Hyperemesis gravidarum

Pregnancy is a time of significant physical and emotional changes for women, and while some discomfort is expected, certain conditions can greatly impact a woman's quality of life. One such condition is hyperemesis gravidarum, a severe form of morning sickness that affects a small percentage of pregnant women. It is essential for expectant mothers to be aware of this condition, its symptoms, and when to seek medical attention to prevent potential complications.

What is Hyperemesis gravidarum?

Hyperemesis gravidarum (HG) is a pregnancy complication that goes beyond the typical morning sickness experienced by many women. HG is characterised by severe nausea, vomiting, and the inability to keep down food or fluids, which can lead to dehydration, weight loss, and electrolyte imbalances. Unlike regular morning sickness, which usually subsides by the end of the first trimester, HG can persist throughout pregnancy and may require hospitalisation for management. The exact cause of HG is not fully understood, but it is thought to be related to the rapid increase in hormone levels, particularly human chorionic gonadotropin (hCG), during early pregnancy. While HG can be debilitating, early diagnosis and proper treatment can help alleviate symptoms and prevent complications for both the mother and the baby.

Women with hyperemesis gravidarum typically experience:

• Severe and persistent nausea and vomiting, often more than three times per day, which can lead to dehydration and significant weight loss

• Signs of dehydration such as dark urine, dry skin, weakness, lightheadedness, or fainting

• Weight loss exceeding 5% of pre-pregnancy weight, which can impact the health of both mother and baby

• Excessive salivation, known as ptyalism

• Constipation due to dehydration and lack of nutrients

• Frequent dizziness, lightheadedness, and headache

Hyperemesis gravidarum (HG) is a severe form of morning sickness that affects some pregnant women. While the exact cause of HG is still under investigation, recent research suggests that a hormone produced by the placenta, known as Growth and Differentiation Factor 15 (GDF15), is the most likely culprit. GDF15 levels rise rapidly in early pregnancy and are associated with symptoms of nausea and vomiting. Additionally, genetic factors may play a role, as some women with HG have variations in the gene that codes for GDF15, which can lead to abnormally high levels of the hormone or increased sensitivity to its effects. While more research is needed to fully understand the causes of this debilitating condition, these findings provide important clues for developing targeted treatments for women suffering from hyperemesis gravidarum.

While any pregnant woman can develop hyperemesis gravidarum, certain factors may increase your risk, including:

• A previous history of HG in past pregnancies

• Carrying twins or multiples

• Having a genetic predisposition, particularly if your mother or sister suffered from HG (suggesting the condition may run in families)

• Being prone to motion sickness

• Having a history of migraine headaches, menstrual pain, sensitivity to oral contraceptives, allergies, high blood pressure, kidney disease, or liver problems

Preventing hyperemesis gravidarum (HG) with complete certainty is not currently possible. Although there are no known methods to entirely prevent HG, some steps can be taken to potentially reduce its severity or prepare for its impact. Women who have experienced HG in a previous pregnancy have an estimated 89% chance of recurrence. Taking a multivitamin containing vitamin B6 before getting pregnant may help reduce the severity of symptoms. Early, pre-emptive use of vitamin B6 supplements and first-line medications has shown effectiveness in preventing the deterioration of HG symptoms. Maintaining a healthy diet rich in nutrient-dense foods and ensuring adequate levels of essential vitamins like thiamine (B1) may also help mitigate the severity of HG. Lifestyle changes, such as eating small, frequent meals high in protein and avoiding spicy, fatty, or oily foods, can be beneficial. However, it is crucial to note that these measures do not guarantee the prevention of HG but can assist in managing and reducing its impact. If you suspect symptoms of HG or have a history of it, consult your healthcare provider promptly.

Diagnosing hyperemesis gravidarum (HG) involves a combination of clinical evaluation, medical history, and physical examination. The healthcare provider will assess the severity of the patient's symptoms, such as severe morning sickness that impairs their ability to eat and drink normally, affecting daily activities. These hyperemesis gravidarum symptoms typically begin between the 4th and 6th week of pregnancy and can persist throughout the first trimester or longer. Blood and urine tests may be ordered to check for dehydration, electrolyte imbalances, and ketonuria, although the presence of ketonuria is no longer considered a necessary criterion for diagnosis. The provider may also perform tests to rule out other causes of nausea and vomiting, such as gastrointestinal illnesses or urinary tract infections. An ultrasound may be used to determine if the patient is carrying multiple fetuses or has other conditions like trophoblastic disease, which can also cause HG. Once diagnosed, appropriate hyperemesis gravidarum treatment can be initiated to manage the condition and alleviate the debilitating morning sickness in pregnancy.

Treatment for hyperemesis gravidarum aims to reduce symptoms, prevent complications, and ensure the patient receives adequate nutrition and hydration. The approach to treatment varies depending on the severity of the condition:

1. Initial and Mild Cases

• Dietary Changes: Patients may be advised to eat small, frequent meals and avoid triggers that exacerbate nausea as part of their morning sickness treatment.

• Anti-Nausea Medications: Mild cases of hyperemesis may be managed with antiemetic medications such as promethazine or meclizine to provide some morning sickness cure.

2. Moderate to Severe Cases

• Hospitalization: Patients with severe hyperemesis gravidarum symptoms may require hospitalization to manage dehydration and electrolyte imbalances. IV fluids and electrolyte replacement are common treatments.

• Rest and Hydration: Temporary cessation of food and drink to give the digestive tract a rest, followed by IV fluids to rehydrate and correct electrolyte imbalances.

• Medications: In addition to antiemetics, other hyperemesis gravidarum medication like methylprednisolone may be used in severe cases, although these carry risks and should be discussed with the healthcare provider.

Consulting a healthcare provider as soon as possible is essential if symptoms of hyperemesis gravidarum are suspected or if there is a history of HG in previous pregnancies. Symptoms that warrant a doctor's consultation include persistent and severe nausea and vomiting that interferes with daily activities and nutrition, weight loss exceeding 5% of pre-pregnancy weight, dehydration indicated by excessive thirst or decreased urine output, electrolyte imbalances identified through blood tests, and psychological distress or significant impact on daily life due to symptoms. If you have a history of HG, discussing your previous experiences and developing a care plan with your healthcare provider before becoming pregnant is advisable. This plan should include pre-emptive treatments such as vitamin B6 supplements and first-line medications for morning sickness. Ensure that your healthcare provider understands your medical history and is prepared to support you with a cohesive hyperemesis gravidarum treatment plan. If symptoms of HG start during pregnancy, seek medical attention promptly, as early treatment can help manage symptoms and prevent complications such as malnutrition, dehydration, and electrolyte imbalances.

• Hyperemesis gravidarum (HG) is a severe form of morning sickness that affects approximately 0.5-2% of pregnant women.

• Symptoms of HG include persistent and severe nausea and vomiting, weight loss, dehydration, and electrolyte imbalances.

• While the exact cause of HG is unknown, it is believed to be related to hormonal changes during pregnancy.

• Treatment for HG may include dietary changes, medications, and in severe cases, hospitalization for intravenous fluids and nutrition.

• Although preventing HG with certainty is not currently possible, steps such as taking a multivitamin containing vitamin B6 before pregnancy and maintaining a healthy diet may help reduce the severity of symptoms.

• If symptoms of HG are suspected or there is a history of HG in previous pregnancies, it is essential to consult a healthcare provider promptly for proper diagnosis and treatment.