Metoclopramide is a medication used to treat gastroesophageal reflux disease (GERD) and diabetic gastroparesis. Metoclopramide is also used in treating nausea and vomiting. If you are pregnant, chances are that you will experience vomiting and nausea. After all they affect close to 70 percent of pregnant women in the first trimester. But, should you consider using metoclopramide during pregnancy?

Can You Use Metoclopramide in Pregnancy?

Metoclopramide should only be used in pregnancy in cases when its benefits outweigh the risks. It is categorized as a Pregnancy Category B drug by US FDA and as Pregnancy Category A drug by the AU TGA.

• US FDA Pregnancy Category B relates to drugs that have been tested on animals but have not been found to pose any risk to the fetus. However, effects of these drugs have not been adequately studied in pregnant women.
• AU TGA Pregnancy Category A relates to drugs which have not caused any documented increase in the occurrence of harmful effects or malformations of the fetus.

Available data relating to more than 1000 cases do not show any malformative toxicity to the fetus. However, use of the medication towards the end of pregnancy may lead to extrapyramidal syndrome in the newborns. The symptoms of the condition can include agitation, tremor, severe trouble breathing, sleepiness, and difficulty in feeding.

Metoclopramide may also increase the risk of postpartum depression and depression in general. For this reason, use of metoclopramide in pregnancy by women with a history of depression should be avoided.

Warnings on Use of Metoclopramide When Breastfeeding           

When used while a mother is breastfeeding, some of the drug gets into the breast milk and ends up in the infant. This can lead to gastrointestinal problems. Metoclopramide is sometimes used to increase milk supply. This, however, has no clinical backing.

Safety of Medications for Morning Sickness in Pregnancy

Many experts recommend that you use non-drug methods to manage morning sickness to avoid early exposure of the unborn baby to medications. However, if these remedies do not help, talk to your doctor about medications for morning sickness. There are supplements and medicines, including pills and suppositories that are safe for use during pregnancy, although they don’t work for everyone. Consult your doctor before use.

Over-The-Counter Medicines for Morning Sickness

• Vitamin B6 is a first line treatment for morning sickness in pregnant women.
• Antihistamines such as doxylamine treat pregnancy-related nausea and vomiting. Do not drive when taking doxylamine as it makes you sleepy.  
• Cases of nausea and vomiting arising due to gastrointestinal distress may be treated with over-the-counter drugs such as pepcid and zantac.

Prescription Medicines

Besides the use of metoclopramide in pregnancy, other prescription medicines are used to treat pregnancy-related sickness. However, because minimal safety information is available, your doctor will weigh the pros and cons of the prescription.

The drugs include:

• Promethazine
• Ondansetron
• Trimethobenzamide
• Prochlorperazine

There is inconsistent safety information on ondansetron, with some studies linking its use to increased risk of heart defects and cleft palate in infants. Other studies report contrary findings. For this reason, ondansetron should only be used when no other available option works.

Management of Hyperemesis Gravidarum

Hyperemesis gravidarum is a condition where a pregnant woman has severe nausea and vomiting that she throws up everything she ingests, including fluids. In such a case, the doctor will usually recommend hospital admission for treatment with intravenous medications and fluids.

The most common IV medications for hyperemesis gravidarum include various antihistamines such as chlorpromazine, serotonin antagonists, dopamine antagonists and glucocorticoids. These treatments are administered under close supervision in combination with fluids, minerals and vitamins.

In cases where no other treatments work, a subcutaneous pump system may be recommended in which medication is continuously administered intravenously throughout the day. Take time to discuss the pros and cons of this treatment method with your doctor.

Natural Ways to Relieve Morning Sickness in Pregnancy

While metoclopramide in pregnancy is sometimes prescribed, there are natural ways to manage pregnancy-related morning sickness. 

• Eat appropriate foods. These include foods high in carbohydrates and protein. Salt and ginger in the foods may be helpful. Avoid fatty and spicy foods.
• Snack regularly instead of taking a few large meals. Start with a snack such as a piece of dry toast immediately you wake up and eat snacks throughout the day. Avoid having an empty stomach, as this can worsen the nausea.
• Drink tons of fluids. Sip on water, ginger ale or similar drink throughout the day. Sucking on hard candy or ice chips can also help.
• Beware of nausea triggers. Some foods, smells and conditions such as stuffiness, noise, humidity, heat, exercises, physical or visual motions may worsen your nausea. Avoid these triggers whenever possible.
• Avoid stuffy or pollution air. Whenever possible, seek out fresh, clean atmosphere where you can breathe fresh air. Keeping windows open and taking outdoor walks can help in this. Taking a whiff of fresh lemon, orange, mint can lower the risk of nausea. You may also use an oil diffuser scented with these smells.
• Brush your teeth after meals. This can prevent symptoms of nausea. Don’t lie down immediately after a meal and avoid making sudden changes in posture.  
• Beware of any effects of prenatal vitamins. Some women experience a sick feeling after taking prenatal vitamins. If you get such a feeling, try taking the vitamins at night or together with a snack. Chewing gum or sucking on hard candy once you’ve taken prenatal vitamins may also help. However, if none of these works, consult your doctor for advice about ways of getting the required vitamins and minerals.