Hyperemesis Gravidarum

Severe morning sickness during pregnancy, characterized by extreme nausea and vomiting.

Hyperemesis Gravidarum: A Severe Form of Nausea and Vomiting During Pregnancy

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Hyperemesis gravidarum (HG) is a pregnancy complication that affects less than 3% of pregnant women. It is characterised by severe nausea and vomiting that can lead to dehydration, weight loss, and electrolyte imbalances. HG can have a negative impact on the physical and mental health of the pregnant woman and may require hospitalisation and treatment.

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What are the Symptoms of HG?

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HG usually starts around six weeks of pregnancy and lasts until the end of the first trimester or longer. The main symptom is persistent nausea and vomiting that occurs more than three times a day and prevents the intake of food and fluids. Other symptoms may include:

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  • Loss of more than 5% of pre-pregnancy weight
  • Dehydration and ketonuria (presence of ketones in urine)
  • Dizziness, fainting, headaches, and low blood pressure
  • Rapid heart rate, dry skin, confusion, and jaundice
  • Anxiety, mood changes, depression, sleep disturbance, and irritability

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What are the Causes and Risk Factors of HG?

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The exact causes of HG are unknown, but it is likely related to hormonal changes during pregnancy. The levels of human chorionic gonadotropin (HCG), a hormone produced by the placenta, peak around 10 weeks of pregnancy and may trigger nausea and vomiting. Other hormones, such as oestrogen and progesterone, may also play a role.

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Some factors that increase the risk of HG are:

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  • First pregnancy or multiple pregnancy
  • Obesity or being underweight
  • Previous or family history of HG
  • Maternal age over 30 years
  • Maternal smoking or asthma
  • Trophoblastic disease (abnormal growth of cells in the uterus)

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What are the Complications and Consequences of HG?

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If untreated, HG can lead to serious complications for both the mother and the baby. Some of these are:

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  • Esophageal perforation (tearing of the oesophagus)
  • Pneumothorax (collapsed lung)
  • Hepatic disease (liver damage)
  • Seizure, coma, or blindness
  • Wernicke-Korsakoff syndrome (brain disorder caused by thiamine deficiency)
  • Preterm labour or delivery
  • Low birth weight or small for gestational age
  • Foetal death or miscarriage

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HG can also affect the quality of life and mental health of a pregnant woman. It can cause social isolation, emotional distress, depression, anxiety, guilt, or post-traumatic stress disorder. Some women may choose to terminate their pregnancy due to severe HG symptoms.

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How is HG diagnosed and Treated?

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HG is diagnosed based on the signs and symptoms, medical history, physical examination, and laboratory tests. Blood tests can check for hormone levels, electrolyte imbalances, dehydration, liver function, and nutritional deficiencies. Urine tests can detect ketones, which indicate starvation. Ultrasound can monitor the development of the embryo and rule out other causes of nausea and vomiting.

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Treatment of HG depends on the severity of the condition and the response to therapy. The main goals are to prevent dehydration, correct electrolyte imbalances, provide adequate nutrition, and control nausea and vomiting. Some treatment options are:

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  • Drinking fluids and eating a bland diet in small and frequent meals
  • Taking oral or intravenous fluids with electrolytes and vitamins
  • Taking antiemetic drugs (such as metoclopramide or ondansetron) to reduce nausea and vomiting
  • Taking antihistamines (such as dimenhydrinate or doxylamine) to prevent allergic reactions
  • Taking vitamin B6 supplements to help with nausea
  • Taking corticosteroids (such as prednisone) in severe cases to suppress inflammation
  • Hospitalisation for monitoring and intravenous therapy

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Psychotherapy may also help with coping skills, stress management, emotional support, and education. Acupressure may provide some relief for some women.

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Conclusion

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HG is a rare but serious condition that affects some pregnant women. It causes severe nausea and vomiting that can lead to dehydration, weight loss, and other complications. It can also affect the mental health and well-being of the pregnant woman. Treatment aims to prevent dehydration, correct electrolyte imbalances, provide adequate nutrition, and control nausea and vomiting. With proper care and support, most women with HG can have a healthy pregnancy and delivery.

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Sources

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1. Debbo Africa: https://debbo.africa

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2. Cleveland Clinic. Hyperemesis Gravidarum: Causes, Symptoms & Treatment [Internet]. Cleveland Clinic [cited 2023 Nov 6]. Available from: https://my.clevelandclinic.org/health/diseases/12232-hyperemesis-gravidarum

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3. MSN. What is Hyperemesis gravidarum and its possible symptoms, causes, risk and prevention methods? [Internet]. MSN [cited 2023 Nov 6]. Available from: https://www.msn.com/en-us/health/condition/Hyperemesis-gravidarum/hp-Hyperemesis-gravidarum?source=conditioncdx

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4. Wikipedia. Hyperemesis gravidarum [Internet]. Wikipedia [cited 2023 Nov 6]. Available from: https://en.wikipedia.org/wiki/Hyperemesis_gravidarum

5. AAFP. Nausea and Vomiting of Pregnancy [Internet]. AAFP [cited 2023 Nov 6]. Available from: https://www.aafp.org/pubs/afp/issues/2014/0615/p965.html