Hyperemesis Gravidarum- Severe Vomiting During Pregnancy

Are you pregnant, and have you felt nauseous early in the morning? Probably you are having morning sickness. It’s common to experience morning sickness (nausea) during pregnancy. Morning sickness subsides within a few days. Nausea and vomiting in pregnancy are harmless but can cause a little discomfort. But it disappears in a few weeks. 

However, nausea makes you feel severely uncomfortable. You may vomit 3-4 times a day, leading to dehydration. The extreme condition during pregnancy is known as a hyperemesis gravidarum. In this article, we will learn about severe morning sickness – Hyperemesis gravidarum

Vomiting in pregnancy: what is normal?

Morning sickness normally comprises nausea that’s sometimes followed by vomiting. Vomiting during pregnancy is common. Approximately 90 percent of pregnant women face morning sickness.

Normally nausea and vomiting in pregnancy fade away after 12 weeks, but sometimes it may take up to 20 weeks or longer. Besides, vomiting does not result in severe dehydration.

Though the condition is morning sickness, it can happen at any time of the day. Usually, it starts in the first month of pregnancy. It vanishes by the third or fourth month. Some researches show that 27-30 percent of pregnant women experience nausea, while 28-52 per cent of women suffer from vomiting. However, People with severe nausea and vomiting during pregnancy, also known as Hyperemesis gravidarum, are just 0.3- 3 per cent. 

Read more – Pregnancy diet: Foods to eat and avoid

Hyperemesis Gravidarum (HG)

The cause of Hyperemesis gravidarum is primarily unknown. However, you can get some relief by managing the symptoms. In this condition, nausea does not disappear, and also severe vomiting leads to dehydration. Due to this, food and fluid can’t stay deprived of the nutrition and hydration necessary during pregnancy. It may also cause loss of weight. 

The symptoms of HG are typically visible between 4-6 weeks of pregnancy and may spike between 9-13 weeks. HG can be highly exhausting, resulting in fatigue lasting for weeks or months. People suffering from HG may be unable to work or carry out their daily activities.

Symptoms of Hyperemesis gravidarum

The primary symptom of hyperemesis gravidarum is extreme nausea and vomiting, which can be more than four times a day. Recurrent vomiting episodes can result in

• Dizziness and lightheadedness
• Weight loss of up to 5 per cent of the total body weight.
• Visible signs of dehydration like dark urine and dry skin
• Electrolyte imbalances 
• Nutritional deprivation
• Increased salivation
• Rapid heart rate
• Low BP
• Headaches
• Symptoms of Jaundice, like yellowing of the skin and eyes
• Depression and anxiety

What causes Hyperemesis gravidarum?

The precise reason for hyperemesis gravidarum is unknown. However, there are several hypotheses about what might influence the start of this disorder process.

Genetic factor

• The most recent study emphasises genetics and suggests a potential role for the appetite genes GDF15 and IGFBP7 as well as the placenta. 

Change in hormones

• Additionally, it has been suggested that hyperemesis gravidarum is influenced by the hormone human chorionic gonadotropin (HCG), which increases during pregnancy.
• Furthermore, higher amounts of oestrogen and progesterone have been linked to nausea and digestive issues.

Gastrointestinal changes

Due to increased levels of oestrogen and progesterone, the lower oesophageal sphincter weakens during pregnancy which causes increased episodes of gastroesophageal reflux disease (GERD). Also, it is well known that one symptom of GERD is nausea.

Other associations include:

• Increased blood levels of thyroxine (a thyroid-produced growth hormone); have been reported in up to 73% of hyperemesis gravidarum cases; it is typically transient and not considered severe.
• A molar pregnancy is characterised by abnormal tissue growth in the uterus and needs treatment; increased HCG with molar pregnancies increases the risk of hyperemesis gravidarum.

What are the risk factors of Hyperemesis gravidarum?

• There is no known cause, but several risk factors are associated with the development of hyperemesis during pregnancy. 
• Enlarged placental mass in case of a molar or multiple pregnancies has been linked with a higher chance of hyperemesis gravidarum. 
• Furthermore, women who suffer from nausea and vomiting other than pregnancy due to the intake of oestrogen-containing medicines, motion sickness, or have a history of migraines are at greater risk of suffering from nausea and vomiting during pregnancy. 
• According to some studies it was found women with first-degree relatives are more likely to develop hyperemesis, such as if their mother or sister had hyperemesis gravidarum.
• Younger maternal age; the risk may decrease after age 35
• Obesity

Duration of Hyperemesis Gravidarum

Hyperemesis gravidarum persists beyond the first trimester and ends by 20 weeks of pregnancy. On average, up to 20% of women with HG will show symptoms for almost all of their pregnancies.

Complications due to Vomiting in pregnancy

If vomiting in pregnancy is left unattended, it can become severe. Negligence can lead to serious hyperemesis gravidarum complications, such as 

• Electrolyte imbalance
• Dehydration
• Malnutrition 
• Preterm labour
• Low birth weight baby

Hyperemesis gravidarum treatment

The severity of your conditions and symptoms will be decisive factors for treatment. Your healthcare provider may suggest lifestyle changes such as

• Eat smaller portions and more frequent meals. 
• Have fluids at short intervals and in small portions. 
• Drink ORS to maintain electrolyte balance and nutritional supplements to prevent nutrient loss due to vomiting. 
• Get as much rest as possible to reduce stress levels.
• Consuming ginger tea and ginger candies(1 to 1.5 grams a day) in small amounts is beneficial for some women. 
• Vitamin B6 (Pyridoxine)- often advised for nausea during pregnancy. Normal doses are 10 mg to 25 mg, 3 times a day. Avoid taking too much, as it can cause temporary nerve damage.
• Vitamin B1 (Thiamine)- Doses of 1.5 milligrams a day can ease vomiting.
• Medicines: Your general practitioners may prescribe one or more drugs to help you provide relief from vomiting. Medicines may be given orally, Intra Venous (IV) or by injection.
  • Metoclopramide – 10 mg every 8 h for 24 h
  • Promethazine – 25 mg every 8 h for 24 h
  • Methylprednisolone – 16 mg every 8 h

All the above-mentioned medicines aid in reducing nausea and vomiting in pregnancy. These medicines are safe and do not cause any malformation.

• Antacids can also benefit. Your doctor will ensure that any medications you take are secure for your child.

If you continue vomiting during pregnancy and are dehydrated, your doctor may suggest you rush to the hospital to get-

• IV fluids, saline, electrolytes, and vitamins to help keep you hydrated.
• Since nothing stays in your stomach, you may be fed using a tube.

Conclusion

The best thing is that vomiting in pregnancy disappears after childbirth. Furthermore, managing HG during pregnancy can lower the chance of complications for you and the unborn child.

Consult your doctor and seek support groups to help you and your family cope with HG. Make sure to express your emotions and symptoms to your therapist and family.

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Frequently asked questions

Disclaimer: This content, including advice and medications, provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your doctor for more details.

Reference:

• About Hyperemesis Gravidarum (HG) – HER Foundation
• Hyperemesis Gravidarum – StatPearls – NCBI Bookshelf (nih.gov)
• Nausea and Vomiting of Pregnancy | AAFP