What Is Hyperemesis In Pregnancy?

Hyperemesis gravidarum (HG) is experienced by a lot of women under a milder form known as morning sickness. This “severe morning sickness” can be a dangerous thing for the mother and fetus if it isn`t treated accordingly. Let`s find out together which are the characteristic symptoms, how it`s diagnosed and treated.

What Is Hyperemesis in Pregnancy?

As already mentioned, hyperemesis gradivarum represents a pregnancy complication that leads to vomiting and serious nausea. HG and morning sickness are 2 distinct medical conditions. They lead to different side effects and complications. It`s crucial to make the distinguishment between the 2 medical conditions in order to treat the signs properly.

This medical issue is characterized not only by severe nausea and vomiting, but also by weight loss and electrolyte imbalance, which affect a percentage about 0.5 to 2% of pregnant women. In mild cases changes in diet are sufficient to relieve the symptoms; instead more severe cases may lead to malnutrition and other serious complications for both the mother and child.

It seems that most women (70% – 80%) experience a form of morning sickness. The signs for this complication occur between 4 and 6 weeks of pregnancy and are exacerbated between weeks 9 and 13, with a slight improvement between weeks 14 – 20, although 20% of women confront with it until childbirth. There is no known cure for this medical condition, but there are ways of improving the associated symptoms.

What Is the Cause of Hyperemesis Gravidarum?

The exact cause isn`t yet known, but some studies have associated its appearance with the hCG hormone produced by the placenta. This hormone occurs in large amounts during pregnancy, constantly doubling along with the pregnancy evolution, and it`s useful even for a the result of a pregnancy test to become positive.

Also, there were several risk factors identified that may contribute to the occurrence of this medical complication:

• Ectopic pregnancy (the hormonal levels are more increased in a obvious way).
• Family history of HG (sister or mother).
• Medical history of motion sickness or migraines.
• A preexisting liver disease.
• Overweight/underweight.
• First pregnancy.
• An increased consumption of animal fats.
• The age of the mother of 35 years old.
• Smoking.
• Specific fetal abnormalities (Down syndrome).

Is Hyperemesis Genetic?

Because the incidence of this illness is most frequently reported to be around 0.5% in the worldwide population, while the sisters of the pregnant women involved in the cases present a high risk of this condition to occur, there are studies that already provide strong evidence that a genetic component of severe vomiting and nausea of pregnancy is involved. In conclusion, these studies prove that the mother`s genetic susceptibility plays an important role in the development of the mentioned symptoms.

Signs & Symptoms

They include:

• Severe nausea & morning sickness.
• Aversion to food.
• Weight loss of 5% or more (from the previous pregnancy weight).
• Reducing the amount of urine eliminated (which may cause ketosis – a disturbance in the equilibrium of pH which results from the excessive presence/accumulation of ketones and constipation).
• Headache.
• Hunger.
• Confusion.
• Fainting.
• Jaundice.
• Excessive fatigue.
• Loss of skin elasticity.
• Rapid heartbeat.
• Anxiety/secondary depression.

A lot of women are influenced by certain odors from the environment that exacerbates the symptoms.

How Is Hyperemesis Gradivarum Diagnosed?

The physical examination needs to evaluate:

• Vital signs, including blood pressure and pulse.
• Body status (the state of mucous membranes, skin appearance, veins).
• Mental status.
• General appearance (nutrition, weight).
• Evaluation of the thyroid, abdomen, heart and neurological.

Lab tests should include the following:

• Urinalysis (to identify ketosis).
• Serum levels of electrolytes and ketones.
• Liver enzymes and levels of bilirubin.
• Levels of amylase/lipase.
• Thyroid stimulating hormone.

• Levels of thyroxine.
• Urine culture.
• Level of calcium.
• Hematocrit level.
• A panel for hepatitis.

Additionally, there may be used additional methods of diagnosis to exclude other diseases with similar symptoms (hormonal, digestive, urinary problems), such as:

• Ultrasounds (for multiple pregnancy or trophoblastic disease, for the evaluation of the pancrease and bile).
• Scans
• MRI (for appendicitis).
• Endoscopy (if there are abdominal pains or gastrointestinal bleeding).

Complications

In mild cases, hyperemesis gravidarum isn`t harmful for the baby! However, in other cases, this complication may lead to baby born underweighted, premature birth, weight loss and nutritional deficiencies in the mother (which in turn affects fetal development). Some studies have found that the baby may suffer later from diabetes, neuropsychiatric disorders or heart diseases.

In addition, various medical conditions might occur, like preeclampsia or Mallory-Weiss syndrome due to excessive vomiting, Wernicke encephalopathy (causes disorientation, confusion and even coma from lack of thiamine) or deep vein thrombosis (a blood clot located in the deep veins). HG may be prevented by hydration, constant movement and administration of heparin.

In the end, keep in mind that if hyperemesis gravidarum is diagnosed and treated in time, the pregnancy may evolve normally, without any future problems.

Treatment

For mild forms, during the first phase is required a change of diet, which will include:

• Toast, biscuits or bananas before getting out of bed.
• The consumption of foods/drinks with ginger
• Frequent and small meals (without starving or feeling full).
• A diet rich in proteins, complex carbs and fat foods.
• Fade, dry foods.
• An increased intake of water.
• Acupressure at the wrist (either with the finger or special bracelet for those with motion sickness).
• Anti-emetic medication (only at the doctor`s recommendation who must also take into consideration the risks).

In more severe cases when hospitalization it`s necessary, it will be turned to fluids intravenously (to restore hydration, the level of electrolytes, vitamins and minerals) or feeding through a tube which can be nasogastric (inserted through the nose to the stomach) or endoscopic (passing through the stomach, surgery being necessary).

Medication may include metoclopramide, antihistamines and anti-reflux drugs or even corticosteroids. It`s also necessary bed rest, with the mention that there may be muscle weakness and weight loss in case of prolonged stay.

One could resort to herbal remedies, like ginger or mint, homeopathic remedies or even hypnosis, but the doctor`s approval is essential (these remedies might prove to be useful or on the contrary, harmful). Usually, there are also vitamins prescribed (pyridoxine).

Is Hyperemesis Gradivarum Life Threatening?

If the condition isn`t treated accordingly using anti-nausea drugs and intravenous fluids, it may threaten the life of the pregnant woman as well as their babies. Around 1% of pregnant women in the United States experience this illness. The American Journal of Perinatology claims the condition strikes around 2% of expecting mothers. In extreme cases, if the life of the pregnant woman is threatened, the pregnancy can be terminated.

What Can You Eat when You Have Hyperemesis Gradivarum?

• Eat small meals or snacks every 2 hours instead of the 3 regular meals that you were used to. You might prevent nausea this way, as you won`t get to be hungry.
• Have a quick snack before bedtime. This might prevent morning sickness when you wake up.
• Swallow Chew the foods in a slow fashion.
• You should consume dry and cold foods, such as toast, cereals or crackers.
• Fruit juices or lemonades might help get rid of nausea.
• Avoid coffee, alcohol or black tea.
• If you feel nauseous in the morning, eat a slice of toast or a few crackers before getting out of bed.
• You should always try and avoid foods with a strong smell. Or you could ask someone close to cook the meals if these smells get in a way.
• You should avoid foods with a high amount of fat, such as rich desserts, fried foods or heavy sauces.