Morning Sickness - Natural Effective Treatments for Nausea and Vomiting in Pregnancy

Morning sickness, also known as nausea gravidarum, affects up to 80% of pregnant women.^[1] Nausea and vomiting are usually limited to the first seven to twelve weeks of pregnancy, but can go on for longer in some women. There are also varying degrees of severity, from mild to severe, with complications such as dehydration. When the vomiting becomes so severe it disrupts food and fluid intake, it can lead to dehydration and electrolyte imbalances which can be harmful to the mother and baby. In addition to the obvious physical effects of morning sickness are the psychological and emotional effects.

Pregnancy should be a time of wondrous joy and preparation; feeling physically ill can take a lot of enjoyment out of the pregnancy experience. Morning sickness is a very real and very common issue for pregnant women, and over the course of many years there have been numerous remedies used such as ginger tea, smelling lemon peel, chewing peppermint gum, wheat germ dissolved in warm milk, apple cider vinegar, and the list goes on. There are some risk factors that make nausea and vomiting in pregnancy more likely. Waking up in the morning on an empty stomach is a common trigger, so eating a high-protein meal before bed and keeping some crackers beside the bed to eat first thing in the morning are good ideas; brushing teeth in the morning before eating can also trigger vomiting for many pregnant women. Unfortunately, for some women the nausea and vomiting are relentless no matter what they eat or what they do. For these women, let's look at the ability of supplementing with B6 and ginger to decrease morning sickness. Are vitamin B6 (pyridoxine) and ginger safe and effective as treatments for decreasing nausea and vomiting during pregnancy?

Vitamin B6 as a Treatment for Morning Sickness

Vitamin B6 is a water-soluble vitamin found in foods such as beans, nuts, eggs, legumes, meats, fish, whole grains, and fortified breads and cereals.^[7] Vitamin B6 helps the body mainly with immune and nerve function, as well as with the proper functioning of red blood cells. Overdosing or taking large doses of vitamin B6 can result in neurological dysfunction or numbness, which is usually reversible upon cessation of large doses. Vitamin B6 deficiency is not common in Canada or the Unites States, and isolated supplementation is rare, too, with the exception of one population: pregnant women. This poses the question: Do pregnant women need more vitamin B6 than the average population, and therefore could a deficiency in the vitamin be a contributing factor in nausea and vomiting? A study published in The American Journal of Clinical Nutrition in 1973 was interested in exactly that question. The results showed of 458 pregnant women, 40-60% of the women were suboptimally supplied with vitamin B6, compared with 300 male and female blood donors.^[4] Also, mothers in the study with more children were slightly more deficient compared to those with less children, suggesting that the degree of vitamin B6 deficiency is correlated to the number of pregnancies. The conclusion of this study was that vitamin B6 supplementation is necessary in 50% of pregnant women.^[4] These are significant results; they show that the average pregnant woman does need extra vitamin B6, due to an underlying deficiency. The next connection that needs to be made is whether this deficiency plays a role in morning sickness.

The next study investigated is more recent and is a randomized controlled trial. Thirty-one of 59 women received 25 mg of vitamin B6 every eight hours for 72 hours; the other 28 women in the same regimen received placebo.^[7] The results showed that there was a significant difference in nausea scores between patients receiving vitamin B6 (mean 4.3 ±2.1) and the placebo patients (mean 1.8 ±2.2) in patients with severe nausea.^[7] Patients with mild to moderate nausea showed no significant difference between placebo and treatment groups. As far as vomiting: total number of patients vomiting in the vitamin B6 treatment group was significantly reduced following vitamin B6 therapy.^[7] These are very encouraging and positive results. This study illustrates that vitamin B6 is beneficial in treating severe nausea and vomiting in pregnancy, and no negative side effects occurred. The study did show that it may not be beneficial for mild to moderate levels of nausea, but overall the evidence is clear: vitamin B6 is a supplement that is safe and effective in pregnant women experiencing morning sickness.^[3] Overall, so far the literature is pointing us in the direction of vitamin B6 as a helpful treatment for nausea and vomiting in pregnancy.

So what dosage of B6 should pregnant women be taking? In a prospective study on the adequacy of vitamin B6 supplementation during pregnancy, the results indicated that the current recommended dietary allowance for vitamin B6 during pregnancy (2.5 mg) is too low, and that 4 mg daily is actually recommended to avoid deficiency.^[2] Studies show that 30 mg/d of B6 is safe and effective in pregnancy.

Ginger as a Treatment for Morning Sickness

A randomized, double-blind, controlled trial took place in 2003 comparing the efficacy of ginger to vitamin B6 in the treatment of nausea and vomiting in pregnancy. A visual analogue rating scale was used for severity of nausea and number of vomiting episodes was recorded by each patient. There were 138 women participating in this study that were separated into two groups: one group took 500 mg of ginger orally three times a day for three days, and the other group took 10 mg of vitamin B6 orally three times a day for three days.^[5] The two treatments appeared identical to the patients and doctors/researchers to ensure the double-blind component of the study. The results showed a reduction in nausea scores in both treatment groups on average from a score of 5.0 to 3.6, with vitamin B6 showing slightly more effectiveness, but with no statistically significant difference.^[5] Ginger and vitamin B6 also significantly reduced the number of vomiting episodes, with ginger being slightly more effective, but again not a statistically significant difference.^[5] It is interesting though that they are both effective, with vitamin B6 being slightly more effective in reducing nausea and ginger being slightly more effective in reducing vomiting episodes. Sedation and heartburn were minor side effects seen in both treatment groups. The conclusion of this study is that vitamin B6 and ginger are both safe and effective in treating nausea and vomiting in pregnancy, with no significant difference between the two.

Conclusion

Ginger and vitamin B6 as treatment options for pregnant women with morning sickness are safe and effective.^[6] None of the studies stated significant negative side effects or safety concerns beyond some mild gastroesophageal reflux. I hope in the future we discover even more effective ways to measure and study the efficacy of vitamin B6 treatment and B6 deficiency in pregnant women. The average frequency and duration of vitamin B6 treatment ranged from 25-30 mg of oral vitamin B6 per day over the course of three days. The length of treatment time only being three days is a weakness in the studies; it would have been interesting to see longer-term effects, for instance 30 mg of oral vitamin B6 every day for 30 days. It would also be fascinating to see some studies using higher doses than 30 mg per day. Vitamin B6 is water-soluble and relatively safe. I would like to see studies demonstrate if reduction of nausea and vomiting are augmented at a dose of 100-200 mg per day. It would also be helpful if these studies used larger groups of women so that the results could be more easily generalized to other populations of women.

In all the studies mentioned above, there were no restrictions of ethnic group, and the patients recruited were from different countries, so this makes the results more generalizable and is a strength of the body of research this article looked at. Based on the research, I definitely recommend vitamin B6 treatment and/or ginger to a pregnant patient suffering from morning sickness. I would recommend 30 mg of B6 per day, or 500 mg of ginger three times a day. It would also be interesting to see if the combination of both therapies has an additive effect on reducing morning sickness. Vitamin B6 and ginger are a great option for pregnant women with nausea and vomiting, and they're safe and effective.