Hyperemesis Gravidarum – More Than Morning Sickness

Hyperemesis Gravidarum

Morning sickness is one of the earliest signs of pregnancy — almost a rite of passage into this new stage of your life.

Sometimes morning sickness lasts all day, and sometimes it doesn’t happen in the morning at all but the afternoon or evening.

For some women, though, morning sickness becomes extreme — the nausea and vomiting of pregnancy may keep her from getting the nutrition she needs.

Called Hyperemesis Gravidarum (HG), this illness in some cases can lead to dehydration, metabolic disruption, and weight loss for the mother-to-be, as well as growth restriction or preterm birth for baby, among other complications.

While not every mother will experience the worst difficulties, all moms with Hyperemesis Gravidarum need treatment and support.

Hyperemesis Gravidarum is characterised as severe nausea and vomiting associated with pregnancy that results in weight loss and metabolic issues. Women with Hyperemesis Gravidarum experience disruptions in hydration and proper nutrition, and may lose 5%-10% of their pre-pregnancy body weight.

In severe cases, hospitalisation with intravenous hydration and nutrition is needed. Hyperemesis Gravidarum is extremely debilitating and interferes with your normal daily routine. It typically begins very early in pregnancy and continues to 21 weeks or longer.

What Causes Hyperemesis Gravidarum?

Researchers don’t know the exact cause of Hyperemesis Gravidarum, but they do have some theories. One belief is that the sudden changes in hCG, oestrogen and progesterone in early pregnancy disturb the balance of hormones for some women.

Other researchers have explored the relationship between Hyperemesis Gravidarum and thyroid hormones, since many women with this illness have elevated thyroxine levels. Another thought is that the same hormones that support pregnancy slow digestions as well. As a result, the gastrointestinal muscles may be slack enough that they cause regurgitation and related nausea and vomiting.

An unlikely theory that persists is that Hyperemesis Gravidarum is related to a woman’s mental state — but most researchers agree that the psychological changes are because of the illness rather than at the root of it.

So the best answer is that researchers don’t know exactly what causes Hyperemesis Gravidarum, and the cause may be different for different women. More research is needed in this area.

Do I Have Hyperemesis Gravidarum or Just Morning Sickness?

Nearly half of pregnant women suffer from nausea and vomiting of pregnancy (NVP), or ‘morning sickness,’ that usually resolves without treatment by the end of the first trimester. While it may be challenging, it is not as incapacitating as HG. NVP typically does not cause weight loss or your ability to eat and drink enough each day. Though you may vomit occasionally with NVP, diet and lifestyle changes tend to help you feel better.

Women with HG, however, lose as much as 5-20 pounds (approx. 2-9 kgs), cannot eat or drink enough to maintain even a low level of hydration, suffer nearly unending nausea, and vomit severely (sometimes even vomiting blood and bile). Changes in diet that are often recommended, including bland foods and not letting your stomach get empty, aren’t enough to keep nausea at bay. Mothers-to-be with Hyperemesis Gravidarum often cannot work, and need help with daily self-care.

What Are The Health Consequences For The Mother-To-Be?

While most women don’t have any lasting health consequences from Hyperemesis Gravidarum, some women suffer complications. Unabated dehydration can lead to kidney stones, and even possibly renal failure. The severe fatigue may lead to muscular atrophy.

Not only do women with Hyperemesis Gravidarum have nutritional inadequacies, but they may suffer tears in the oesophagus from persistent vomiting and changes in the gastrointestinal tract including pH imbalance and gastric ulcers. Hyperemesis Gravidarum can also lead to deconditioning of the heart muscle, a decrease in blood volume, deficits in blood clotting, and constriction of blood vessels in the brain. The liver can be affected, potentially causing jaundice, and the spleen may separate from its normal location.

All body systems are affected by Hyperemesis Gravidarum. Women whose Hyperemesis Gravidarum is adequately treated as early in pregnancy as possible are at a lower risk for long-term health problems related to the HG.

What Are The Potential Complications For Baby?

Some researchers believe that chronic stress for a pregnant mother may lead to future health consequences for a fetus. Other complications include an increased risk of preterm birth, low birth weight, congenital heart defects, neural tube defects, and more. These consequence are theoretical because no studies have tracked the long-term health of babies born to women with Hyperemesis Gravidarum.

How Is It Treated?

Intravenous rehydration is typically the first line of treatment for Hyperemesis Gravidarum. This sometimes requires hospitalisation, with the length of therapy will depend on the severity of the symptoms. Often bed rest is recommended, and even if not, the fatigue a mother experiences leads to this anyway. Since maternal nutritiona is so important during pregnancy, nutritional therapy is often included as part of the HG treatment. This may mean parenteral nutrition (nutrition intravenously) in severe cases, and in milder cases, just working with a dietician to ensure the mother-to-be is taking in adequate calories and nutrients.

Medications are often part of the treatment regimen for women with Hyperemesis Gravidarum. The drugs most often prescribed for Hyperemesis Gravidarum fall into these categories: serotonin antagonists, corticosteroids, antihistamines, phenothiazines, anti-reflux medications, antispasmodics and prokinetic agents.

No drug is completely safe in pregnancy, but the benefits of pharmacologic therapy in most cases of hyperemesis greatly outweigh the risks.

What Can Support People Do To Help?

Partners and other support people may question if her symptoms are actually as severe as they seem — the best thing you can do is believe her, and to do anything you can to support her through this challenging time. She may need you to help her with even the most basic daily tasks. If you have other children, she will likely need help caring for them. She may feel anxious and depressed — these are common occurrences with Hyperemesis Gravidarum. She may need someone to advocate for her with healthcare providers, who may not have experience with her condition. Keep in mind that even when the nausea and vomiting abate, she will need to recover from this prolonged period of illness while still growing a baby inside — continued support may be needed for things like housekeeping, childcare and employment-related duties.

Will I Have HG Every Time I Am Pregnant?

Because no one knows what causes Hyperemesis Gravidarum, it cannot be prevented. But having gone through it once, you can be prepared. You will likely recognise the symptoms and seek treatment sooner with subsequent pregnancies. This early treatment may lessen the symptoms and severity of the HG.

The absolute best resource for mothers experiencing Hyperemesis Gravidarum is the Hyperemesis Education and Research Foundation. Visit their website at www.helpher.org for mother-to-mother forums, research, blog posts, and more. Share the website with your healthcare provider ” he or she can find a recommended protocol, as well as practice tools and current research. Share it with your family and friends so they can learn more about your condition, including the best ways to help. And share your experience with others through the Support Forums.

You don’t have to suffer with severe morning sickness. Find a physician who will take your symptoms seriously, and who will help you find a treatment regimen that works for you.