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February 1, 2004
Therapy for "Morning Sickness"

Nausea and vomiting of pregnancy (NVP) affects up to 80% of all pregnant women. Many pregnant women with unrelieved nausea and vomiting lose weight, become dehydrated and end up in the hospital for intravenous nutrition and fluids. Therefore, intervention with safe and effective therapy is highly desirable. Bendectin® was first marketed in the U.S. in 1956 to treat NVP, and by 1980, 10-25% of pregnant women in the U.S. took the drug. It is estimated that Bendectin® was used in 33 million pregnancies throughout the world by 1983, when due to an overwhelming number of lawsuits claiming that the drug caused birth defects, Merrell Dow Pharmaceuticals voluntarily withdrew the formulation (which contained doxylamine succinate and pyridoxine) from the market.

Subsequent to the withdrawal of Bendectin®, meta-analyses of many studies involving thousands of births and over 30 years of published data have demonstrated the absence of a detectable teratogenic ("birth defect causing") effect. Doctors and scientists agree that studies have shown doxylamine and pyridoxine (vitamin B-6) pose no detectable risk of birth defects.

The combination of pyridoxine 10 mg and doxylamine 10 mg is now commonly used in Canada to treat NVP. At the Motherisk Program, University of Toronto, research indicates that for maximal benefit, the formulation should be dosed according to each woman’s body weight and severity of symptoms, up to four doses daily.

Ginger has also been shown in two studies to reduce NVP. Thiamine (vitamin B-1) deficiency can lead to Wernicke's encephalopathy in women with severe NVP. Replacement is needed for all women with vomiting of more than 3 weeks' duration. Preventive therapy with multivitamins and supplementation with vitamin B-6, with or without doxylamine, are reported to be safe and effective therapies for NVP.

Birth Defects Res Part A Clin Mol Teratol. 2003 Feb;67(2):88-97
J Obstet Gynaecol Can. 2003 Oct;25(10):830-3
Am J Obstet Gynecol. 2002 May;186(5 Suppl Understanding):S256-61
Bendectin: Revised 3/1/1998. © 2004 March of Dimes Birth Defects Foundation

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