This week: morning sickness, weaning, travel, and the NoseFrida
Welcome back for this week’s subscriber-only Q&A. Submit questions for future weeks here.
Emily, please lend me your brain for this. Safety of Zofran in the first trimester for morning sickness? It is weirdly difficult to get a “yes, it’s totally fine” vibe from googling. I am six weeks pregnant and starting the vomiting already. Didn’t take it with my first pregnancy because of the ambiguity and was being type A about it — but oh my god did I suffer.
—Can’t Do That Again
Nausea and vomiting in pregnancy is one of those things that is “expected” and, I think as a result, undertreated. Many women have the sense that this is just how it is supposed to go, and they suffer in some degree of silence for far longer than is necessary — in your case, all the way to the second pregnancy! It may be helpful to set a baseline by saying that, in fact, vomiting multiple times a day is not the typical experience, even if some nausea and food aversion is common.
But you asked a specific question, which is about Zofran. Zofran (generic name: ondansetron) is commonly used to treat pregnancy nausea and vomiting. It’s more effective than the first-line treatment, which is usually a combination of behavioral modification (eat more small meals) and Diclegis (which is itself a combination of Unisom and vitamin B6). If those options do not work, Zofran is usually next.
The concerns that you raise about Zofran stem in large part from a study of 1.8 million births that analyzed birth defects, comparing women who did and did not take ondansetron during the first trimester. Many things about this study were extremely reassuring: overall, the authors found no increase in birth defects as a result of medication usage, and they saw nothing when they looked at cardiac malformations in particular. However, they did find an increase in oral-cleft risk — the risk increase is 3 in 10,000. A meta-analysis (which included that study) found a similar increase.
In statistical terms, this increase is significant. But it is worth noting that it is a very small number. Oral clefts are a rare birth defect, and this increase is small even as a share.
The combination of some evidence of risk, but that risk being small, makes this choice not necessarily obvious. I’d say the first step is not to suffer in silence, and to talk to your OB immediately. Among other things, Zofran is not the only treatment available if nausea and vomiting doesn’t respond to initial efforts like Diclegis and behavior change. Even if you’d decided for sure that Zofran is not for you, it’s still worth talking about what options are on the table.
Hi! I have a six-month-old and am going to start weaning him from breastfeeding. I have a decent stash of milk in the freezer and I’m wondering what’s the best way to go through it. Should I use it all up and then switch to formula? Or should I extend the life of the breast milk by supplementing some bottles with formula? Is one way better than the other in terms of extending the benefits of breast milk (especially antibodies from being vaccinated and boosted)?