How to Prevent Nausea and Vomiting during Pregnancy by Judy Slome Cohain
Abstract: To avoid nausea and vomiting during pregnancy, take 50 mg of highquality vitamin B6 daily for six months before getting pregnant. In addition to avoiding vitamin B6 deficiency, taking this and other proactive steps toward improving health may contribute to a feeling of control over one’s body and a sense of well-being. Vitamin B6 is a good present to give women who are considering having children and want to have nausea-free pregnancies.
V
irtually every scientific article about nausea and vomiting in pregnancy (NVP) begins with the same sentiment: “No cause of nausea and vomiting of pregnancy has ever been identified.” Is this true, or is it just another lie reflecting the greed of pharmaceutical companies? Vitamin B6 Deficiency
We know that there is a definite connection between nausea and vomiting in pregnancy and vitamin B6 deficiency. Research evidence suggests that NVP is due to an unacceptably low level of vitamin B6 at the start
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of a pregnancy (Niebyl and Goodwin 2002). The connection between vitamin B6 deficiency and NVP was known long ago. The drug Bendectin, for the treatment of nausea and vomiting, was introduced to the market in 1953 with vitamin B6 as one of its three ingredients—indicating that more than 70 years ago, NVP was already related to B6 deficiency. However, even then, it was not enough to just market B6 alone as a treatment because, in order to make lots of money selling drugs, it is necessary to add something that can be patented in order to charge a higher price. One 50 mg B6 pill at Puritan.com costs two cents; one 25 mg B6 pill from Solgar costs seven cents. One Diclectin pill, the current brand name for Bendectin, which contains 10 mg of B6, costs $2.00 online at canadadrugs.com. Once NVP has begun, taking B6 a few times a day has been found effective for severe nausea and vomiting. In a 1991 study, 31 women received 25 mg vitamin B6 tablets orally every eight hours for three days. Twelve of the 31 patients in the vitamin B6 group rated their nausea severe (at least a 7 out of 10).
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After three days of B6, the 12 women with severe nausea rated the severity of their nausea lower, saying it had decreased from about 7/10 to about 4/10 on average—so it seemed to help for them. But the women with milder nausea, which they rated less than 7/10, did not find B6 effective. Impressively, 8 of the 15 women who had vomiting before therapy had no more vomiting after only three days of B6 therapy. (Sahakian et al. 1991) Based on my own research, if a woman does not want to wait until she suffers from NVP, she can prevent it by taking preconception vitamin B6. Among 100 clients of mine who took 50 mg daily doses of high quality vitamin B6 for three to six months before pregnancy, all reported either having no NVP or much less than in previous pregnancies in which they had not taken B6 pre-conception. Taking 50 mg of vitamin B6 daily for six months costs as little as $5. Fifty mg of daily vitamin B6 has no ill side effects. However, it must be purchased from a reputable company to ensure that the pill actually contains B6. In cases where there is no actual B6 in the pills or where the product has been sitting Photograph | Esther Edith—estheredith.com
on a store shelf for months, it does not work. Interestingly, I also found that my clients who took B Complex labeled as containing B1, B2, B3, B6, B12, and folate, instead of just B6, still experienced NVP—although I don’t know why. These results, along with research previously mentioned, lead me to believe that NVP is due to women having an unacceptably low level of vitamin B6 at the start of pregnancy. Most people are thought to be deficient in vitamin B6 (Harker, Montgomery, and Fahey 2004). The main role of vitamin B6 is protein metabolism but it is also a catalyst in 100 other common reactions in the body (Institute of Medicine 1998). When vitamin B6 is lacking, the omega-3 and -6 essential fatty acid reactions compensate for this deficiency, causing deficiencies in other reactions and metabolic damage. Vitamin B6 deficiency impairs cellular immunity and antibody responses (Harker, Montgomery, and Fahey 2004). In addition to NVP, lack of vitamin B6 can contribute to premenstrual syndrome and menopausal hot flashes (Ibid). Pregnancy, cortisol, and oral contraceptives cause vitamin B6 deficiency (Halsted, Hackley, and Smith 1968) which would explain why often NVP is worse in subsequent pregnancies after several closely timed pregnancies without B6 supplementation. Because vitamin B6 plays a role in so many critical processes in the body, it seems that the amount and length of the B6 therapy before conception would depend on how long it takes each individual woman to replenish vitamin B6 when it is low. As stated, vitamin B6 deficiency results in damage to metabolic pathways. It may be that this damage must be repaired before conception to avoid NVP. In addition to physical benefits, perhaps taking daily B6 for several months before conception gives the woman a feeling of control over her pregnancy and having control contributes to less NVP. The effectiveness of B6 for NVP is not a secret that I alone figured out. The American College of Obstetrics and Gynecology (ACOG) recognizes that B6 can be used to treat or prevent NVP and hyperemesis, although their actual recommendations do not reflect the research data because they arbitrarily recommend a month of prenatal vitamins before pregnancy (pg e16) and they do not mention what dose of B6 is helpful,
instead stating that “[t]reatment of nausea and vomiting of pregnancy with vitamin B6 alone or vitamin B6 plus doxylamine in combination is safe and effective and should be considered firstline pharmacotherapy.” (pg e25) The clinical studies of vitamin B6 involve small samples of women, generally fewer than 50 women. These studies found that dietary changes, 25 mg of daily vitamin B6, acupuncture, acupressure, ginger, and hypnosis can be beneficial for some women, but far from all women (Cohain 2003). For example, in one typical study, 40 mg of vitamin B6 was given to 35 women for four days (Firouzbakht et al. 2014).
Another theory is that NVP somehow helps prevent miscarriage. The simple experiment of following 100 women suffering from NVP in the first trimester of their first pregnancy and counting how many miscarry, controlling for age, smoking—a study which would require one day of work, extracting data from any clinic database—has never been carried out. Summary
The cause of NVP as stated in every article up to now is supposedly unknown. NVP is preventable with daily preconception vitamin B6. Anything that increases a woman’s control may lessen symptoms. Taking 25 or 50 Other Contributors to NVP mg of daily vitamin B6 costs very little and Loss of control and anxiety are linked to has no ill side effects. Vitamin B6 is a good all forms of nausea and vomiting. Due to present to give women who want to have increased control, pilots, drivers, and ship nausea-free pregnancies. captains are less likely to suffer from nausea and vomiting than passengers, flight crews, References: Practice Bulletin 189: Nausea and Vomiting of Pregor seamen on the same vehicles (Rolnick and ACOGnancy. 2018. Obstet Gynecol 131(1): e15–30. Lubow 1991). One study showed that women Cohain, JS. 2003. “Biofeedback and visualization to control nausea and vomiting.” BMJ 11(7): 450–53. who are ambivalent about their pregnancies Firouzbakht, M, et al. 2014. “Comparison of ginger with are more likely to experience NVP than those vitamin B6 in relieving nausea and vomiting during pregnancy.” Ayu 35(3): 289–93. who are not (Leeners, Sauer, and Rath 2000). Halsted, JA, BM Hackley, and JC Smith. 1968. “Plasma-zinc Morrow, Lindke, and Black (1991) showed and copper in pregnancy and after oral contraceptives.” Lancet 3 2(7562): 278–79. that during the course of repeated chemoN, A Montgomery, and T Fahey. 2004. “Treating therapy treatments, 25% of patients begin to Harker, nausea and vomiting during pregnancy: case progresexperience nausea in anticipation of future sion.” BMJ 328: 337. chemotherapy treatments. The more severe Institute of Medicine. 1998. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, the vomiting after chemotherapy, the more Pantothenic Acid, Biotin, and Choline. Washington, DC: The National Academies Press. doi.org/10.17226/6015. likely they were to experience nausea in anand S Saha. 2011. “Nausea and vomiting of pregticipation of the next treatment. Nausea and Lee, NM, nancy.” Gastroenterol Clin North Am 40(2): 309–34. vomiting may be a result of fear arousing the Leeners, B, I Sauer, and W Rath. 2000. “Nausea and vomiting in early pregnancy/hyperemesis gravidarum. Cursympathetic autonomic system, producing rent status of psychosomatic factors.” Z Geburtshilfe increased cortisol and vasoactive intestinal Neonatol 204(4): 128–34. [Article in German] Morrow, GR, J Lindke, and PM Black. 1991. “Anticipatory peptides. Non-Evidence Based Theories Regarding NVP
Two popular theories are used to explain NVP other than vitamin B6 deficiency, but neither is backed by science. Although high levels of the hormone human chorionic gonadotropin (HCG) often coincides with NVP, just as frequently this is not the case. All pregnancies throughout the world have high HCG peaks yet some countries and some cultures report little or no NVP. An excellent review article found an equal number of studies reporting that HCG is correlated with NVP as there were studies that show HCG level is not related to NVP (Lee and Saha 2011).
nausea development in cancer patients: replication and extension of a learning model.” Br J Psychol 82 (pt 1) 61–72. Niebyl, JR, and TM Goodwin. 2002. “Overview of nausea and vomiting of pregnancy with an emphasis on vitamins and ginger.” Am J Obstet Gynecol 186 (5 Suppl Understanding): S253–55. Rolnick, A, and RE Lubow. 1991. “Why is the driver rarely motion sick? The role of controllability in motion sickness.” Ergonomics 34(7): 867–79. Sahakian, V, et al. 1991. “Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study.” Obstet Gynecol 78(1): 33–36.
Judy Slome Cohain, CNM, is a licensed nurse-midwife with a masters in midwifery, who worked as a hospital midwife in Israel starting in 1986 and has been doing homebirths since 1996. She practices evidence-based midwifery. E-mail her at
[email protected].
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