Archived Article from American Baby
|From American Baby Magazine:
More Than Just Morning
About Hyperemesis Gravidarum
Pregnant for the first time, Anne Marie King of Dallas assumed that getting sick every time she ate or drank was normal: "When I was five weeks along, I started vomiting several times an hour around the clock. I couldn't even keep down water."
After a week of this, her husband insisted she go to the hospital. Dehydrated and weak, King received intravenous fluids there. Her doctor sent her home with a prescription for anti-nausea medication, but she vomited up the pill. By the end of her first trimester, King had made several trips to the hospital for IV hydration and had lost 20 pounds. At that point, her doctor placed a feeding tube directly into her stomach so she could get nourishment.
For the next four months, King spent most of her time at home in bed, where her husband and a nurse took turns tending the feeding tube and giving her injections of powerful anti-nausea drugs every four hours. In her final trimester, her nausea eased enough that she could choke down an occasional bite of food, but it didn't lift completely until she gave birth. Her relief was immediate. "The minute my son popped out, I begged for a bottle of water," King recalls. "I drank a mouthful and started crying for pure joy."
Although 50 to 80 percent of pregnant women experience some degree of morning sickness, a tiny minority endure the rare extreme variation known as hyperemesis gravidarum, or HG. Because it affects only 1 to 2 percent of all pregnant women, this intense nausea and vomiting is not widely studied. In fact, women suffering from HG are still sometimes told it's all in their head! However, it is real and it is serious. With the right help, you can get through it and have a healthy baby.
The Mystery of HG
Morning sickness probably developed millions of years ago as nature's way of preventing women from eating toxic substances that might harm the developing fetus. We don't know what causes HG, says T. Murphy Goodwin, MD, chief of maternal-fetal medicine at the University of Southern California in Los Angeles, but basically it's the biological reflex in overdrive: The placenta produces such high levels of nausea-inducing hormones that they overwhelm a woman.
Doctors do know that the condition runs in families. You may also be prone to HG if: you're carrying multiples, you have a history of gallstones or inner ear problems, birth control pills containing estrogen make you queasy, or you're prone to motion sickness. What's more, Dr. Goodwin adds, if you've had HG once, your chances of suffering from it during a subsequent pregnancy are two out of three.
Environmental factors may also play a significant role. All pregnant women are more sensitive to smells, but many women with HG say their noses start working overtime; they get sick from a whiff of laundry detergent, a once-favorite food, or even a family member's natural scent.
A Body Under Siege
HG shows up dramatically and without warning, usually in the second month of pregnancy, but sometimes much sooner. On average, it lasts into the fourth month, but some women, like King, suffer almost from the day they conceive to the day they deliver, says Miriam Erick, RD, author of Managing Morning Sickness (Bull Publishing, 2004).
Unless women end up in the hospital with severe dehydration, they often aren't diagnosed until a prenatal appointment reveals they're losing weight, Erick says. Even then, some doctors may first try treating women for thyroid problems or a stomach virus.
Because most women with HG have never been pregnant before, they may have no idea that they're experiencing anything other than ordinary morning sickness — but throwing up all day, every day, for weeks at a time is not normal.
Getting a Handle
Experts agree it's critical to treat the symptoms before they spin out of control. That means not waiting until you're so sick you can barely walk. If you are vomiting more than a few times a day, note as best as you can every bit of liquid you do keep down. If it doesn't add up to 10 cups every 24 hours, Erick says, hurry to the ER, because you're at risk of dehydration. Other danger signs include constant rather than occasional nausea; weight loss, especially more than two pounds a week or more than 5 percent of your prepregnancy weight; and vomiting blood or bile. If you have any of these symptoms, tell your ob-gyn immediately.
Your doctor will probably start treatment by administering IV fluids and vitamins to rehydrate you. You might need this treatment regularly. Next, he may recommend you take vitamin B6 with over-the-counter Unisom sleep tablets, a combination that has a stomach-soothing effect. If this doesn't get your nausea under control, the next step is a prescription anti-nausea medication such as Zofran or Phenergan. Although these powerful drugs are most often given to chemotherapy patients, they've also been prescribed for HG for 20 years and are proven both safe and effective. Women who get no relief from anti-nausea drugs can try corticosteroids, but only after 10 weeks of pregnancy.
"After I started taking Zofran, I still got sick,
but it was only five or six times a day, not 20 or
30," says Erika Martin of Seattle. "I
was miserable, but at least I could get through the
In extreme cases, a woman with HG may be so ill that only IV fluids and a feeding tube keep her from literally starving to death as her body directs all available nutrients to the developing fetus. Your body is designed to feed your growing baby first and will begin to break itself down in order to provide the nutrients needed. But getting assistance early is important to help you avoid permanently damaging your own health. The happy mystery of HG is that, for all the suffering it causes women, they deliver healthy babies.
Fawn Fitter is a writer in San Francisco.
Originally published in American
Baby magazine, May 2004.
Updated on: Apr. 18, 2013