Hyperemesis gravidarum: When it’s not just morning sickness

Kate Middleton's recent pregnancy put Hyperemesis gravidarum into the headlines. But what is this condition all about?

Photo: FameFlynetUK/FameFlynet

Photo: FameFlynetUK/FameFlynet

Women expect to throw up during the first months of pregnancy; morning sickness is a rite of passage for many expecting mothers. But no one expects this typical pregnancy symptom to morph into a monster that can threaten the health—and sometimes the lives—of a mom and baby.

Hyperemesis gravidarum (HG) is an extreme form of morning sickness, defined by the Hyperemesis Education and Research Foundation as “unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids.” You may have learned about the condition when it landed Kate Middleton in the hospital while she was pregnant with Prince George. She has since suffered from the illness twice more with her following two pregnancies. Affecting about one to three percent of women, HG can lead to weight loss, malnutrition and dehydration. In severe cases, it can lead to miscarriage and, rarely, it can be fatal.

I had HG with my third pregnancy. I lost 15 pounds, broke the blood vessels in my eyes from vomiting so much and had to take three months of sick leave. I often spent the day on the bathroom floor, too weak to get up.

“You know that sick feeling you have right before you throw up?” says Erin Rundquist, an Ottawa mother of three who lost 40 pounds in her first pregnancy due to HG. “Imagine that 24 hours a day for nine months. Throwing up 20 to 30 times was a good day.”

Gideon Koren, a paediatrician, pharmacologist, and the director of the Motherisk program at Toronto’s Sick Kids Hospital, says that pregnant women who are throwing up or nauseated—especially those who can’t eat or drink—need to discuss treatment with their doctors or midwives. “People still believe any medication in pregnancy is not good for the fetus. This is simply not true,” Koren says. “Women are willing to suffer so their baby won’t. But if they suffer, baby suffers, too.”

A woman can be diagnosed with HG by her doctor, who will be looking for rapid weight loss (1.5 pounds or more per week), recurrent ketosis (urine is positive for ketones) and frequent and/or severe nausea and vomiting. “Regular” morning sickness, on the other hand, has little to no weight loss or ketosis, and less frequent bouts of nausea/vomiting, but is still a treatable condition.

Koren and his team recently completed a study showing that early treatment lessens the severity of symptoms of HG, leading to healthier moms and babies. He says women should insist on proper medical treatment—too many health professionals dismiss the signs pointing to HG, or ask a woman to “wait and see” if symptoms resolve; this delay could start “a vicious metabolic cycle that is hard to get out of,” Koren says. If that sounds like your situation, seek out a second opinion. Treatment of HG often involves strong yet safe anti-vomiting drugs, as well as intravenous (IV) fluids if the mother is dehydrated. Very sick women may have a semi-permanent line placed in their arms for daily IV fluids and medication. Women with severe cases of HG are also fed intravenously.

A great resource is the Motherisk website and hotline (1-800-436-8477) that helps pregnant women suffering from nausea and vomiting. It is also publishing a morning sickness survival guide in the spring of 2013; women can download it or order a paper copy from the website.

This article appeared in our winter 2012 issue of Today’s Parent Pregnancy with the headline “When it’s not just morning sickness”, pp. 28.

Read more:
The facts of morning sickness
Common miscarriage questions
Prenatal appointments: What to expect during each trimester

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