Hyperemesis
Gravidarum – The pregnancy Voms
“Aah Phoebes, you have
that wonderful pregnancy glow. Glow … that is sweat! You throw all morning and
see how you glow” – F.R.I.E.N.D.S
That unmistakable wave of nausea is commonly one of the
earliest signs of pregnancy. It can be bitter sweet, as no one really likes to
feel nauseous, but when pregnancy is your goal, it is really exciting. 70 -90%
of women experience nausea and some vomiting in the first trimester. The cause
of nausea in pregnancy is not completely understood, but does appear to be
linked to the production of Human Chorionic Gonadotropin (HCG) hormone. Nausea
usually starts at around 4-8 weeks and subsides around 12-14 weeks.
For around 5% and up to 20% of these women, this will
continue throughout the pregnancy. Hyperemesis Gravidarum (HG) is the most
severe form of nausea and vomiting in pregnancy, associated with ketosis,
weightloss, dehydration, electrolyte and acid imbalances, and nutritional
deficiencies. Severe cases may need hospitalisation. Women that are more likely
to develop HG: developed symptoms in previous pregnancies; have menstrual
migraines; develop similar symptoms taking oestrogen (birth control);
experience motion sickness; and have GI problems such as ulcers or reflux.
Your obstetrician or midwife will usually start by trying
natural nausea prevention methods such as Vitamin B6 and Ginger, eating smaller
frequent meals, and dry food such as crackers. Drinking plenty of fluids to
stay hydrated. Now, pregnant moms that I have given this advice to move from
sarcastic, to nuclear, and then often to defeated. I asked some of my mom’s to
tell me about their experience:
I have been pregnant twice and in
both my pregnancies I have suffered terribly from nausea and vomiting. It
started around 8 weeks and continued throughout the pregnancy. With my first I
lost 10kg, and with the second it was 7kg. I felt nauseous all the time and
certain smells and foods would set me running to the toilet. Nothing worked, I
tried everything. My doctor even put me on medication but to no avail. I was
open to all advice, I would have tried anything to stop it. Donna Matthews
Severe
cases may require hospitalization. Pregnant women who are unable to keep fluids
or food down due to constant nausea or vomiting will need to get them intravenously.
Medication is necessary when vomiting is a threat to the mother or child. Majority
of mothers try avoid medications at all costs during pregnancy, so usually if a
pregnant mom is asking for medication, she really is desperate.
I
was very excited when I found out I was pregnant with my first daughter, sadly
that excitement was very soon replaced with nausea and vomiting which lasted
all day. It started at about the same time that I began to suspect that I was
pregnant and worsened as my pregnancy advanced.
I told my Gynae at time that I was suffering from severe morning
sickness and could barely keep any food down. I was given Asic tablets and told
to eat small meals regularly, this did not help one bit. The gynae would not
give me anything stronger as she was unsure of what effect it may have on the
baby. I was unable to go into any shop which stocked meat of any form as the
smell made me vomit and I regularly had to leave a trolley full of groceries
and run. My husband and I turned vegetarian for almost 6 months because I could
not cook any meat. My work was
compromised, some days I only managed to get to work around midmorning and many
days I had to call in sick. I vomited for a full 39 weeks and was totally
exhausted and despondent by the time my C-section date arrived. I suffered from exhaustion and postpartum
depression for a long time after my daughter was born and I think a lot of it
could be linked back to the hyperemesis. It took us 6 years to work up the
courage to go through all of that again despite people telling me that the next
time might be different. When I found out I was pregnant with my second
daughter I made the Dr redo the blood test 3 times just to be sure as I was
slightly nauseous, but not vomiting, however by week 7 the vomiting had set in
again. When I was 10 weeks pregnant I was hospitalised for 4 days because I
could not keep anything down and was becoming dehydrated. When I was discharged
my Gynae prescribed Zofur which reduced the vomiting to mornings only, however
the nausea remained. We finally got the vomiting under control around the 20th
week of my pregnancy, even though the nausea was never controlled and I
struggled to eat many things. I felt a lot better and had far more energy going
into the birth the second time around and am coping much better in the weeks
following the birth. I had many people giving me advice about what worked to
reduce their morning sickness, including ginger suckers, teas and small meals.
None of this advice was helpful as none of it worked and I got progressively
more frustrated and despondent. Hyperemesis is debilitating and frustrating and
I don’t think that women who truly suffer from it are taken seriously, I mostly
felt like a hypochondriac when I told people how terrible I was feeling. I will
definitely not be having any more children as I cannot go through those months
of vomiting again. Meagan Mansell
Medications
that are commonly used:
Antihistamines
such as Diphenhydramine or Meclizine, these commonly cause drowsiness.
Other
anti-nausea medications such as promethazine and metoclopramide are available
for use. Zofran (Ondansetron) is commonly used to help with HG. Zofran blocks
the actions of chemicals in the body that can trigger nausea and vomiting.
The way
that medications are used can improve efficacy.
-
Changing medications abruptly and frequently is
counterproductive
-
Scheduled dosing improves response, rather than
taking when needed.
-
Wean slowly after a few weeks of stability and
adequate nutritional intake
-
Medication may be needed until delivery
Complementary treatments can be used such as acupuncture,
acupressure, and hypnosis. These have been helpful for certain women.
Many of the moms worry how the HG will affect the baby. Although
the pregnancy may be long and tedious,
nausea and vomiting of pregnancy is typically not associated with adverse
pregnancy outcomes in the absence of severe malnutrition or weight gain <7kg.
There is strong evidence that women with nausea and vomiting in early pregnancy
have a lower rate of miscarriage than women without these symptoms. Larger
follow-up studies are needed to determine whether HG has long-term effects on
offspring.
There are others that have HG and they are usually your best
resource, even if it is just to know that you will survive it.
www.HelpHER.org
info@HelpHER.org
facebook.com/HERFoundation
twitter.com/HGmoms
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