(The Dallas Examiner) – Nausea and vomiting affect approximately 75% of pregnant women and peak between the 8th and 10th week of pregnancy. However, some mothers suffer severe nausea and vomiting, resulting in hospitalization. These cases represent 1% to 3% of pregnancies estimated as having hyperemesis gravidarum – pronounced hy·per·em·e·sis gra·vuh·deh·ruhm. In hyperemesis gravidarum pregnancies, 34% end in miscarriage, termination, stillbirth or preterm birth.
Hyperemesis gravidarum is not morning sickness. It is a rare disorder that causes extreme, persistent nausea and vomiting during pregnancy. It can lead to dehydration, weight loss, electrolyte imbalance, and various other physical and mental health issues that can increase the risk of adverse outcomes for the mother and baby. Undertreated HG has significant morbidity for mothers and may impact the entire family. Standard treatment approaches are often ineffective and lead to misery and preventable complications.
Recently, the Health and Human Services Commission Office of Disability Prevention for Children and the Hyperemesis Education and Research Foundation held a webinar on preventing and treating HG, called Demystifying Hyperemesis Gravidarum – What’s New? What Works? During the event, experts discussed the cause, impact and treatment strategies to assist mothers in having healthier pregnancies and babies. The event was facilitated by Jay Smith and featured presenters Dr. Aimee Brecht-Doscher, MD, OBGY, HER medical advisor and Kimber Wakefield MacGibbon, RN, HER executive director.
Causes of HG
Brecht-Doscher discussed the theorized causes of hyperemesis gravidarum.
“One of the major theories has been HCG because it tends to peak, which is the pregnancy hormone that tends to peak around the time the nausea and vomiting symptoms peak,” Brecht-Doscher explained.
Hyperemesis gravidarum is also hereditary. Genetic studies found that placental and appetite regulators GDF15 and IGFBP7 and their receptors may cause hyperemesis gravidarum.
“Twenty-six percent of patients lose greater than 15% of their body weight due to HG. Twenty-two percent have symptoms until delivery,” Brecht-Doscher said.
Other risks to the mother include:
- Deciding not to have additional children
- Detached retinas, pneumothorax, esophageal tears, rib fractures, blown eardrums
- Liver, kidney, gall bladder dysfunction, sepsis, pre-eclampsia
- Increased reporting of postpartum blood clots
- Electrolyte abnormalities/arrhythmia
There are risks for the baby as well. Those risks include:
- Preterm birth
- Growth restriction
- Neurodevelopmental delay (smaller brain volumes)
- Congenital disabilities
- Failure to thrive
- Inflammatory bowel disease
- Multigenerational effects
- Miscarriage, termination, or stillbirth
Treatments for HG
Hyperemesis gravidarum is treated with medication. Those medications include:
- Antihistamines (doxylamine, diphenhydramine, hydroxyzine, meclizine)
- 5HT3 agonists (ondansetron, granisetron, mirtazapine)
- H2 blockers
- Proton pump inhibitors
“There are a lot of medications that can be used, and some patients will respond well to some of them, and some patients will respond well to others. It’s good to be aware of all of the options and be ready to try them to find the right thing for the patient,” Brecht-Doscher stated, “The risks of medications are lower than the risks of dehydration or malnutrition, so definitely treat the patient.”
If the mother suffers from dehydration, treatment could include IV fluid replacement, IV medication, or electrolyte replacement.
Brecht-Doscher encouraged mothers to be proactive when they experience early symptoms of HG.
Black moms with HG
Though HG does not discriminate regarding who experiences its symptoms, Black pregnant women may face barriers to proper health care and treatment in the delivery room. Research has uncovered “strong evidence” showing significant disparities in medical care – with additional systemic barriers for those with HG, which has resulted in negative outcomes for Black women, according to the HER Foundation.
“We are committed to providing research, resources and support for women and families affected by HG. We advocate for every woman and continually work to expand our resources to every corner of the globe. Our goal is expanding access to treatment for HG for every woman facing debilitating symptoms,” the foundation expressed.
“After pregnancy, it just doesn’t go away, and they’re better. Recovery can last for months or years,” she cautioned.
Although nausea and vomiting may dissipate, the mother may have lost severe muscle weight and may experience postpartum depression and trauma. Breastfeeding can also be affected by HG and PTSD.
During recovery, it is important for mothers to have a healthy diet of unprocessed foods, along with supplements such as prenatal vitamins or multivitamins.
For mothers wanting to conceive another child after suffering from HG, it is recommended they ensure adequate recovery time between pregnancies; use highly effective contraception to time the subsequent pregnancy; take supplements for at least three months before the next pregnancy; have prescriptions in advance for antiemetics for proactive treatment; and have a medical, financial and social plan in place.
MacGibbon discussed resources provided by the HER Foundation. Those resources include:
- Social media support groups
- Zoom support groups
- Patient and family brochures
- Volunteer network
- Provider tip sheets, treatment algorithms
- Referral network
Additional information and resources can be found at https://www.hyperemesis.org.