What is Hyperemesis Gravidarum?
This is a severe condition categorized by vomiting, severe nausea, and weight loss as well as electrolyte imbalance. Cases that are mild are usually treated with rest, dietary changes as well as antacids. Severe cases where the women experience dehydration, vitamin and mineral deficit as well as the loss of greater than 5% of original body weight usually require a hospital stay so that the prospective mother may receive nutrition and fluids thru an IV line. It is important to remember that NO MEDICATIONS be taken to resolve this condition without the advice of the medical provider.
This condition can be referred to as HEG. Nausea and vomiting of pregnancy is referred to as NVP and is widely known as morning sickness. Many researchers believe the NVP needs to be classified as a continuum of symptoms that can impact an affected woman’s mental, physical and social wellbeing to varying degrees. HEG represents the severe end of this continuum.
It is estimated that approximately 70% to 85% of pregnant women are affected with some form of NVP while pregnant, but only 1.5% to 2% suffer from HEG. HEG is most common in pregnant women who are very young or women who have had multiple pregnancies in a very short period of time.
Hyperemesis Gravidarum Symptoms
The symptoms of HEG are usually at their highest at eight to twelve weeks of the pregnancy. They should usually get better by the 16th week.
The major symptoms of HEG are long-lasting and severe nausea and vomiting. Other collective symptoms consist of:
- Ptyalism – excess production of saliva
- Fatigue
- Weight loss
- Fainting – known as syncope
- Lightheadedness
- Frequent urination
- Weakness
- Palpitations
- Headaches
The following can also be observed in some women with HEG:
- No appetite
- Severe dehydration
- Jaundice
- Concentration that decreases
- Depression and acute situational anxiety
- Generalized anxiety disorder
- Panic disorder
- Post-traumatic stress disorder
- Obsessive compulsive disorders
- Mood changes
- Irritability
- Sleeping problems
- Sensitivity to smells which is extreme
- Sense of taste which is impaired
Hyperemesis Gravidarum Causes
The exact reason that HEG occurs is not currently known. But some theories maintain that there are several risk factors that could be the cause of HEG. These factors include:
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- Emotional changes causing anxiety and stress
- Hormonal changes such as increase of progesterone, estrogen, and beta HCG or Human Chorionic Gonadotropin
- Deficiency of nutrients
- Digestive tract dysmotility for instance food not moving smoothly thru digestive tract
- Women with history of prior pregnancy with HEG
- Bacteria known as Helicobactor pyloria
- Genetic condition – family history of extreme morning sickness
- History of motion sickness
- Migraine headaches
- Diabetes diagnosed prior to pregnancy
- Hyperthyroidism
- Pyridoxine deficiency which is a form of vitamin B6
HEG is known to be linked with the following:
- Carrying a fetus that is female
- Multiple gestation – more than one fetus
- Rare chromosomal disorder known as triploidy
- Down syndrome
- Prior or current molar pregnancy
- Abnormal accumulation of fluid in the fetus
But it needs to be noted that the presence of HEG does not mean that the fetus has any of the above conditions.
Hyperemesis Gravidarum Treatment
Before the techniques of intravenous IV were available, HEG was a leading cause of maternal death due to dehydration’ but, death from HEG is extremely rare currently. Malnourishment and injuries can happen however, so a mother who believes she has HEG needs to notify her OBGYN about her symptoms. The physician will order some tests in order to rule out any other causes of the extreme vomiting. The doctor will then decide if the mother needs to be treated at home or in the hospital.
HEG hospitalization is the 2nd leading reason for hospitalization during pregnancy – the 1st being preterm labor. If the physician decides to put the mother in the hospital, she will be treated with IV fluids in order to restore the body’s fluid and level of electrolytes. If the mother is able to tolerate taking fluids by mouth without vomiting, she will mainly be placed on a clear liquid diet; including Jell-O, broth that is clear, fruit juices without pulp, tea, coffee and soda. Then gradually she will be re-introduced to solid foods.
If at home, the physician will advise changing the diet to one with more protein and complex carbohydrates, such as cheese and crackers, nuts, and milk. These foods should be eaten in small portions, several times thru out the day. Avoid eating fatty foods, drink lots of water and get as much rest as possible.
Medications that the physician may prescribe or recommend for severe HEG include:
- Antihistamines, which eases nausea and motion sickness
- Phenothiazine which helps ease nausea and vomiting
- Vitamin B6, which helps ease nausea – if unable to take orally the physician can give injections.
- Metoclopramide, which helps increase the rate the stomach moves food to the intestines
- Antacids, which absorb stomach acids and help prevent acid reflux.
