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For extreme nausea in pregnancy, drug offers lifeline - and quandary

The mere thought of a salad - all those curly, crunchy leaves - made Bevin Reilly queasy. The odor of a dog treat during a long car trip with her new puppy prompted dry heaves by the side of the road.

Bevin Reilly is expecting a baby in August. When her second trimester failed to bring relief, she agreed to medication. A nightly dose remade her world.
Bevin Reilly is expecting a baby in August. When her second trimester failed to bring relief, she agreed to medication. A nightly dose remade her world.Read moreDAVID MAIALETTI / Staff Photographer

The mere thought of a salad - all those curly, crunchy leaves - made Bevin Reilly queasy. The odor of a dog treat during a long car trip with her new puppy prompted dry heaves by the side of the road.

And when her husband made butternut squash soup, hoping the mild recipe would be something his pregnant wife could tolerate, Reilly became so ill that she made him eat it alone in their bedroom.

It wasn't just morning sickness; it was all-day, everyday nausea that led to fatigue that bloomed into low-level depression. She subsisted on juice and toast and guilt. She lost six pounds in her first trimester, when her doctor thought she should be gaining weight.

"I had a lot of worry that I wasn't feeding my baby well," Reilly, 30, recalls. "I tried Dramamine and Kaopectate, but it was like a Band-Aid over a bullet wound. I was dry-heaving several times a day, but trying to downplay how horrible I felt."

When her second trimester failed to bring the relief that others, including her doctor, had promised, Reilly agreed to take a drug approved in 2013 by the U.S. Food and Drug Administration and also endorsed for treating nausea and vomiting in pregnancy by the American College of Obstetricians and Gynecologists (ACOG).

A nightly dose of Diclegis - a timed-release combination of vitamin B6 and doxylamine, an antihistamine used in some sleeping pills - remade Reilly's world. "I woke up and felt better immediately," she recalls.

She ate hummus for the first time in months, then gradually added other foods: chicken pot pie. Vegetables. Scrambled eggs.

What's more, she started enjoying her pregnancy. "No one tells you how feeling so sick like that can be emotionally debilitating," says Reilly, whose first child is due Aug. 4. "In the beginning, I thought I should just be able to handle this. Now I think that was crazy."

Measuring discomfort

According to ACOG, about 75 percent of pregnant women suffer some degree of nausea and/or vomiting, ranging from daily retching to months of chronic queasiness to hyperemesis gravidarum, in which a woman can't keep down any food or liquid and risks dehydration if not treated.

But nearly as troubling as the nausea itself is the psychological quandary: How to weigh one's own distress against the health of a growing fetus. How to locate the line between pregnancy's routine discomforts and a medical problem that calls for treatment.

In the case of Diclegis, says Reilly's physician, Thomas S. Dardarian of Main Line Women's Health Care Associates, the first question has been set aside by exhaustive research on the drug. For Dardarian and his colleagues in the practice, which delivers 500 babies a year, the ACOG recommendation and FDA approval of Diclegis were "game-changing."

"Why do women have to accept nausea and vomiting in pregnancy?" he said. "Why suffer, if we can give you a med to stop it?"

Dardarian, an ob/gyn who has been with the Main Line practice for six years, is also a paid consultant for Duchesnay USA, maker of Diclegis. But his comfort with the drug is echoed by other physicians, including reproductive toxicology expert Anthony Scialli, a professor of obstetrics and gynecology at George Washington University School of Medicine.

"There isn't any other drug that's been as well-studied in pregnancy for fetal safety" as Diclegis, says Scialli, who sometimes advises patients to make their own version - minus the timed-release component - with over-the-counter vitamin B6 and doxylamine if they can't afford the prescription drug (about $570 for a little more than a month's worth). "I have no qualms about pregnant women taking this medication," he says.

Neither does Jacqueline Gutmann, a reproductive endocrinologist with fertility practice RMA of Philadelphia, who generally sees women early in their pregnancies, before the worst of their nausea kicks in.

Like other physicians, Gutmann recommends conservative measures first: small, frequent meals; avoiding smells or foods that trigger nausea; breath mints to quash the sour taste; ginger chews; acupressure bands.

But if those methods fail, Gutmann urges her patients to take care of themselves along with the babies they're carrying. "If somebody is miserable, and they've gone through ginger and B6 and Sea-Bands, I'll say, 'Let us know. There's medication we can give you.' "

Laura Sirott, an ob/gyn who served on the ACOG review committee that included Diclegis in its revised 2015 practice guidelines, agrees that the medicine is safe and effective. "No one wants to take anything; women barely want to breathe when they're pregnant," she says. "But I don't think there's anything to be proven by saying, 'I didn't need any [medication].' "

Talking is crucial

Val McMorrow of Pottstown woke up on a Wednesday morning, about six weeks into her 2015 pregnancy, and felt something worse than a hangover. "It was the most god-awful experience and feeling. A dull, chronic nausea. A very sour taste in my mouth that constantly made me feel like I wanted to throw up."

The sight of formerly beloved foods sickened her: avocados, lentils, coffee. Cheese, red sauce, chocolate. Peppermint made her gag. At work as a clinical researcher for pharmaceutical companies, she sat zombie-like through meetings; she spent evenings supine on the couch.

Still, she felt reluctant to take medication. "People said, 'Stop trying to be Superwoman.' But I thought I could muscle through the first trimester."

Then one day, nearing her 15th week of pregnancy, McMorrow's nausea vanished. "It was like somebody turned off the switch." She began craving lentils, then fish. "I was able to be social again. I felt like I had my life back."

For physicians - even the most zealous boosters of Diclegis - as for pregnant women themselves, there is no clear-cut resolution to the problem of pregnancy nausea and vomiting. Even the definition of "problem" varies; some women are untroubled by vomiting once or twice a day, while others find that scenario intolerable.

The most important recommendation, says Dardarian, is to talk about nausea symptoms - with friends, midwives and doctors. "A lot of women think this is a rite of passage and they should power through it. But being silent is not appropriate."

Reilly agrees. "No one talks about how unpleasant pregnancy is. It's a big deal, when you're growing a person, to feel bad for most of a year."

aehoch@aol.com