There is a severe form of nausea and vomiting called hyperemesis gravidarum that affects some pregnant women, causing dehydration, weight loss, and electrolyte imbalance. This is different from morning sickness that most pregnant women experience. A variety of causes can cause hyperemesis gravidarum, including hormonal changes, genetic factors, or infections. Blood tests, urine tests, or ultrasound can be used to diagnose it. It can be treated with medications, fluids, or nutrition. It can be prevented by avoiding triggers, taking supplements, or getting early prenatal care.
As the placenta produces high levels of human chorionic gonadotropin (hCG), a hormone that causes hyperemesis gravidarum, we do not know the exact cause of hyperemesis gravidarum. The symptoms of hyperemesis gravidarum usually peak around the 10th week of pregnancy when hCG levels peak.
Some factors that may increase the risk of hyperemesis gravidarum are:
Having a previous history of hyperemesis gravidarum or motion sickness.
Having a family history of hyperemesis gravidarum or nausea and vomiting during pregnancy.
Having a multiple pregnancy, such as twins or triplets.
Having a female fetus.
Having a history of migraine headaches, anxiety, or depression.
Having a preexisting medical condition, such as thyroid disease, diabetes, or gastrointestinal disorders.
Having an infection, such as Helicobacter pylori, cytomegalovirus, or toxoplasmosis.
Taking certain medications, such as antihistamines, antidepressants, or opioids.
There are several symptoms associated with hyperemesis gravidarum, including persistent and severe nausea and vomiting that occur more than three times a day and interfere with daily activities.
Other symptoms of hyperemesis gravidarum may include:
Loss of appetite and aversion to certain foods or smells.
Weight loss of more than 5% of pre-pregnancy weight.
Dehydration and dry mouth.
Low blood pressure and fast heart rate.
Headache, dizziness, or fainting.
Fatigue and weakness.
Mood changes and depression.
Constipation or diarrhea.
Dark or scanty urine.
Ketones in urine or blood, which indicate the breakdown of fat for energy.
The diagnosis of hyperemesis gravidarum is based on the medical history, the physical examination, and the results of some tests. As well as any other symptoms, risk factors, or complications, the doctor will ask about the frequency, severity, and duration of nausea and vomiting. Furthermore, the doctor will check the woman's weight, blood pressure, pulse, and hydration.
Some tests that may be done to diagnose or rule out hyperemesis gravidarum are:
These tests can determine the cause and severity of hyperemesis gravidarum, as well as the risk of complications.
Urine tests, which can check for the presence of ketones, protein, or infection. These tests can also help assess the hydration and the kidney function of the pregnant woman.
An ultrasound can be used to determine the number, size, and position of the fetus or fetuses, as well as the condition of the placenta and amniotic fluid. The use of ultrasound can also rule out other causes of nausea and vomiting, such as ectopic pregnancy, molar pregnancy, or fetal abnormalities.
Hyperemesis gravidarum is treated by relieving the symptoms, correcting the dehydration and electrolyte imbalance, and preventing or treating any complications. Treatments may include:
Antiemetics, antihistamines, steroids, and antibiotics are examples of medications that may help reduce nausea and vomiting, or treat the underlying cause. These medications can be given orally, intravenously, or subcutaneously.
Fluids and electrolytes, which can help rehydrate and replenish the body. These can be given orally, intravenously, or through a nasogastric tube.
Providing adequate calories and nutrients for the fetus and pregnant woman can be achieved through nutrition therapy. Enteral or parenteral nutrition may be necessary in some cases, as well as eating small and frequent meals, avoiding spicy or fatty foods, or taking vitamin and mineral supplements.
There is no sure way to prevent hyperemesis gravidarum, as it is a complex and unpredictable condition. However, some measures that may help reduce the risk or the severity of hyperemesis gravidarum are:
Seeking early prenatal care and regular follow-up visits, which can help monitor the health and the development of the pregnant woman and the fetus, and detect and treat any problems that may cause or worsen hyperemesis gravidarum.
Avoiding triggers that may induce nausea and vomiting, such as certain foods, smells, or motions. This may include eating bland or cold foods, using ginger or peppermint, or wearing acupressure bands.
Taking vitamin B6 or doxylamine, which are supplements that have been shown to reduce nausea and vomiting during pregnancy. These supplements can be taken before or during pregnancy, as recommended by the doctor.
Getting psychological support, which can help cope with the stress and the emotional impact of hyperemesis gravidarum. This may include counseling, therapy, or joining a support group.
