Hyperemesis Gravidarum: Symptoms, Causes, Treatment

Overview

For some women, pregnancy is a beautiful journey. In comparison, others experience severe morning sickness. Morning sickness reduces or completely goes away within 12 weeks. However, when morning sickness becomes severe, the doctors refer to it as hyperemesis gravidarum. 

The condition makes expectant mothers vomit more than four times daily, causing dehydration. Pregnant women may also experience constant dizziness, lightheadedness and weight loss.

This blog is a comprehensive understanding of hyperemesis gravidarum, its symptoms, causes, complications, risk factors, and treatment.

What is hyperemesis gravidarum?

As mentioned above, hyperemesis gravidarum is an extreme form of morning sickness resulting in severe vomiting and nausea. Less than 3% of pregnant women experience the condition. The symptoms include constant vomiting that causes dehydration, weight loss, frequent dizziness and lightheadedness. However, the symptoms become extreme that the expectant mothers cannot retain any food. In such cases, doctors recommend hospitalization. 

There is no need to worry as this condition is temporary, and there are different ways to manage the same. 

Morning sickness often disappears by the end of the first trimester, but hyperemesis gravidarum generally lasts longer. Pregnant women start to experience this condition anytime between the 4^th to 6^th week; it may worsen between the 9^th – 13^th week of pregnancy. In this time frame, women experience severe vomiting that hinders their daily activities. However, for most women, the symptoms improve by the 20^th week of pregnancy.

Doctors are unaware of the causes of hyperemesis gravidarum. However, they believe it is associated with a hormone level rise. Women who had hyperemesis gravidarum in their first pregnancy are at a greater risk of getting it again in their subsequent pregnancy. 

What is the difference between morning sickness and hyperemesis gravidarum?

It is vital to note that morning sickness and hyperemesis gravidarum are different conditions with distinct symptoms and complications. However, distinguishing both helps proper diagnosis.

The typical symptom of morning sickness is nausea, sometimes accompanied by vomiting. Close to 90% of women experience it. Morning sickness usually goes away after 12 weeks of pregnancy but may continue till 20 weeks or longer. However, vomiting due to nausea does not cause severe dehydration. The pregnant woman may also experience fatigue, lack of appetite, and disruption in daily activities, but this may not need  hospitalization.

On the other hand, hyperemesis gravidarum only occurs in 0.5 to 2% of pregnancies. It begins with nausea and severe vomiting that may lead to severe dehydration, loss of appetite, and severe weight loss. Also, patients with this condition cannot retain food or fluid. In extreme cases, the patient may need to be hospitalized due to malnutrition and dehydration. 

What are the symptoms of hyperemesis gravidarum?

Typically, hyperemesis gravidarum starts in the first trimester of pregnancy. The symptoms can appear and disappear. Therefore, sometimes, women may require hospitalization to manage their symptoms, and at other times they may manage at home . Some of the most common symptoms of hyperemesis gravidarum include:

• A feeling of constant nausea
• Loss of appetite
• Frequent vomiting
• Dehydration
• A sense of lightheaded or dizziness
• Weight loss of more than 5 per cent of the body weight due to nausea or vomiting

When should women seek medical advice? 

Women must contact the doctor if they are pregnant and have severe nausea and vomiting. They must also contact the doctor if they have the following symptoms:

• Blood in the vomit
• Light-headedness or dizziness
• Abdominal pain
• Signs of dehydration
• Cannot tolerate any fluids for over 12 hours
• Loss of weight

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What are the causes of hyperemesis gravidarum?

When women experience a rapid increase in serum levels of hormones, such as human chorionic gonadotropin (hCG) and oestrogen, it causes hyperemesis gravidarum. Extreme nausea and vomiting during pregnancy can sometimes also suggest multiple pregnancies (women carry more than one baby) or hydatidiform mole (an abnormal tissue growth that is not a pregnancy).

What are the risk factors of hyperemesis gravidarum?

The risk factors for hyperemesis gravidarum include:

• Being obese
• First pregnancy
• Having multiple pregnancies (twins or triplets)
• Hyperemesis gravidarum during a previous pregnancy
• The presence of trophoblastic disease (the abnormal growth of cells inside the uterus)

How is hyperemesis gravidarum treated?

The treatment for hyperemesis gravidarum depends on the severity of the woman’s symptoms. Some of the possible treatments might include:

• Preventive measures may include a pressure-point wristband, vitamin B6 and ginger. 
• Small frequent meals: doctors can advise women to consume smaller, more frequent meals and dry foods such as crackers. They must also drink plenty of fluids to remain hydrated.
• Intravenous fluids: pregnant women must maintain their fluid intake. Intravenous (IV) fluids may be required if women continue to vomit throughout pregnancy. In severe cases, women can need hospitalization and be given IV fluids. Doctors can discontinue IV fluids if women can take in fluids orally.
• Total parenteral nutrition: for the most severe cases of hyperemesis gravidarum, women can require a complex, balanced solution of nutrients that doctors must give through an IV throughout pregnancy. It is known as total parenteral nutrition (TPN).
• Medicines: Doctors prescribe medications to prevent nausea when persistent vomiting poses risks to the woman or the baby. If women cannot take medicines orally, doctors can administer them through an IV or a suppository. 

Can hyperemesis gravidarum be prevented?

Although doctors do not know how to prevent hyperemesis gravidarum completely. Women can try the following measures to prevent nausea and vomiting  from becoming severe:

• Consume small, frequent meals
• Eat bland foods (foods that are soft, less spicy, and contain less fibre)
• Wait until nausea has improved before consuming iron supplements
• Use a pressure-point wristband, and consume vitamin B6 or ginger, as the doctor recommends

What are the complications of hyperemesis gravidarum?

A pregnant woman experiences hyperemesis gravidarum, which can create complications for the mother and child. The following are the complications:

• Weight loss: It is a common complication. Pregnant women may lose 5% of their total body weight. 
• Kidney issues: The condition may cause kidney problems as it stops performing its normal functions. It results in reduced urine output.
• Electrolyte imbalance: Expectant mothers may experience changes in electorlyte l levels. These include potassium and sodium, are electrolytes that the body needs. However, an imbalance in the levels of these minerals results in dizziness, weakness, and changes in blood pressure. 
• Muscle weakness: Malnutrition, electrolyte imbalance, and the constant need to rest may lead to weakness in the muscle.
• Excessive saliva production: The body may produce saliva in excess. So, when a pregnant woman swallows it, it may result in nausea .

Conclusion

The symptoms of hyperemesis gravidarum disappear after the birth of the child. Treating this condition during pregnancy can lower the risk of complications for the woman and the baby. Women can deal with hyperemesis gravidarum by consulting the doctor .

Frequently Asked Questions (FAQs)

1.Is hyperemesis gravidarum fatal?

Hyperemesis gravidarum is not fatal since it does not threaten the life of the woman or the baby.

2.How is hyperemesis gravidarum diagnosed?

The doctor will discuss the woman’s symptoms, evaluate their medical history and conduct a physical exam. Additionally, the doctor can ask for specific lab tests to make a diagnosis.

3. Can hyperemesis gravidarum go away on its own?

Generally, hyperemesis gravidarum affects women during the first trimester of their pregnancy.