Hyperemesis Gravidarum

Definition

Hyperemesis gravidarum means excessive vomiting during pregnancy.

Description

In pregnant women, nausea and vomiting (morning sickness) are common, affecting up to 80% of pregnancies. Hyperemesis, or extreme nausea and excessive vomiting, occur in about 1% of pregnancies. This condition causes uncontrollable vomiting, severe dehydration, and weight loss for the mother. However, hyperemesis gravidarum rarely causes problems for the unborn baby.

Causes and symptoms

The cause of nausea and vomiting during pregnancy is unknown but may be related to the level of certain hormones produced during pregnancy. Hyperemesis is seen more often in first pregnancies and multiple pregnancies (twins, triplets, etc.). The main symptom of hyperemesis is severe vomiting, which causes dehydration and weight loss.

Diagnosis

Although many women with morning sickness feel like they are vomiting everything they eat, they continue to gain weight and are not dehydrated; they do not have hyperemesis gravidarum. Women with this condition will start to show signs of starvation, including weight loss. Physical examination and laboratory tests of blood and urine samples will be used to help diagnose the condition. One of the most common tests used to help diagnosis and monitor hyperemesis gravidarum is a test for ketones in the urine. Excessive ketones in the urine (ketonuria) indicate that the body is not using carbohydrates from food as fuel and is inadequately trying to break down fat as fuel. Ketonuria is a sign that the body is beginning to operate in starvation mode.

Treatment

Hospitalization is often required. Intravenous fluids with substances that help the body conduct nerve signals (electrolytes) may be given to correct the dehydration and excessive acid in the blood (acidosis). Anti-nausea or sedative medications may be given by injection to stop the vomiting. In some cases, oral medication may be prescribed to control the nausea and vomiting while food is reintroduced. If food cannot be tolerated at all, intravenous nutritional supplements may be necessary. Injections of vitamin B₆, in particular, may help overcome nutritional deficiencies that often occur.

Alternative treatment

The severe vomiting associated with hyperemesis gravidarum requires medical attention. Milder episodes of nausea or vomiting may be reduced with deep breathing and relaxation exercises. The use of herbal remedies should be done with extreme caution during pregnancy, especially in the first trimester. Natural remedies to reduce nausea include a teaspoon of cider vinegar in a cup of warm water, or tea made from anise (Pinpinella anisum ), fennel seed (Foeniculum vulgare ), red raspberry (Rubus idaeus ), or ginger (Zingiber officinale ). Wristbands can be positioned over acupressure points on both wrists. Aromatherapy with lavender, rose, or chamomile can be soothing, as can smelling ground ginger. Homeopathic remedies—which use extremely diluted solutions as treatments—can be safe and effective for controlling symptoms in some women.

Prognosis

In virtually all cases, the pregnancy can continue to the successful delivery of a healthy baby.

Prevention

Although there is no evidence that hyperemesis gravidarum can be prevented, vomiting during pregnancy sometimes may be lessened. Maintaining a healthy diet, getting adequate sleep, and controlling stress may contribute to prevention or improvement of symptoms. Several strategies may help lessen the nausea and vomiting. Eating dry foods and limiting fluid intake may also be helpful. Small meals should be eaten frequently throughout the day, with a protein snack at night. Eating soda crackers before rising from bed in the morning may help prevent early morning nausea. Iron supplements may cause nausea and can be eliminated until the nausea is controlled. Sitting upright for 45 minutes after meals may also help.

Resources

OTHER

Levy, B. T., and P. L. Brown. "Nausea and Vomiting in Pregnancy." The Virtual Hospital Page. University of Iowa. 〈http://www.vh.org〉.

"Natural Remedies During Pregnancy: Frequently Asked Questions." Childbirth.Org. 〈http://www.childbirth.org/articles/remedy.html〉.

KEY TERMS

Ketonuria— The presence of large amount of ketones in the urine. These byproducts of inadequate breakdown of nutrients indicate that the body is in starvation.