About Hyperemesis Gravidarum
 Pregnant
for the first time, Anne Marie King of Dallas assumed
that getting sick every time she ate or drank was normal: "When
I was five weeks along, I started vomiting several
times an hour around the clock. I couldn't even keep
down water."
After a week of this, her husband insisted she go
to the hospital. Dehydrated and weak, King received
intravenous fluids there. Her doctor sent her home
with a prescription for anti-nausea medication, but
she vomited up the pill. By the end of her first trimester,
King had made several trips to the hospital for IV
hydration and had lost 20 pounds. At that point, her
doctor placed a feeding tube directly into her stomach
so she could get nourishment.
For the next four months, King spent most of her time
at home in bed, where her husband and a nurse took
turns tending the feeding tube and giving her injections
of powerful anti-nausea drugs every four hours. In
her final trimester, her nausea eased enough that she
could choke down an occasional bite of food, but it
didn't lift completely until she gave birth. Her relief
was immediate. "The minute my son popped out,
I begged for a bottle of water," King recalls. "I
drank a mouthful and started crying for pure joy."
Although 50 to 80 percent of pregnant women experience
some degree of morning sickness, a tiny minority endure
the rare extreme variation known as hyperemesis gravidarum,
or HG. Because it affects only 1 to 2 percent of all
pregnant women, this intense nausea and vomiting is
not widely studied. In fact, women suffering from HG
are still sometimes told it's all in their head! However,
it is real and it is serious. With the right help,
you can get through it and have a healthy baby.
The Mystery of HG
Morning sickness probably developed millions of years
ago as nature's way of preventing women from eating
toxic substances that might harm the developing fetus.
We don't know what causes HG, says T. Murphy Goodwin,
MD, chief of maternal-fetal medicine at the University
of Southern California in Los Angeles, but basically
it's the biological reflex in overdrive: The placenta
produces such high levels of nausea-inducing hormones
that they overwhelm a woman.
Doctors do know that the condition runs in families.
You may also be prone to HG if: you're carrying multiples,
you have a history of gallstones or inner ear problems,
birth control pills containing estrogen make you queasy,
or you're prone to motion sickness. What's more, Dr.
Goodwin adds, if you've had HG once, your chances of
suffering from it during a subsequent pregnancy are
two out of three.
Environmental factors may also play a significant
role. All pregnant women are more sensitive to smells,
but many women with HG say their noses start working
overtime; they get sick from a whiff of laundry detergent,
a once-favorite food, or even a family member's natural
scent.
A Body Under Siege
HG shows up dramatically and without warning, usually
in the second month of pregnancy, but sometimes much
sooner. On average, it lasts into the fourth month,
but some women, like King, suffer almost from the day
they conceive to the day they deliver, says Miriam
Erick, RD, author of Managing Morning Sickness (Bull
Publishing, 2004).
Unless women end up in the hospital with severe dehydration,
they often aren't diagnosed until a prenatal appointment
reveals they're losing weight, Erick says. Even then,
some doctors may first try treating women for thyroid
problems or a stomach virus.
Because most women with HG have never been pregnant
before, they may have no idea that they're experiencing
anything other than ordinary morning sickness — but
throwing up all day, every day, for weeks at a time
is not normal.
Getting a Handle
Experts agree it's critical to treat the symptoms
before they spin out of control. That means not waiting
until you're so sick you can barely walk. If you are
vomiting more than a few times a day, note as best
as you can every bit of liquid you do keep down. If
it doesn't add up to 10 cups every 24 hours, Erick
says, hurry to the ER, because you're at risk of dehydration.
Other danger signs include constant rather than occasional
nausea; weight loss, especially more than two pounds
a week or more than 5 percent of your prepregnancy
weight; and vomiting blood or bile. If you have any
of these symptoms, tell your ob-gyn immediately.
Your doctor will probably start treatment by administering
IV fluids and vitamins to rehydrate you. You might
need this treatment regularly. Next, he may recommend
you take vitamin B6 with over-the-counter Unisom sleep
tablets, a combination that has a stomach-soothing
effect. If this doesn't get your nausea under control,
the next step is a prescription anti-nausea medication
such as Zofran or Phenergan. Although these powerful
drugs are most often given to chemotherapy patients,
they've also been prescribed for HG for 20 years and
are proven both safe and effective. Women who get no
relief from anti-nausea drugs can try corticosteroids,
but only after 10 weeks of pregnancy.
"After I started taking Zofran, I still got sick,
but it was only five or six times a day, not 20 or
30," says Erika Martin of Seattle. "I
was miserable, but at least I could get through the
day."
The foods you can tolerate may change from day to day,
or even from hour to hour. Kimber MacGibbon, director
of the nonprofit Hyperemesis Education & Research
Foundation, vividly describes being unable to eat anything
but watermelon and cantaloupe, then suddenly finding
them repulsive. Don't worry about a balanced diet,
says Erick. Get any nutrition possible into your body. "Potato
chips, lemons -- anything is better than nothing," she
says.
In extreme cases, a woman with HG may be so ill that
only IV fluids and a feeding tube keep her from literally
starving to death as her body directs all available
nutrients to the developing fetus. Your body is designed
to feed your growing baby first and will begin to break
itself down in order to provide the nutrients needed.
But getting assistance early is important to help you
avoid permanently damaging your own health. The happy
mystery of HG is that, for all the suffering it causes
women, they deliver healthy babies.
Fawn Fitter is a writer in San
Francisco.
Originally published in American
Baby magazine, May 2004.
© Copyright 2004, Meredith Corporation, All Rights Reserved
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