It wasn’t a major shock to me when, about eight weeks into my first pregnancy, I started throwing up. Morning sickness, right? Lots of people have morning sickness, my doctor assured me. I was actually thrilled that I hadn’t been sick earlier. A friend of mine had spent every morning from five weeks until twelve weeks with her head in the toilet. I had gone from feeling fine to feeling like I had been run over, literally overnight. I didn’t know at the time that the very delay in sickness was a symptom of something far more serious.
Everyone assured me that it would go away in a few weeks. So, even though it was escalating, I figured it was OK. I wasn’t just sick in the morning; I was sick all day. But I kept telling myself it would pass, so I didn’t seek treatment for it. I threw up nearly everything, whether I ate or not, whether I drank or not. But week 12 rolled around, and I felt worse. Much worse. The night my husband watched me throw up water, he got scared. So I went to the doctor the next day, and she explained that there might be something else going on. It was the first time I heard the term hyperemesis gravidarum, but certainly not my last dealing with this rather nasty disease. One of the downfalls to HG is that it tends to come back every time a woman is pregnant if she has HG with her first pregnancy. That held true for me with both of my biological children.
The terms are taken from Greek and Latin: hyper mean “excessive”, emesis means “vomiting”, and gravi means “pregnant”, giving a meaning of “excessive vomiting in pregnancy”. No kidding, at my worst with this disease I was literally throwing up 40-50 times a day.
The line between morning sickness and HG is often blurred, and fail.ing to seek help when that line is crossed can be dangerous, even ultimately fatal, for both the mother and the baby. Education is key, so let me share what I have learned through two nasty bouts of HG.
When to seek treatment: symptoms of HG
Most doctors will require several of the following symptoms before defining HG, but the main qualification is severe vomiting leading to weight loss (from 5-30 percent of the pre-pregnancy body weight) and dehydration. Other symptoms include:
An altered sense of taste and smell. Things that normally smell good, like flowers and food, can smell entirely off to a woman suffering from HG. This was true in my case. Cigarette smoke, which usually makes me gag, actually smelled good to me during my pregnancies. Coffee, which I have literally been addicted to since college, smelled absolutely disgusting. Some smells were enough to actually make me vomit. For example, walking into the garage at my in-laws house made me sick, which makes no sense since it is a well-ordered, neat garage (compared to, say, the one at my house, which is an utter disaster). The only thing I can come up with is perhaps they used a certain type of paint on the walls? Being a teacher, I never knew what a child was going to bring into the classroom. One girl brought in a duck one day, and the smell of the duck had me running for the nearest trashcan. It was a very strange experience. Fortunately for me, the altered smells didn’t last past pregnancy. Some people report alterations, especially in taste, lasting for years after they have had their children. I don’t remember if any food tasted different to me during pregnancy; I honestly never ate much of it.
Ketosis. In my second pregnancy, the nurses gave me a set of sticks that would pick up ketosis (acetone in the urine, caused by a breakdown in fatty acids). When the stick turned color, I knew it was time to go back to the hospital. Ketosis is caused by dehydration and is very dangerous, especially for a pregnant woman. Several diets have claimed ketosis as positive proof of fat loss, and it is, but it can also lead to damage in the brain and kidneys if left untreated. In addition, in a diabetic patient, ketosis can lead to coma and death.
Sensitivity of the brain to motion. In some cases, this is so severe it leads to vertigo after pregnancy. I didn’t experience this symptom as much, but there were definite times I felt like I was moving, especially in a sort of swaying motion, when my eyes were closed. It is almost like the feeling of stepping back onto solid land after many hours in a boat, when it feels like the land is moving. It was a very odd feeling, and I hope that it never happens again. Occasionally, I would notice that when I moved too quickly, I would get a strange, almost ice-pick pain in one of my temples. This also went away right after pregnancy.
Stomach irregularities. The main thing that happens in HG is that food leaves the stomach more slowly. This is caused by the pregnant woman’s body trying to hold the food in her stomach to be digested. This often, however, leads to more nausea and can also cause constipation. These irregularities can also cause stomach contents to move back up from the stomach. This manifests as both vomiting and acid reflux. Neither is a pleasant feeling.
Subconjunctival hemorrhage (broken blood vessels in the eyes). These hemorrhages are cause by strain on the eyes from repeated vomiting. My eyes got so bad that I could not wear my contacts. I also had broken blood vessels on my cheeks, which looked almost like bizarre red freckles. After I had stopped vomiting so much, around 24 weeks in my first pregnancy, after birth in my second, the spots went away. I was glad; Raggedy Anne was not a look I favored. I feel almost cheated that the “glow” most women get from pregnancy never happened to me. The only color I was glowing was green.
Fainting. Fainting can be caused by low blood pressure, which in turn is caused by dehydration. I never fainted while pregnant, but my blood pressure did drop dramatically. When I was admitted to the hospital while pregnant with my daughter, at about 15 weeks, my blood pressure was 77/35.
Confusion / Hallucinations. Confusion and hallucinations are caused by severe dehydration. I was lucky enough to avoid these particular side effects, but woman should get help immediately if either happens, because this indicates a severe hormonal or brain chemistry imbalance.
How many women are affected?
Hyperemesis gravidarum is classified as a rare disease, which means that less than 200,000 people in the United States suffer from it. The National Organization for Rare Diseases (NORD) HG page can be seen here http://www.rarediseases.org/rare-disease-information/rare-diseases/byID/1110/viewAbstract The percentage of pregnant women who suffer from HG is generally thought to be between .03% and 1%.
However, since many people don’t truly understand the difference between HG and morning sickness, it is likely that this disease is underreported. Also, since women who have had it in the past but aren’t currently pregnant (like me) are not considered to “have” HG at this actual moment, the number would be much higher if it were counted as anyone who has ever suffered from this disease, and therefore making it not such a “rare” disease at all.
What is the difference between morning sickness and HG?
The American Pregnancy Association has a chart where symptoms can be checked. The chart can be seen here: http://www.americanpregnancy.org/pregnancycomplications/hyperemesisgravidarum.html. The biggest difference is in the vomiting. Morning sickness is classified by nausea, which can be severe and debilitating, but which is not always accompanied by vomiting. HG is always accompanied by severe vomiting, which will not subside after the first trimester. Many HG sufferers, myself included, actually find that the second trimester is the worst in terms of both nausea and vomiting. This happened in both my pregnancies, leading to multiple IV re-hydrations and in the case of my second pregnancy, a lengthy hospital stay. Morning sickness will not lead to dehydration, while the dehydration associated with HG requires immediate medical attention.
How is HG treated?
The bad news is there is no cure for HG. The good news is that it can be treated with varying degrees of success. To start with, fluid is necessary for rehydration. Occasionally, diet and rest will be enough to help a woman overcome HG. However, for most women IV therapy rehydration is necessary, and for some women, inpatient hospital admission is needed. There are also medications that can be used in pregnancy to treat this disease. The most commonly used medications are Zofran, Tigan, Reglan, Phenergan, and Compazine. All are available by prescription only, and all have been deemed safe for use in pregnancy. There is some evidence that medicinal marijuana can be used to relieve nausea, but it also has been proven to contribute to birth defects in unknown babies, and should be avoided for that reason. Many over the counter remedies that work well with morning sickness have no effect on hyperemesis gravidarum. Some “cures” that have been discounted include ginger, peppermint, lemon, and motion-sickness bands. It is vital to talk to a doctor before taking any medication or attempting any treatment at home. Women suffering from HG should also get behavioral support or therapy, as this condition can lead to a feeling of being alone and depression, if untreated.
What are the effects to the mother and the baby?
Here’s where HG can get very scary. Physical and emotional stress of pregnancy on the body is exacerbated by HG, especially if left untreated, and it can lead (in very extreme cases) to both mother and baby dying.
The side effects to the mother can include long term nutritional deficiencies, but with treatment the likelihood of this diminishes. Metabolic imbalances can be caused by rapidly changing hormone levels during pregnancy, and sometimes these imbalances need medication to be corrected. Other long term effects, mainly from dehydration, are low blood pressure, jaundice or decreased liver function, rapid heart rate, loss of skin elasticity and extreme fatigue. Secondary anxiety or depression, especially with less desirable outcomes, can lead to post-partum depression, a chemical imbalance that needs to be treated immediately. In addition, reports of renal failure, Mallory-Weiss syndrome, hypoglycemia, atrophy, and Wernicke’s encephalopathy have been reported, though less commonly.
The side effects to the baby seem depend on how much weight the mother is able to gain while pregnant. A study in The Journal of Obstetrics and Gynecology showed that mothers who gain less than 7 kg (15.4 pounds) during pregnancy are more likely to have babies who are small for gestational age, low birth weight, and are often born prematurely (before 37 weeks). However, for a woman who manages to gain at least 7 kg, her newborn has the same chances as a child from an uncomplicated pregnancy. For more on this study, visit http://www.ncbi.nlm.nih.gov/pubmed/16449113.
It is even possible for both mother and baby to die from hyperemesis itself. The author Charlotte Bronté, and her unborn child, are thought to have died from untreated HG.
For more information on hyperemesis gravidarum, and links to support groups and available help, visit http://www.helpher.org/hyperemesis-gravidarum/
I was lucky that in my second pregnancy, I knew about the problems that my first caused. My weight gain in my first pregnancy was only 14 pounds (and it was tough even getting that on), and in my second, even though I was much sicker, I managed to gain nearly 24 pounds. Not a lot, but a big deal for someone with HG. Because of that my daughter weighed in at 7 pounds 3 ounces, on her due date. She was still small, but much bigger than my 4 lb 14 oz son, who was born at 36 weeks. Because of the warning that HG can actually be worse in later pregnancies, and the toll that the second pregnancy took on my body and my career, and the fact that we now had three great children (my middle child is adopted), my husband and I decided that our family was complete. I haven’t regretted that decision at all, and I love being able to enjoy life again. It is extremely important to get all the facts when faced with a diagnosis or suspicion of hyperemesis gravidarum, because sometimes the side effects can be deadly.