Hyperemesis Gravidarum: It’s Not Just ‘Morning Sickness’

While 75% percent of pregnant women will have nausea and vomiting in pregnancy, luckily only 1.5% are diagnosed with the more serious hyperemesis gravidarum. HG occurs when the nausea and vomiting is relentless despite all conservative measures, resulting in severe dehydration and weight loss. If untreated a state of partial starvation occurs that can cause electrolyte imbalances and even death.

Luckily, with modern medicine, severe complications rarely occur. The initial step when treating HG  is hospital admission with intravenous hydration and nausea medication. After getting their dehydration fixed, some women will then be able to go home with oral anti nausea medications.  Ondansetron works well and is available as a tablet that dissolves under the tongue. Its most common side effect is constipation. At other times they may need a continuous infusion pump of mediation under their skin, or in rare cases being sent home with IV fluids and IV vitamins may be necessary. Another common medication is Promethazine. It can be given as a pill, cream or rectal suppository, and may make you feel sleepy.

Nausea and vomiting in pregnancy and its more serious cousin, HG are thought to be caused by rising levels of the hormones HCG (Human Chorionic Gonadotropin) and estrogen during the first trimester.  Most women’s symptoms will resolve around 16 weeks as these levels begin to drop.  Also HG is more common in female fetuses, hence the estrogen association.

Women can have HG with one pregnancy and not the next.  Often if they do get recurrent HG the severity can vary between pregnancies, even when carrying the same gender.  We are unsure why such variance occurs, other than the old adage ”every pregnancy is different.”

When nausea first rears its ugly head, some initial approaches to calm it would be:

Bland diet: Avoid spicy food, coffee, sugary and fried food. Stick to breads, nuts, bananas, applesauce and rice.

Eating often: Eat small amounts every couple hours. Try to never get hungry or full. Keep crackers by your bed so you can eat before you even get up in the morning.

Avoiding triggers: If certain smells (i.e. gas, meat, a dog) trigger nausea, do everything you can to avoid these smells.

B6: Vitamin B6 25 mg every 6 hours taken alone or in combination with doxylamine (unisom) is one of the safest, best studied medication for nausea. Both are available over the counter.

If you continue to have symptoms of severe nausea and are unable to hold down food for 24 hours; or are losing weight, you may be developing HG and should contact your provider.

For those of you that have struggled with HG, what did you find most helpful to ease your nausea?

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