UMEM Educational Pearls

As many pregnant and previously pregnant women will tell you, the term morning sickness is really a misnomer. Nausea and vomiting can really occur at any time of day (and often does). The mechanisms through which this happens is really unknown. Limited research suggests that the placenta may be responsible for the symptoms given that patients with hydatidiform molar pregnancies (no fetus) have some of the most severe cases of nausea and vomiting. 


  • Vitamin B6 has been shown in a number of randomized placebo-controlled trials to be very effective in treatment of the 1st trimester nausea and vomiting and is a supported recommendation by the American College of Obstetrics and Gynecology (ACOG).
    • For refractory symptoms, efficacy is increased with supplementation of the sleep aide Doxylamine (found in Unisom pills over the counter)
    • Dosing of Vitamin B6 is 10 to 25mg every 8 hours daily
    • Dosing for Doxylamine is 12.5mg as needed in the morning, 12.5mg as needed in the afternoon, and 25mg as needed at bedtime.
  • Ginger (ginger ale and ginger supplements) taken at 250mg daily doses has been recommended as 1st line treatment by ACOG.

Consider these therapies the next time you see a pregnant with persistent nausea and vomiting in her 1st




Niebyl, Jennifer MD. Nausea and Vomiting in Pregnancy. The New England Journal of Medicine. Oct 2010. 363:16.