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It refers to nausea and vomiting that progresses severely in pregnant women in medicine.
You’ve heard of morning sickness during pregnancy, but what happens when nausea and vomiting are so severe that the mother loses more than 5 percent of her body weight and suffers from malnutrition?
And unlike morning sickness, which tends to last only during the first trimester, this can last 20 weeks into the pregnancy or longer. This is a condition called hyperemesis gravidarum.
Hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy. It is the second leading cause of preterm delivery as a cause of hospitalization during pregnancy.
It is a debilitating and relentless condition that significantly affects a woman and her family. Women with hyperemesis gravidarum find it challenging to carry out their usual activities and find that this disorder alters their physical, psychological, and social functioning.
Many women are left wondering why they have this serious condition. While the exact cause is unclear, new research identifies some specific links that may help determine who is most at risk for hyperemesis gravidarum.
What is hyperemesis gravidarum?
Up to 80 percent of pregnant women experience nausea and vomiting during pregnancy.
Morning sickness usually involves nausea that is sometimes accompanied by vomiting, and it usually goes away at about 12 weeks of pregnancy or earlier.
However, in the case of hyperemesis gravidarum, this is characterized by nausea accompanied by severe vomiting and does not disappear until later or not at all during pregnancy.
Hyperemesis gravidarum also tends to cause severe dehydration and does not allow you to retain any food, so it is normal to lose 5 percent of your body weight or more.
About 0.3 to 2 percent of pregnant women suffer from hyperemesis gravidarum. For some women, hospitalization or spending time away from work is necessary.
Some women lose their jobs due to the time it takes to hyperemesis. Women with this condition often feel under-treated and stigmatized by the disorder, as people assume it is psychological.
What are the signs and symptoms of hyperemesis gravidarum?
If not appropriately managed, hyperemesis gravidarum can lead to significant problems such as:
- The does nutrition.
- Electrolyte imbalance.
- The thrombosis .
- Depressive illness.
- Bad pregnancy results.
Symptoms of this condition usually begin between 4 and 6 weeks of pregnancy, peak at nine weeks, and disappear around 20 weeks. However, for less than half of women with hyperemesis, symptoms can last throughout the pregnancy.
The most common symptom of hyperemesis gravidarum is severe nausea and vomiting. Most women affected by this condition experience numerous episodes of vomiting throughout the day with few (if any) periods of no symptoms.
This is especially true during the first 3 to 4 months of pregnancy.
The most common signs and symptoms of hyperemesis gravidarum can include:
- Severe nausea and vomiting
- Dehydration.
- Electrolyte imbalance.
- Nutrient deficiencies.
- Decreased urination
- Dizziness.
- Fainting.
- Extreme fatigue
- Confusion.
- Weight loss (5 percent or more of the pre-pregnancy weight).
- Food aversions and cravings.
- Headaches.
- Jaundice .
- Loss of elasticity of the skin.
- Low blood pressure .
- Elevated heart rate
- Difficulty with daily activities.
Some research shows that hyperemesis gravidarum is associated with an increased risk of adverse pregnancy outcomes, including problems such as low birth weight, preterm labor, and babies that are small for gestational age.
These problems are often a threat in the most severe cases of hyperemesis when the mother is losing a lot of weight and suffers from prolonged nausea and vomiting. These complications also increase if medical intervention is delayed or inappropriate.
Hyperemesis gravidarum also increases the risk of placental disorders, such as placental abruption, especially if symptoms continue during the second trimester of pregnancy, and increases the risk of depression, anxiety, and mental health problems during pregnancy, as well as Postpartum depression.
In addition to these problems during pregnancy, research indicates that women with hyperemesis gravidarum are more likely to develop muscle weakness, motion sickness, autoimmune disorder, and post-traumatic stress disorder after pregnancy.
And babies are more likely to experience colic, fussiness, and growth restriction.
Causes and risk factors of hyperemesis gravidarum
The cause of hyperemesis gravidarum is unknown, but there are numerous theories about its etiology. Every year, new findings emerge and show that hyperemesis is a complex physiological disorder likely caused by many factors.
Researchers recently made a scientific breakthrough when they used human genetics to determine what influences the risk of this severe condition.
In 2018, a UCLA-led study identified two genes associated with hyperemesis gravidarum. These genes, known as GDF15 and IGFBP7, are believed to be involved in the development of the placenta, and they play an essential role in early pregnancy and appetite regulation.
The two genes are also linked to cachexia, which causes symptoms similar to hyperemesis gravidarum, including weight loss and muscle wasting.
When the scientists compared variations in the DNA of pregnant women without nausea and vomiting with women with hyperemesis gravidarum, they found that the DNA variation around the GDF15 and IGFBP7 genes were associated with the condition.
These findings were confirmed in an independent study that evaluated women with hyperemesis gravidarum.
GDF15 and IGFBP7 proteins are abnormally high in women with severe nausea and vomiting, and researchers are now trying to determine whether these genetic protein levels can be safely altered during pregnancy to minimize symptoms.
Before this recent research, studies on why some pregnant women develop symptoms of hyperemesis never clearly identified a cause.
Researchers believe that the following problems can cause hyperemesis:
- Hormonal fluctuations.
- Nutritional deficiencies
- Gastrointestinal dysfunction.
- Asthma.
- Allergies
- Liver abnormalities
- Autonomic nerve dysfunction.
- H. pylori infection.
Psychosomatic causes
According to research published in the International Journal of Women’s Health, hyperemesis gravidarum is associated with many risk factors; Pregnant women with this condition are more likely to be younger, pregnant for the first time, and a person of color, and less likely to drink alcohol.
The data also suggests that females are connected to hyperemesis gravidarum. Women whose mothers or sisters also experienced severe nausea and vomiting during pregnancy are at increased risk of developing hyperemesis gravidarum.
Although recurrence rates are high for women with hyperemesis gravidarum, they are not 100 percent, suggesting that many factors come into play here and that the cause of hyperemesis is not just based on the genetics of a pregnant woman.
With more research, mainly focusing on the role of gene protein levels in the prognosis of hyperemesis, we may have a clear answer to the causes of this condition shortly.
How is hyperemesis gravidarum diagnosed?
The diagnosis of hyperemesis gravidarum is usually made by monitoring weight loss (with a loss of more than 5 percent of pre-pregnancy body weight indicating hyperemesis).
Another way to diagnose hyperemesis gravidarum is by monitoring the rise in ketones, which accumulate in the blood when dehydration or electrolyte imbalance occurs, and by assessing the General Condition of the pregnant woman.
Some other signs of hyperemesis that can be tested in a laboratory include increased liver enzymes, abnormal thyroid, parathyroid levels, and increased hematocrit, indicating contracted blood volume and dehydration.
What is the conventional treatment for hyperemesis gravidarum?
Management of hyperemesis gravidarum involves correcting an electrolyte imbalance and dehydration, correcting nutritional deficiencies, preventing complications, and providing symptomatic relief.
Early intervention is critical. Managing or regulating symptoms will promote a healthy outcome for both mother and baby.
If a patient is admitted to the hospital for hyperemesis gravidarum, they will usually receive fluids intravenously and, in some cases, maybe be given tube feedings to restore nutrients.
Antiemetics are commonly used to control nausea and vomiting in patients who choose to use low-dose medications when dietary measures have failed, and symptoms continue.
Some antiemetic agents used for hyperemesis include:
- El Ondansetrón.
- La Metoclopramide.
- Meclizine.
- At promethazine.
Proton pump inhibitors and antihistamines are also sometimes used as add-on treatments.
These are the nine natural remedies to improve the symptoms of hyperemesis gravidarum
- Dietary changes
Proper nutrition is one of the most challenging problems for women with hyperemesis. Although a pregnant woman needs a variety of nutrients for the health and moral development of her baby, the symptoms of hyperemesis can make it impossible to eat a balanced diet.
According to research published in Obstetrics & Gynecology, “modifying the amount and size of meals eaten throughout the day can help relieve symptoms.”
This can be helpful for women who can tolerate meals that are made from certain foods.
Instead of eating 2 to 3 large meals per day, consuming smaller amounts of food and fluids more often can help.
Researchers also suggest that eating foods that contain more carbohydrates than fat and acid and foods high in protein can help decrease symptoms. In addition to this, any food that causes nausea should be identified and avoided.
For some women with hyperemesis, eating any food can be nauseating. If this is what you are dealing with, seek medical treatment before becoming dehydrated and malnourished.
Early intervention is essential for your health and the health of your baby.
- Reduce stress and rest
Women suffering from symptoms of hyperemesis gravidarum should do everything possible to reduce stress and get as much rest as possible.
Prolonged fatigue is familiar with this condition, and bed rest is often necessary, sometimes for an extended period.
Sometimes women with this condition find it helpful to get emotional support from a psychologist to help treat debilitating symptoms.
Counseling and support forums can be beneficial for women desperate for these seemingly endless symptoms.
For hyperemesis gravidarum support, you can visit the Foundation for Research and Research in Hyperemesis (HER). This handy website has support forums, blogs, information, and research on this persistent condition.
- Chiropractic care and massage therapy
Chiropractic adjustments and massage therapy can help women experiencing pain due to atrophy, musculoskeletal changes, and immobility.
This type of care can also aid in muscle relaxation and the release of toxins.
A study conducted in Sweden found that tactile massage serves as a good alternative and complement to traditional treatment for severe nausea and vomiting during pregnancy (SNVP).
When ten women with SNVP received touch massages on three different occasions while hospitalized for their symptoms, it was said to promote relaxation and give the women a chance to regain access to their bodies.
- Physiotherapy
Physical therapy may be beneficial for bedridden women for an extended period due to the severity of hyperemesis symptoms.
Learning simple exercises to help the mother maintain muscle tone and flexibility can help lessen the impact of inactivity.
Physical therapy can also help with postural balance, especially for those affected by hyperemesis who generally have poor postural stability and balance and a high risk of falls compared to pregnant women who do not have this condition.
- Ginger
Ginger can block gastrointestinal responses that cause nausea and increases GI tract motility. Studies suggest that the health benefits of ginger may help some women with hyperemesis gravidarum, especially in mild to moderate cases.
One study administered one gram of ginger daily for four days. The preference among patients to receive ginger versus placebo was significant.
However, some studies suggest that taking ginger may make hyperemesis symptoms worse. Based on the data, testing ginger for four days will help a woman with this condition determine whether or not ginger is effective for her symptoms.
If you want to start with smaller amounts of ginger to see how it reacts, try ginger essential oil or ginger tea.
- Vitamin B6
Studies show that vitamin B6 may be better than a placebo in reducing the severity of hyperemesis symptoms, especially at higher doses.
In a review that evaluated five studies that included participants taking vitamin B6 for mild to moderate symptoms of hyperemesis, vitamin B6 led to a reduction in symptoms of vomiting and nausea, especially in women with more severe symptoms.
Generally, supplementing 25 to 50 milligrams of vitamin B6 three times a day will help reduce nausea and vomiting. Before taking high doses of vitamin B6, talk to your healthcare provider about the proper course of action.
- Thiamine
Research suggests that pregnant women should ingest 1.5 milligrams of thiamine per day. It should be taken intravenously if they cannot take thiamine by mouth due to vomiting.
Wernicke’s encephalopathy is caused by a thiamine deficiency and can lead to severe neurological damage.
Hyperemesis is associated with this rare neurological disorder, so thiamine supplementation is crucial for women with severe nausea and vomiting during pregnancy.
- Acupressure and acupuncture
Although research on the efficacy of acupressure and acupuncture in treating hyperemesis gravidarum is mixed, there is evidence that this form of therapy is helpful for some women who experience severe nausea and vomiting during pregnancy.
A study conducted in Croatia evaluated the antiemetic effects of acupuncture and acupressure.
The trial included 36 pregnant women with hyperemesis gravidarum.
The researchers found that the efficacy of acupuncture treatment of the PC6 point (above the wrist on the inner forearm) was 90 percent. The acupressure treatment of PC6 was 63 percent, compared to treatment with placebo, which was 12.5 and 0 percent effective.
- Hypnotherapy
Hypnotherapy is a therapeutic tool that guides an individual to a relaxed state, promoting a sense of well-being and tranquility.
A scientific review published in the Journal of Obstetrics and Gynecology analyzed six studies describing hypnosis in treating hyperemesis gravidarum. The researchers found that the methodology of the studies was different, but all reported encouraging positive results.
Key points
- About 0.3 to 2 percent of pregnant women suffer from hyperemesis gravidarum, characterized by severe nausea and vomiting.
- Hyperemesis gravidarum can be highly debilitating for pregnant women, often leading to hospitalization. If not managed properly, it can lead to significant health problems for both mother and baby.
- Symptoms of hyperemesis usually begin between 4 and 6 weeks of pregnancy, peak at 9 weeks, and disappear around 20 weeks.
- The cause of hyperemesis gravidarum is not yet precisely known, but new research suggests that two genes are associated with the disease.
- Diet and lifestyle changes are the first line of defense for hyperemesis. Many patients turn to antiemetics to relieve nausea when these changes do not improve symptoms.
