Hyperemesis Gravidarum
Extreme Morning Sickness Can Cause Dehydration, Malnutrition
Hyperemesis gravidarum is severe morning sickness that affects some pregnant women. It can result in dehydration, electrolyte imbalance and malnutrition.
Many pregnant women experience “morning sickness,” nausea and vomiting that can occur at any time of day. However, some women will experience extreme nausea and vomiting, called hyperemesis gravidarum.
Seventy to 85 percent of women with normal pregnancies experience some sort of morning sickness. With normal morning sickness, the mother continues to gain weight, can keep food down and does not get seriously dehydrated. Normal morning sickness also usually resolves by the end of the first trimester, around 12 weeks gestation. However, for about 2 percent of pregnant women, morning sickness symptoms are far worse and can result in weight loss, nutritional deficiencies and dehydration; this may be hyperemesis gravidarum. Hyperemesis gravidarum can persist past the end of the first trimester.
Causes and Risk Factors
No one knows for certain what causes hyperemesis gravidarum. There may be a genetic tendency to have extreme morning sickness; sisters or daughters of women with hyperemesis gravidarum have a higher incidence of having it themselves than women with no family history of hyperemesis gravidarum. Also, women who have had it in previous pregnancies are more likely to have hyperemesis gravidarum again. Some have suggested that the bacteria Helicobacter pylori may contribute to hyperemesis gravidarum, but the scientific data is inconclusive about whether this is actually a contributing factor or not.
However, hyperemesis gravidarum is known to be associated with the following:
- Carrying a female fetus
- Multiple gestation (more than one fetus)
- Triploidy – a rare chromosomal disorder
- Trisomy 21 – also called Down syndrome
- Current or prior molar pregnancy
- Hydrops fetalis – abnormal accumulation of fluid in the fetus
It should be noted that the presence of hyperemesis gravidarum does not necessarily mean that the fetus has any of the above conditions.
Some mothers have a higher risk factor for developing hyperemesis gravidarum because of previous or current medical conditions. Women with the following may be at greater risk for developing hyperemesis gravidarum:
- History of motion sickness
- Migraine headaches
- Psychiatric illness
- Diabetes diagnosed prior to pregnancy
- High or low pre-pregnancy weight
- Hyperthyroidism
- Pyridoxine deficiency
- Gastrointestinal disorders
Symptoms of hyperemesis gravidarum
There are many symptoms of hyperemesis gravidarum. A woman who experiences the following symptoms should notify her obstetrician:
- Nausea accompanied by uncontrolled vomiting
- Inability to keep any food down
- Nausea and/or vomiting that does not get better after the first trimester (about 12 weeks gestation)
- Severe dehydration
- Food aversions
- Loss of 5 percent or more of mother’s pre-pregnancy weight
- Decreased urination
- Headaches
- Confusion
- Jaundice
- Fainting
Treatment of hyperemesis gravidarum
Before intravenous (IV) techniques were available, hyperemesis gravidarum was a leading cause of maternal death because of dehydration; however, death from hyperemesis gravidarum is rare now. Injuries and malnourishment can occur, however, so a mother who suspects hyperemesis gravidarum should notify her obstetrician of her symptoms. The physician may order tests to rule out any other cause of the extreme vomiting. The physician will then decide if the mother can be treated at home with medication or if she should be hospitalized.
Hospitalization for hyperemesis gravidarum is the second leading cause of hospitalization in pregnancy; the first is preterm labor. If the physician does decide to hospitalize the mother, she will be treated with IV fluids to help restore her body’s fluid and electrolyte levels. The mother’s physician may also decide to give her anti-nausea medications to help avoid vomiting. When the mother can tolerate taking fluids by mouth without vomiting, she will probably be placed on a clear liquid diet; this includes Jello, clear broth, fruit juices without pulp, coffee, tea and soda. Then she will be gradually reintroduced to solid foods.
Resources:
"Hyperemesis Gravidarum." American Pregnancy Association.
"Hyperemesis Gravidarum." Merck Manual online.
Wilcox, Susan Renee, MD. "Hyperemesis Gravidarum." eMedicine.com
