Hyperemesis Gravidarum

Many pregnant women experience morning sickness. While it’s normal for most, there are few, however, who have it more intense — hyperemesis gravidarum.

Hyperemesis gravidarum refers to severe nausea and vomiting occurring beyond the first trimester of pregnancy. In this article, we identify the 5 main signs of the condition and ways how to avoid these.

 

Nausea and vomiting during pregnancy may be a sign of more than just morning sickness.

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What is it?

Hyperemesis gravidarum often referred to as severe morning sickness, is a rare disorder causing extreme nausea and vomiting during pregnancy. Hyperemesis gravidarum extends beyond the first trimester and lasts until the 20th week.

While morning sickness and vomiting in pregnancy are generally harmless, hyperemesis gravidarum can lead to severe dehydration and weight loss. Hospitalization and treatment with intravenous fluids may be required to treat the condition.

The Causes

The exact cause of hyperemesis gravidarum during pregnancy is unknown. Several causes and risk factors may play a role in the onset of hyperemesis gravidarum.

Hormone changes during hyperemesis gravidarum

Elevated levels of human chorionic gonadotropin (hCG) and estrogen are thought to contribute to persistent nausea and vomiting during pregnancy. These hormones are produced by the placenta as a biomarker for the detection of pregnancy and signals preparation for fetal growth and maturation.

Abnormal levels of these hormones in the blood are seen during the first three months and decrease later on in the pregnancy.

Hyperemesis Gravidarum: Gastrointestinal problems

The relaxation of the lower esophageal sphincter can lead to an increased occurrence of gastroesophageal reflux disease (GERD) during pregnancy. GERD is a known condition to manifest symptoms of nausea and vomiting.

Genetics: Hyperemesis Gravidarum

Women with family members who have experienced hyperemesis gravidarum are at increased risk of having the same disorder. A study shows how placenta and appetite genes, GDF15 and IGFBP7 are linked to the occurrence of hyperemesis gravidarum.

Multiple pregnancies

A pregnant woman who carries twins or more than one baby is at higher risk for developing hyperemesis gravidarum.

Trophoblastic Disease

Gestational trophoblastic disease (GTD) refers to a group of rare disorders causing abnormal growth of cells or tumors in the womb.

Hydatidiform Mole

Hydatidiform Mole, or molar pregnancy, is a type of GTD referring to abnormal growths of mass at the beginning of pregnancy. It mimics a normal pregnancy first, but no fetal formation occurs.

What are the signs and symptoms?

Morning sickness subsides by the end of the first trimester of their pregnancy. Women experiencing hyperemesis gravidarum manifest the following signs and symptoms:

  • Severe nausea and vomiting more than four times a day
  • Losing of 5% of body weight or more
  • Dehydration, with signs of dry skin and dark urine
  • Dizziness and lightheadedness
  • Headaches

 

A pregnant woman experiencing dizziness and headache

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Hyperemesis Gravidarum & Morning Sickness

Morning sickness and hyperemesis gravidarum start during the first three months of pregnancy. Symptoms of morning sickness usually begin nine weeks after conception and fade by the end of the 12th week of pregnancy. Few experience it throughout the entire pregnancy.

It occurs when the human chorionic gonadotropin (hCG), which is a hormone released by the placenta, is at its peak. This causes women to experience nausea and vomiting at any time of the day.

Hyperemesis gravidarum, on the other hand, can start as early as the 6th week. Episodes of persistent nausea and frequent vomiting can last until the 20th week of gestation. Most women have intractable nausea, which refers to a form of nausea that is difficult to control. Hyperemesis gravidarum is often accompanied by severe vomiting, causing women to reduce appetite and lose weight.

Related conditions in pregnant women

Severe nausea and vomiting during pregnancy may arise from other health concerns. Differential diagnosis may be useful in evaluating the cause of the condition.

Gastrointestinal disorders such as infection in the GI tract, appendicitis, and bowel obstruction are often characterized by fever, abdominal pain, nausea, and vomiting. Diseases affecting the urinary and reproductive systems may also be associated with the same symptoms. These can include kidney infection (pyelonephritis), degeneration of abnormal growths of tissue (fibroid degeneration), and twisting of the ovary due to cysts (ovarian torsion).

Who’s at risk?

The chances of developing hyperemesis gravidarum are increased in women who have any of the following risk factors:
  • Had the condition during a previous pregnancy
  • Multiple pregnancies
  • Younger maternal age
  • Family history of hyperemesis gravidarum
  • Nausea and vomiting from motion sickness, strong odor or taste
  • Being a first-time mother
  • Being overweight

 

If any of the above apply to you, you may be at risk of hyperemesis gravidarum.

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Can it be prevented?

There are no known measures to completely prevent hyperemesis gravidarum. However, there are ways how to control hyperemesis gravidarum.

Small, frequent meals

Too little or too much food can trigger nausea and vomiting. Eating small, frequent meals with 2-3 hours intervals stabilizes blood sugar levels and alleviates common symptoms of morning sickness.

Hyperemesis Gravidarum: Eating bland foods

A pregnant woman may benefit from a bland diet when severe hyperemesis occurs. Dry foods such as toast, cereal, or crackers can be eaten before going out of bed. Drinking fluids in between meals allows food to be digested slowly.

Avoiding triggers of hyperemesis gravidarum

Spicy, fried, or greasy foods induce nausea. Eating in a cold environment can help avoid the smell of strong odors.

Use of sea bands for hyperemesis gravidarum

Sea bands help relieve feelings of nausea, motion sickness, and morning sickness. These work by acupressure and are often applied to the wrist.

Vitamin B6: Mitigating Hyperemesis Gravidarum

Vitamin B6, or Pyridoxine, works by processing amino acids in the body, which in turn improves nausea.

Ginger

Ginger protects gastric health by promoting digestion and increased emptying. Adequate amounts in drinks or supplements relieve morning sickness.

Waiting for severe nausea and vomiting to subside before taking iron supplements

Iron is an important blood nutrient for pregnancy. However, iron supplements can also result in cramps, diarrhea, and nausea. Doctors may advise taking it with food or waiting until your hyperemesis gravidarum symptoms improve.

 

It's important to regulate your iron intake during pregnancy.

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How is it diagnosed?

Hyperemesis gravidarum is diagnosed by performing a medical history. Your doctor will ask about your symptoms, including how often or severely you’ve been having them. Risk factors are also determined to evaluate the chances of developing the disorder.

Hyperemesis gravidarum Diagnosis

The physical exam is done to assess signs of dehydration and weight loss. Typically, it is performed by examining the following:
  • Fetal heart rate (depending on the gestational age)
  • Fluid status
  • Blood pressure
  • Heart rate
  • Skin turgor

Hyperemesis gravidarum is often manifested by rapid pulse and low blood pressure. Excessive salivation can also be observed in affected pregnant women.

Your physician may order additional tests during your physical exam, such as blood and urine tests to rule out other causes of nausea and vomiting during pregnancy. An ultrasound can also reveal whether multiple pregnancies are the reason for experiencing hyperemesis gravidarum symptoms.

 

A physical exam will help determine whether what you're experiencing is hyperemesis gravidarum.

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Treatment and medications

Prolonged hyperemesis gravidarum can result in fluid and electrolyte imbalances in the body. Depending on the severity of your condition, care is focused on improving the health state of both the mother and baby.

Preventive measures of hyperemesis gravidarum such as small-frequent meals, bland diet, and use of sea bands usually do the trick in treating hyperemesis gravidarum. Your physician may also recommend taking anti-nausea medications.

Hyperemesis Gravidarum Common Medications:

  • Vitamin B6 supplements (Pyridoxine)
  • Doxylamine (Unisom)
  • Antihistamines such as Diphenhydramine and Promethazine

Moderate to severe cases of hyperemesis gravidarum often result in sodium and potassium imbalances. Pregnant women suffer from loss of appetite and weight loss. Hospitalization may be required to treat the condition.

Healthcare providers administer intravenous fluids to replenish lost vitamins caused by excessive vomiting due to hyperemesis gravidarum. In severe cases, total parenteral nutrition is given to supply daily nutrients.

Parenteral nutrition is usually sustained until such time the patient can feed by mouth. Medications such as Promethazine and Metoclopramide are also combined to treat severe nausea and certain conditions of the gastrointestinal system.

 

Your doctor may prescribe vitamin B6 supplements, doxylamine, or other common medications as treatment.

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Alternative Remedies of Hyperemesis Gravidarum

Traditional interventions have also proven to be effective in relieving severe symptoms of hyperemesis gravidarum during pregnancy. Many women also benefit from combining these therapies along with medical treatments.

Hyperemesis Gravidarum Remedies:

Acupressure

Acupressure works by inducing pressure on specific parts of the body, also called acupoints. Techniques are aimed to release muscle tension and stimulate blood and hormonal circulation. relaxation.

Aromatherapy

This form of treatment uses natural extracts to improve overall health. Aromatherapy eases pain, stress and helps promote relaxation.

Hypnosis

Hypnosis works by increasing concentration and focus. The use of hypnotherapy is often regarded as a state of sleep. Rather, a therapist assists the pregnant woman in taking the mind to a “different place” with guided images and words.

 

Hypnotherapy may prove effective in remedying hyperemesis gravidarum.

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What are the possible complications?

Rarely does hyperemesis gravidarum cause serious complications. Women of severe cases typically experience signs of dehydration accompanied by fluid and electrolyte depletion and poor weight gain.

Prolonged hyperemesis gravidarum poses a risk for preterm labor. A study reveals that apart from preterm labor, extreme nausea and vomiting during early pregnancy are also linked to low birth weight.

Research on Hyperemesis gravidarum

Recent research has proven several complications related to the disorder. These include:
  • Blood clots
  • Esophageal rupture
  • Kidney failure
  • Liver disease
  • Lung collapse
  • Vitamin deficiencies

Wernicke’s encephalopathy is a rare disorder of the neurological system caused by Vitamin B1 deficiency. It is characterized by confusion, lack of voluntary movement coordination (ataxia), and paralysis of the eye (ophthalmoplegia). This potentially-life threatening condition is reversible with early treatment.

 

Extreme nausea and vomiting can affect not only you, but your baby as well.

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In conclusion

The five main signs of hyperemesis gravidarum may help differentiate normal nausea from morning sickness in your pregnancy. Currently, there are no known ways to avoid it but increasing studies have come up with ways how to control your HG symptoms.

A variety of treatment options are at hand to address hyperemesis gravidarum. Despite the number of complications accompanied by it, rapid diagnosis is key to preventing hyperemesis gravidarum from progression.

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