Pregnant Women With Morning Sickness Need To Be Offered Alternative Treatments, Report Advises

'Nobody should suffer unnecessarily.'

22/06/2016 14:01

Women experiencing morning sickness during pregnancy need more support, the Royal College of Obstetricians and Gynaecologists (RCOG) has argued.

With an estimated 80% of women experiencing nausea in the first 12 weeks of pregnancy, the RCOG has issued guidance on treatments in their latest report published on 22 June 2016.

The report also discussed how morning sickness can affect a woman's quality of life, adding that practitioners are advised to assess a woman’s mental health status during the pregnancy and refer her for psychological support if necessary.

"Women suffering from nausea and vomiting and hyperemesis gravidarum can face a challenging time in early pregnancy," said the study's lead author, Dr Manjeet Shehmar, a consultant obstetrician and gynaecologist.

"It is therefore vital that women with this condition are given the right information and support."

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The RCOG advises that women experiencing morning sickness should be managed with antiemetics - a drug that is effective against vomiting and nausea. 

The latest guidance also gives suggestions for alternative therapies such as acupressure or eating ginger to help mums-to-be.

Morning sickness, the most severe form of which is called hyperemesis gravidarum (HG), can affect women at any time of the day.

According to the NHS, some women may feel sick all day long. It's thought hormonal changes in the first 12 weeks of pregnancy are likely to cause this feeling.

The NHS advises women whose morning sickness doesn't improve after they make changes to their diet and lifestyle, to contact their GP who may recommend a short-term course of an anti-sickness medicine.

"This type of medicine is called an antiemetic," the website states. "The commonly prescribed antiemetics can have side effects. These are rare, but can include muscle twitching."

The RCOG report advises combinations of different drugs should be used in women who do not respond to a single antiemetics - the drug metoclopramide is "safe and effective", but should only be used if initial treatment doesn't work.

The drug ondansetron was also said to be "safe and effective", but because data on it is limited, it should also only be used as second-line therapy.

For women diagnosed with HG, the RCOG advised corticosteroids should be used if standard therapies have failed.

If medicines do not ease a woman's symptoms of morning sickness, the RCOG said "enteral or parenteral treatment" (feeding through a tube) should be considered. 

"There are no defined criteria for parenteral or enteral feeding," they wrote.

"Their effectiveness is not well established. Anecdotally, they can be successful and are often employed as a last resort when all other medical therapy has failed and the only other practical option is termination of the pregnancy."

Commenting on the report, Louise Silverton, director for midwifery at the Royal College of Midwives, said: “This is an important guideline that acknowledges how disruptive nausea and vomiting can be for women during pregnancy, as well as providing treatment options.

"Much nausea and vomiting is in early pregnancy sometimes before women have entered the maternity care services. Where women have received midwifery care, it is important that women know how to contact services when vomiting becomes persistent or debilitating."

Dr Helen Webberley, GP for, said women being prescribed medication that is "safe and effective" isn't always easy. 

"Prescribing during pregnancy is always a difficult decision for doctors and pharmacists, and we have to continually weigh up the pros and cons of treating versus not treating, and the effects on both the mother and the developing baby," she told The Huffington Post UK

"Not only do we have to look at risks versus benefits for the mum and baby, we also have to be aware that these are continually changing as pregnancy progresses. Something that might be safe in early pregnancy might not be safe in later pregnancy.

"Morning sickness can be very debilitating and worrying, and causes a lot of GP appointments, hospital admissions and time off work.

"I welcome more help for pregnant women and as long as we balance the risks with the benefits of treating morning sickness, then nobody should suffer unnecessarily."

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