HYPEREMESIS GRAVIDARUM: CAUSES, SYMPTOMS & DIAGNOSIS

Hyperemesis gravidarum, what is it? It’s a severe form of morning sickness that affects 1 to 3 percent of pregnant woman. While regular morning sickness is inconvenient and uncomfortable, hyperemesis gravidarum (HG) can be classified as hell on earth! The condition is treatable and most likely; if you have it you will give birth to a healthy baby, but if the condition goes untreated it can result in death or severe complications for both mother and child. 


An HG diagnosis is given when:
•    A pregnant woman loses more than 5% of her pre-pregnancy weight. An average weight loss for HG sufferers is 10 percent. 
•    Ketones are produced due to severe dehydration.
•    Nutritional deficiencies due to excessive vomiting.
•    Metabolic imbalances due to vomiting and dehydration.
•    Experiencing difficulty with completing everyday tasks due to fatigue.
HG is different for every sufferer. Many patients begin to experience symptoms between 4 and 6 weeks with a peak between 9 and 13 weeks. Sometimes the HG resolves itself around 20 weeks, while other sufferers do not have a symptom free day for the duration of their pregnancy. 


Treatment


The condition can be managed from a medical perspective, but in most cases, the pain and discomfort of the mother are not completely alleviated. Her condition can only be made bearable. 


•    Medication
As mentioned above every case is unique. The most common form of treatment is prescription anti-nausea medication (including steroids), coupled with nutritional and fluid intravenous treatments. In many cases, women are hospitalised until their condition can be stabilised with medication. They might have to return for IV treatments for the duration of the pregnancy. Although the anti-nausea medication can prevent some vomiting, in cases of HG it usually doesn’t eliminate it.  


•    Psychotherapy
HG sufferers often experience psychological stress, anxiety, depression, and posttraumatic stress disorder. The reason being that there is a lack of awareness amongst the medical community and society at large about the impact and severity of HG—symptoms that go above and beyond normal morning sickness. Women suffering from HG often feel isolated and unheard, because the majority of people around them (including doctors) tell them they’re making it up. In such cases, women begin to believe they must be going crazy or are too weak to handle “normal” morning sickness and terminate the pregnancy. In cases where depression and anxiety have been brought on by HG, psychotherapy is advised. 


•    Therapeutic Abortion
Therapeutic abortion of the pregnancy is an official “treatment” of HG; however, it is not commonly advised and is considered a last resort. Cases of therapeutic abortion often lead to severe depression.


Causes


Sadly, research studies involving the causes and treatment of women suffering from HG are limited, since it affects such a small number of pregnant women and it is hard to objectively measure something like nausea. There are some common threads that seem to appear in many pregnancies that are complicated by HG. It is theorised that no one thing “causes” HG, but rather a combination of several things contributing to the condition. 


•    The Human Chorionic Gonadotropin (hCG) hormone
At the beginning of pregnancy, women experience an increase of hCG. Most theories involving the causes of HG revolve around the fact revolves around the fact that an influx of hCG directly correlates to increased nausea. This is considered to be the most “common” explanation for women suffering from HG. 


•    Thyroxine Levels
Thyroxine is a hormone produced by the thyroid which helps regulate body function (commonly referred to as T3 and T4), by binding to proteins produced by the body. The increased level of hormones in the body during pregnancy can result in what is known as transient hyperthyroidism and has been found in many HG patients. Seventy percent of women suffering from HG experience increased thyroxine levels. Basically, the thyroid starts producing too much thyroxine causing an imbalance. 


•    Gastric Neuromuscular Dysfunction
When people suffer from motion sickness, it is because the normal muscle patterns of the intestines get interrupted, which causes nausea. The same thing can happen in women with HG. Essentially the normal muscle patterns of their intestines are thrown off resulting in vomiting. The vomiting continues, and the intestines are never allowed a chance to regulate, resulting in a cyclical pattern of constant nausea and vomiting. 


•    Nutritional Deficiencies
All cases of HG result in some level of nutritional deficit due to the inability to eat or retain food. But deficiencies in both zinc and pyridoxine have been reported. It is not yet understood why these deficiencies may cause nausea, but it is thought to be related. 

Thiamine (vitamin B1) is also quickly depleted in cases of HG. A deficiency in thiamine can cause what is known as Wernicke encephalopathy—a neurological condition caused the depletion of B vitamin reserves. This condition can cause severe and permanent damage to the central nervous system. If left untreated it can cause death. 


HG is an extremely debilitating and under-researched condition. If you think you have it, seek medical attention immediately! In the last couple of years, women suffering from HG have become more outspoken in hopes of convincing the right people to research the illness and find answers. HG’s most famous victim is perhaps Kate Middleton. Women all over the world have felt compassion for her and her suffering. They are also thankful that her suffering has brought the condition to light and hope that more people will educate themselves and make sure that HG patients get the care they deserve.  


Citations
http://www.hyperemesis.org/
https://www.ncbi.nlm.nih.gov/pubmed/12011886?dopt=Abstract
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410506/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755698/ 

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