Let’s Talk: Hyperemesis Gravidarum

You may be familiar with morning sickness where you experience nausea and vomiting for the first 12 weeks. In fact, around 80% of all pregnant women will be familiar with morning sickness. Unfortunately for some women, Hyperemesis Gravidarum (HG) is a rare condition that involves severe vomiting and nausea, much more so than even the worst case of morning sickness! 

What is Hyperemesis Gravidarum

Hyperemesis Gravidarum (HG) is a pregnancy complication in which the mother experiences extreme nausea and vomiting, not just for days or weeks but sometimes for months. This affects about 1% of all pregnant women and is an extremely debilitating condition. As you are unable to keep any food or fluids down, it can lead to severe dehydration and weight loss if not monitored. Thankfully, if monitored, it is usually not harmful to your unborn child. 

Causes of Hyperemesis Gravidarum

The cause of hyperemesis gravidarum is still unknown but research has suggested it could either be due to high levels of the hormone Human Chorionic Gonadotropin (hCG) in the body, increased oestrogen levels, nutritional deficiencies especially a lack of vitamin B6, or gastric problems due to the presence of the progesterone hormone. 

You’re more likely to suffer from HG if:

• you suffered from HG in an earlier pregnancy 
• you are a first time mother 
• you are overweight
• you are having multiple pregnancies
• there is the presence of abnormal growth of cells inside the uterus which is due to trophoblastic disease

Signs and Symptoms of Hyperemesis Gravidarum

Here are the signs and symptoms that you may have HG:

• Prolonged and severe nausea and vomiting
• Weight loss below 5% of pre-pregnancy weight
• Low blood pressure when standing 
• Dehydration with symptoms of feeling of thirst, dizziness, not urinating frequently, and having a dark colour urine
• Electrolyte imbalance
• Feeling dizzy
• Thyroid and liver dysfunction in severe cases

Symptoms of HG start showing approximately between 4-6 weeks, worsen between 9-13 weeks, and tend to subside by 20 weeks. However it may continue for some throughout the rest of the pregnancy with some of the symptoms gradually disappearing as the pregnancy progresses. 

Treatment of Hyperemesis Gravidarum

Unfortunately, there is no cure for HG just yet but there are measures that can be taken to help improve the symptoms. It is absolutely vital that you seek medical advice as soon as you can if you are suffering from HG to ensure both yourself and baby stay healthy for the duration of your pregnancy. 

Depending on the severity of your HG, you may first be advised by your healthcare professional to try natural remedies at home or alter your lifestyle habits to see if this could help. This includes acupressure, consuming ginger, plenty of rest, or changing the timings and portions of your meals. 

If you are still unable to keep fluids or foods down, you will then be recommended to take anti-sickness medication (anti-emetics). These are safe to take in the first trimester and a careful assessment by your doctor will be followed through to weigh the risks against the  benefits. It is normal to be given a combination of anti-emetics to take if a single type isn’t working and if you are unable to stomach the oral medication, you will be given suppositories to insert anally. 

If you are unable to keep down the oral anti-emetics or continue to lose weight due to nausea and vomiting despite the medication, you may need to be admitted into hospital where you will be placed on an IV drip to remain hydrated and injected with medicine directly into the muscle. 

What Happens Next

Whilst HG symptoms should ease by 20 weeks, some women may continue to suffer throughout their pregnancy. The symptoms should stop completely once the baby is born if they haven’t stopped before then. 

Depending on the severity of your symptoms, HG can be extremely taxing on both your mental and emotional wellbeing. It can cause anxiety and depression, a change in attitude to future pregnancies, and a fear of pregnancy and even sex. It can make living a normal life extremely difficult especially if you are working and/or have a family to look after. If you find that HG is impacting your life mentally and socially, please do speak to your midwife or doctor about how you are feeling. It may also help to speak to your partner. 

If you would like more support, here are a few resources that can help you:
https://www.hyperemesis.org/
https://www.pregnancysicknesssupport.org.uk/

References

1. https://www.ncbi.nlm.nih.gov/books/
2. https://www.rcog.org.uk/
3. Journal of Perinatology (2008) 28, 176–181
4. https://www.hey.nhs.uk/patient-leaflet/hyperemesis-gravidarum/