Just Morning Sickness?
Hyperemesis Gravidarum, or excessive nausea and vomiting during pregnancy, affects 1-2% of all pregnancies. Although most pregnant women, approximately 75%, experience some morning sickness in their 1st or 2nd trimester, a few can have the severe form of hyperemesis which can lead to malnutrition of both mother and fetus.
Other abnormalities such as hyponatremia, renal failure, Wernicke’s encephalopathy, muscle wasting, deep venous thrombosis, pulmonary emboli, esophogeal tears, and a host of other adverse events can occur if not treated properly. Luckily, with good care, these conditions are rarely encountered.
The exact etiology of HG is not known. Perhaps the most widely held theory is that the pregnancy hormone called Human Chorionic Gonadotropin or HCG, is the main culprit. It is believed that some women have an unusually strong response to the fast rising hormone in which the developing fetus is seen almost as a foreign body. That’s why HG is more common among multiple gestations and molar pregnancies which are those with the highest HCG levels.
Time Periods When It’s the Worst
HCG peaks at about 10 weeks and begins to taper off at 12- 13 weeks. This falling HCG level is when most women will start to feel better.
OB/GYN American Fork Further Expounds on Possible Causes
Another possible link is found in the very fast rising estrogen levels, which can be up to 100 times normal values during pregnancy. The thought is that estrogen and progesterone cause decreased motility in the gut and therefore decreased gastric emptying and more nausea and vomiting.
Pre-Natal Vitamins and HG
Symptoms of HG may be worsened by the iron found in pre-natal vitamins which is why many practitioners advise to stop the vitamins until the symptoms improve.
Don’t Get Dehydrated!
Strong odors in some foods can trigger symptoms. This is termed “hyperolfaction.” For an unknown reason, some HG sufferers develop a sense of hypersalivation in which they are constantly spitting and trying to get rid of saliva. This is very detrimental as they are ridding themselves of the very fluid they stand in need of. The nausea and vomiting lead to dehydration which in turn leads to further nausea and then further dehydration. This becomes a vicious cycle!
OB/GYN American Fork’s Treatments, Medications and Natural Remedies
The main treatment consists of replacing the lost fluid and electrolytes. I encourage my patients to drink sips of sport drinks and this also helps with some lost calories. Common medications used to treat emesis or antiemetics, include antihistamines (such as diphenhydramine) promethazine also known as Phenergan, Reglan, Vitamin B6, (up to 100 mg twice a day), and Ondansetron otherwise called Zofran. Ginger is used by some as well as acupuncture, or acupressure but their effectiveness is inconclusive.
A brand new medication called “Diclegis” has just been approved by the FDA for treatment of nausea and vomiting in pregnancy. It is a combination of doxylamine and pyridoxine (Vitamin B6 ). It was originally sold as “Bendectin” between 1956 and 1983 when it was unfortunately taken off the market for safety concerns. It has undergone some of the most intensive investigations since then and now is the only pregnancy category “A” drug that I know of. This means it is proven beyond a doubt to be totally safe during pregnancy. (Zofran by the way has been associated potentially with cleft palate although very widely used.)
When You’re Not Able To Manage It On Your Own
Women with severe hyperemesis gravidarum occasionally will require hospitalization. Treatment consists of I.V. hydration and replacement of electrolytes. Rarely TPN (total parenteral nutrition) or placement of a naso-gastric tube may be necessary for nutritional needs to be met. In the past home i.v. therapy with a PICC line was used for long term i.v. needs. This is now highly discouraged as nearly 1/3 people with PICC lines developed infections or worse yet, DVT’s or deep venous thrombosis from these types of iv’s.
Ultrasound Can Detect Other Pregnancy Issues
Because HG is associated with high HCG levels, an ultrasound may be recommended to rule out the possibility of multiple gestation or a molar pregnancy. Although a few women may have HG throughout their entire pregnancy, most will have complete resolution of their symptoms by 20 weeks gestation. With a little help and compassion from your doctor, hyperemesis gravidarum can usually be managed on an outpatient basis.