Hyperemesis Gravidarum: More Than Morning Sickness

At least 50% of women in their first trimester experience nausea and vomiting. We know this as "morning sickness". But for approximately 1 in 100 women, the nausea is consistent, lasts longer, and leads to effects such as dehydration and weight loss. This condition is called Hyperemesis Gravidarum and it is a severe medical condition that may lead to the pregnant women needing to be hospitalised for a period of time to be rehydrated and given anti-nausea medication.

What is Hyperemesis Gravidarum

Simply put, Hyperemesis Gravidarum means "Excessive Vomiting During Pregnancy". It begins between four and seven weeks into your gestation and usually lasts until around 20 weeks. However, for some women it continues right up until the day they give birth.

Hyperemesis Gravidarum is a serious and debilitating condition. If you are experiencing HG, chances are you will struggle to eat anything, keep any food (or even water) down, and living your daily routine will become a real struggle.

Symptoms of Hyperemesis Gravidarum

• Nausea and severe vomiting: i.e. vomiting that is persistent throughout the day and which makes it difficult to eat
• Food aversions
• Weight loss of 5% or more of pre-pregnancy weight
• An inability to swallow saliva; an excessive production of saliva
• Dehydration: loss of skin elasticity, furry tongue, breath that smells like nail polish or rotten apples (this is a big warning sign), reduced urination, or tachycardia (fast heartbeat)
• Muscle weakness/wasting
• Headaches
• Confusion

Could it be something else?

There are alternatives to Hyperemesis Gravidarum, especially if your symptoms start later in pregnancy (12 weeks or later), or are accompanied by fever or pain.

Alternatives to HG include:

• Urinary Tract Infection
• Hepatitis
• Peptic Ulcer
• A reflux disorder (such as Reflux Oesophogitis)
• Pancreatitis
• Hypercalcaemia
• Addison's Disease (an autoimmune disorder involving the adrenal gland)

How do I know I have Hyperemesis Gravidarum?

HG is diagnosed by a process of elimination.

Initial investigations will usually involve testing your weight (to see if you've lost weight); checking your temperature, pulse and blood pressure; and assessing for signs of dehydration (dry mucous membranes in the mouth, ketones in the urine, concentrated urine).

After that, you will probably have a series of urine-, blood-tests, and general examinations, including:

• Full blood count: - people with HG often have a raised Haematocrit (that is the volume percentage of red blood cells in your blood)
• Urine test: - testing for ketones; also looking for evidence of a Urinary Tract Infection that may be the alternate cause.
• Urea and Electrolyte Test (U&E):- in severe HG, raised serum levels, Hyponatraemia (low sodium in the blood) and Hypokalaemia (low potassium in the blood) are often found.
• Liver Function Test (LFT):- up to 50% of people with HG have moderately raised Transaminases (an enzyme that catalyses a reaction between amino acids and a-keto acids; high levels indicate liver damage). This usually reverses. New LFTs should be taken every two weeks.

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• Calcium blood test: - Hypercalcaemia (high calcium in the blood) is a rare but treatable cause of symptoms that mimic HG and should be tested for.
• Pelvic ultrasound: - to rule out molar pregnancy (a potentially-malignant mass that mimics pregnancy)

Once you've had these tests, your doctor can be quite sure if you're suffering Hyperemesis Gravidarum.

Next, we look at causes, treatment, complications self-help, and what you can do now.

More About Hyperemesis Gravidarum

Why Have I got Hyperemesis Gravidarum?

No-one knows exactly why it develops. It appears there are several factors involved, including the hormonal changes of pregnancy. However, it does appear that you are more likely to develop HG if:

• You're having a girl,
• It's your first baby
• You were overweight at the start of pregnancy
• You're a young mum
• You're pregnant with multiples: e.g. twins or triplets
• You're prone to travel sickness or migraines
• Hormonal contraception made you nauseous
• Your mum or sister had HG when they were pregnant
• You had HG in a previous pregnancy.

Treatment

Treatment of HG has three aims: rehydration, rebalance of electrolytes, and prevention of further complications.

Many patients may need to be hospitalised due to complications caused by dehydration. While hospitalised, you may need to be fed by intravenous tube, to rehydrate, restore electrolytes and rebalance necessary vitamins and minerals.

After that, you should be offered anti-nausea medication. Although many mothers-to--be want to avoid medication while pregnant, and with good reason, anti-nausea medication has a good safety record for pregnant women (Promethazine, Cyclizine, and Metoclopramide have all been used by pregnant mothers-to-be), so work with your doctor to find something that can help you with your nausea, and which won't harm Baby: It's far more dangerous for Baby to have a dehydrated mum.

Even if you don't need hospitalisation, have a word with your doctor about your nausea. If you have HG, they should prescribe you something to minimise the problem and prevent you becoming dehydrated.

Complications of Hyperemesis Gravidarum

• Wenicke's encephalopathy: - caused by exhausting vitamin B reserves, this causes confusion, ataxia (an abnormal gait and poor coordination), and opthalmoparesis (weakness or paralysis of the muscles responsible for eye-movements)
• Vitamin deficiencies: - especially B12 and B6
• Small birth-weight baby: - the unlikely but possible result of the mother-to-be being ineffectively treated
• Mallory-Weiss syndrome:- tearing to the mucosa of the oesophagus and stomach, caused by severe vomitting
• Spontaneous rupture of the oesophagus
• Pneumothorax:- a collection of gas in the pleural space (commonly called collapsed lung) that interferes with breathing.
• Deep vein thrombosis
• Pulmonary embolism

Self Help For Hyperemesis Gravidarum

If you know you have Hyperemesis Gravidarum, here are a few handy hints to help you:

• Don't worry about eating a healthy, balanced diet:- Eat the food you can stomach. Eating food you can't keep-down, just because it's healthy, won't do you or Baby any good.
• Eat dry biscuits, bread or cereal before getting out of bed in the morning: - Also, get out of bed very slowly and avoid sudden movements. Go on, be waited on for a change.
• Drink between, rather than with, meals:- This will reduce the amount you're consuming at any one time. Alternatively, if you find it hard to drink, suck ice cubes. Other good fluid suggestions include
  • Ice lollies
  • Lemonade: - for some reason, most people can stomach lemonade, even when drinking water is an impossible task
  • Ginger ale: - like lemonade, plus the ginger can be soothing to the stomach
  • Milkshakes
  • If tap water turns your stomach, try mineral water, kept in the fridge
  • Ice cubes made with flat Coca-Cola, instead of water.
• Have snacks around the house:- Have small snacks available for as soon as you feel you can eat something: crackers, oat cakes, rice cakes, and cereal bars all make excellent options.
• Try a little ginger: If you find your nausea peaking, try some cubes of crystallised ginger. Ginger can be very helpful to nausea, and is even recommended to cancer-patients. However, don't have more than 4mg a day.
• Avoid greasy or spicy food

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• Eat in well-ventilated rooms and try to keep them odour-free
• Rest if you can:- tiredness will exaggerate the effects of the nausea.

What should I do now?

If you suspect you have Hyperemesis Gravidarum, book yourself an appointment with your doctor. There's no point in waiting until you can't eat or drink anything; go to your doctor as soon as symptoms star affecting your life.

Even if you're not losing weight, it's still a cause for concern if you're vomiting consistently and can't stomach food. You also need to return to your doctor if you know you have HG and the medication has not worked.

If you have Hyperemesis Gravidarum, you may feel like you're struggling to be taken seriously, to have your problem not dismissed as "just morning sickness". But don't give up. Be persistent. Hyperemesis Gravidarum is more than morning sickness, it's a potentially-devastating condition.

And remember: you are not alone. 1 in 100 women are suffering as you are. 

Above all, try not to worry. As long as you are treated, you can go on to have a healthy pregnancy and a healthy baby.