870h.jpg“O.K., so I can’t look at pizza the same way. Saltine crackers seem to be my go-to snack for sustenance and don’t even SAY the word ‘curry!’ Oh no, I said it… Please excuse me while I hurl,” said Nicole, 34, who’s pregnant with her second child.

For many of the moms I counsel as a teratogen information specialist with the international non-profit, MotherToBaby, this is part of the reality of becoming a mom – nausea and vomiting of pregnancy (NVP).

Yes, it’s a real diagnosis. “Please help me! Can I take something to help this nausea?” is usually the caller’s desperate question following her description of how she’d rather swim with sharks than accidentally catching a whiff of chicken tikka masala. Nausea and vomiting of pregnancy (NVP) affects most pregnant women, whether it’s their first pregnancy or a subsequent one. For nearly a third it can be serious enough to disrupt their usual lives and routines. In the past, it has too often been discounted, but now more health care providers are willing to take it seriously and treat their patients. One of the drugs I get asked about more and more often recently is ondansetron, or Zofran, as it’s more commonly known.

Ondansetron is FDA-approved for use with nausea and vomiting in non-pregnant patients, but has been found to be effective for and used increasingly to treat NVP.  Early studies demonstrated no increased fetal risk with its use.  Two more recent studies found very small associations with oral clefting (cleft lip and or palate).  Oral clefting defects are very common, so associations with exposures are more likely to be coincidental.  These studies have not conclusively shown ondansetron to cause clefting or any other defect.  Therefore, it is unlikely the drug needs to be avoided during pregnancy

Other drugs to treat NVP have also been shown not to be a problem for the baby.  The combination of doxylamine and vitamin B6 has been used for many years and is effective for many women.  This combination is now available in the newly-marketed Diclegis.  Ginger, whether in its raw form or in tablets, also works well for some expectant moms.

“So there are options?” exclaimed Nicole. “Thank goodness! Is it appropriate to ask my older child to work with daddy to get me some medication for nausea this Mother’s Day - instead of flowers?” she giggled.

For some women, the nausea and vomiting subside greatly after the first trimester, but for those who need extra support with some treatment, encourage the moms-to-be in your life to consult their health care providers for options. And, whatever you do, do not, I REPEAT, do NOT show up with a potpourri basket for mom coupled with freshly-made Panang curry this Mother’s Day.

Lynn Martinez is a Senior Teratogen Information Specialist with MotherToBaby Utah, a program with the health department and University of Utah that aims to educate women about medications and more during pregnancy and breastfeeding. Along with answered questions from women and health providers regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free hotline and email counseling service.  Lynn has also traveled around the state educating doctors, nurse midwives, pharmacists and others over the past three decades.

MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies, including the Centers for Disease Control and Prevention (CDC). If you have questions about medications, alcohol, diseases, vaccines,  or other exposures during pregnancy or breastfeeding, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate.

References:

  1. Pasternak B, Svanstrom H, Hviid A, “Ondansetron in pregnancy and risk for adverse fetal outcomes” New England Journal of Medicine.  February 28, 2013; 368(9): 814-823
  2. Anderka M, Mitchell A, Louik C, et al, “Medication used to treat nausea and vomiting in pregnancy and the risk of selected birth defects.”  Birth Defects Research Part A: Clinical and molecular teratology.  January 2013; 94(1): 22-30
  3. Einarson A, Maltepe C, et al, “Treatment of nausea and vomiting of pregnancy: an updated algorithm.”  Canadian family physician Medecin de famille canadien.  December 2007; 53(12): 2109-2111
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