Nausea meds, mucus plugs, and OB access

Welcome to the weekly ZIP - your Zenith Informed Pregnancy!

Read on for a quick zip through 3 of the week’s most popular pregnancy questions, and the evidence behind them. Plus - bonus content on the latest & greatest in the world of pregnancy research. 

This week's top pregnancy questions:

1️⃣ Pregnancy-safe nausea medicines?

2️⃣ What’s a mucus plug?

3️⃣ When should I stop sleeping on my stomach?

Pregnancy-safe nausea medicines?

Morning sickness is one of the most common (about 70-80% of women experience it!) and notorious symptoms of early pregnancy - and yet doesn’t have an easy remedy. There’s always the well-meaning, but incredibly frustrating “have you tried small meals or nibbling on some crackers?” Here’s some of the evidence on medicines if you’re looking for support beyond the ice chips and ginger chews. 

📚The tl;dr from the evidence: There are a handful of different medication options often used – clinical guidelines on which to prescribe are based on a balance of the known risk level, alongside the severity of symptoms and what’s already been tried. Most commonly, a combination of vitamin B6 and doxylamine (commonly known as Unisom) is recommended first - studies have shown that the combination is safe and often effective. 

For more severe or persistent nausea and vomiting, prescription  antiemetics (aka medicines that prevent vomiting) like ondansetron (Zofran) can be highly effective. While effective, evidence on safety is more mixed: some studies suggest a slight increase in birth defect (oral cleft) risk, though findings aren’t conclusive. As a result, this medication is often discussed and prescribed only after several other options don’t work. 

👀Read Penny’s full summary of the evidence for more on nausea medicines

What’s a mucus plug?

If you’ve ever perused any of the pregnancy forums, you’ve inevitably seen a borderline-graphic photo of someone trying to crowdsource whether or not they’ve lost their mucus plug. It's easy to be impatient trying to figure this out, as it’s a tangible sign the body is getting ready for labor. So what actually is the mucus plug, and how can you tell (without sharing a photo to strangers on the internet!) if you’ve lost it?

📚The tl;dr from the evidence:  The mucus plug is, as literally as it sounds, a collection of mucus inside of your cervix that creates a barrier of protection against bacteria and other germs entering the uterus and reaching your baby. When your body starts preparing for labor, your cervix softens and dilates, releasing the mucus plug - typically after ~37 weeks, anywhere from weeks to hours before your due date.

It’s often described as a clear, off-white, brownish, pink, or slightly blood-tinged color that is thick, jelly-like, and sticky – thicker than normal pregnancy discharge. Not all women will notice losing it - sometimes, it doesn’t come out until active labor; other times it can come out gradually or unnoticeably. If you don’t see it, fear not - it’s not necessarily predictive of when labor will start, and other signs will help you know it’s time for labor.

👀Read Penny’s full summary of the evidence for more on mucus plugs and how to identify them

When should I stop sleeping on my stomach?

Feeling comfy when sleeping is critical to a good night’s rest, especially during pregnancy. Advice about avoiding stomach or back sleeping can spark anxiety for those who are usually comfiest in those positions – where does this advice come from, and when is it actually important?

📚The tl;dr from the evidence: This one is pretty straightforward - the size of your bump and whether or not you’re experiencing discomfort while laying on your belly dictates when it’s time to try a new sleeping position. Typically, this happens around the second trimester, when your bump is big enough and extends far enough beyond your hip bones to make it uncomfortable to sleep belly-down. 

So where does all the advice on side sleeping come from, if sleeping on your stomach is fine as long as it’s logistically possible? The main concern is on back sleeping when the baby is bigger (around the third trimester), as research has shown an increased risk of stillbirth associated with consistent back sleeping. This is because the increased weight of the uterus can compress major blood vessels, which can potentially reduce blood flow and oxygen to the baby. 

👀Read Penny’s full summary of the evidence for more on sleeping positions

🤓 Zenith's top read of the week

Bonus: what the Zenith team found interesting this week. Think cool pregnancy research or recently published studies, news in pregnancy health and policy, and more!

Geographic Disparities in Obstetric Care Access (Dr. Valerie Chen, et al - Obstetrics & Gynecology) - This research brief highlights the dire need for improving access to obstetrics care across the US. The authors looked at all 3,143 US counties, finding that a shocking 1,473 (~47%) counties did not have a single practicing OB. In addition, they found that the large majority (94%) of the counties without an OB also didn’t have any midwives. 

This is alarming, and paints a picture of the unfortunate reality for many moms – needing to travel outside of their own county up to 20, 50 or sometimes even a hundred miles away from their homes in order to receive pregnancy care or deliver their babies. While seeing the numbers illustrates the highly concerning care gaps that exist, we’re hopeful that it can serve as a call to action for both awareness of the need, and for creative solutions to bring high quality care to moms across all counties.

Key Excerpt:

“Nearly half of U.S. counties do not have any practicing obstetrician–gynecologists, with greater disparities found in nonmetropolitan areas…. Notably, only 103 (7.0%) counties without an ob-gyn had any midwives.”