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"When Morning Sickness Won't Go Away"

by Beth Kanter, Medical Writer

Laurie Adler was so sick during her first pregnancy she could not even keep water down. The 37-year-old suburban Maryland writer lost almost 15 pounds off her already-petite 98-pound frame, and the constant vomiting and nausea left her weak, malnourished, and dehydrated to the point where she had to check into the hospital five separate times to be hooked up to intravenous lines. "I didn't even look pregnant until my ninth month," says Adler who gave birth to a healthy son despite her illness. "I was in my natural childbirth classes and the other women glared at me. I just looked at them and thought, 'I wished I looked like you.'"

Adler suffered from hyperemesis gravidarum, a severe nausea and vomiting disorder during pregnancy that hospitalizes about 55,000 US women a year, according to US Department of Health and Human Services records. Unlike "normal" morning sickness, hyperemesis can cause weight loss, dehydration, electrolyte imbalance, neurological disturbance, and, in the worse cases, liver damage and death. Experts still do not know why the condition occurs, although healthcare professionals have moderate success in managing it with diet and medicine. A recent study, however, linked increased saturated fat intake with a higher risk for developing hyperemesis, but most view this as only one small piece in this puzzle. What doctors do know is that most--but not all--patients begin to feel better at 14 weeks and wind up having healthy babies. About 18 months after delivering her son, Adler and her husband decided to have a second child. Told by their physician that they could expect the hyperemesis to reoccur, the couplearranged for at-home nursing care and intravenous therapy.

"We thought we had it all figured out," says Adler, an otherwise-healthy vegetarian. "I thought I could live on an IV for 4 months but it was so much worse than I ever imagined. My chances for survival were very slim, and the chances of my baby surviving were very slim. Damage had already been done to my liver and the rest of my system." They made the difficult choice to terminate the pregnancy. Their case shows how devastating the consequences of hyperemesis gravidarum can be when it takes its most aggressive form.

Estrogen and Saturated Fat

Estrogen and other hormones appear to play a key role in this debilitating condition. Women with hyperemesis test so high for hormone levels that many are at first told they may be carrying twins. Intrigued by the high estrogen levels, epidemiologist Lisa Signorello conducted a study in an effort to isolate a nutritional factor that could trigger higher hormonal levels and thereby increase the chances for developing the disease. What she concluded after examining early and pre-pregnancy diets was that for each additional 15 grams of saturated fat consumed--about the equivalent of a quarter-pound cheeseburger--the risk of being hospitalized for hyperemesis rose significantly. A woman who typically eats 30 grams of saturated fat a day is five times more likely to develop the vomiting disorder than someone who eats 15 grams of saturated fat a day, according to Signorello's findings published in the November 1998 issue of Epidemiology. "Women who eat saturated fat make more estrogen," explains Signorello of the International Epidemiology Institute, adding that the condition rarely is studied. While Signorello calls her findings strong, her conclusions don't explain why all women develop hyperemesis. "[Eating less saturated fat] is not a bad thing to do, but it is hard to say that this is going to work for everyone," says Miriam Erick, author of No More Morning Sickness and a registered dietician at Boston's Brigham and Women's Hospital who specializes in treating hyperemesis. "I've seen women sick as dogs who are athletes and don't eat any fat."

Eat What You Can

Erick first recommends that women try to eat whatever they can, regardless of its nutritional value, during their better moments. For most this means a
bland diet, but she says sometimes she sees women who can only digest Doritos and candy bars. "There is not one food that works for everyone," says Erick, who often consults with her patients as they hunch over a wastepaper basket. "Some people are only able to eat cornstarch and flour, which is really just carbohydrates with no smell or taste. You have to go with someone's taste buds, and it changes all the time. But the more picky people are, the more probable that it is going to work." Women should try to eat whatever they can, regardless of its nutritional value.

Foods that she has found help break the vomiting cycle include raspberry tea, lemon drops, potato chips, bee's honey, and ginger ale made with real ginger. "I tell women to go with every craving," says Dr. Mari-Kim Bunnell, an obstetrics, gynecology, and reproductive biology instructor at Harvard Medical School. "These patients don't gain weight but their babies grow like weeds. It is very rare to see a weight- restricted baby of a hyperemetic woman. The baby needs very little."

In addition to following hunger impulses, a sufferer can also alter the environment and get some relief that way. When Erick admits patients she turns off all the lights and tries to prevent food, perfume, and other odors from entering the room. She believes that eliminating stress factors also can help relax the woman's gastrointestinal track. "If you are under stress the vomiting is going to get worse," says Dr. John Larsen, chairman of maternal fetal medicine at George Washington University. "That may mean cutting off well-meaning loved ones from hovering around."

Drug Treatments

Replenishing fluids and controlling diet and environment often are not enough. Several drugs can be administered to help the patient maintain hydration and baseline nutrition on her own. Dr. Bunnell often has success prescribing prochlorperazine (Compazine), diphenhydramine (Benadryl), and ondansetron (Zofran), an expensive but effective drug used with chemotherapy patients. She also recommends doxylamine/pyridoxine (Bendectin,) an antiemetic no longer available in the United States but still widely used in Canada and Europe. "I do tell patients that it does get worse with each pregnancy," Dr. Bunnell says. "And you have a smelly, poopy baby to take care of."

Laurie Adler certainly found this to be true, as do many other women who have gotten pregnant after experiencing hyperemesis. Whitney Price, a high-risk obstetrical nurse from Tulsa, Oklahoma, had to be hospitalized for 4 days on her own floor during her second viable pregnancy. (Between giving birth to two healthy babies, she had one pregnancy with no nausea that spontaneously aborted at 6 weeks.) "Right off the bat I was nauseous, which I was so glad to have at first but then it progressed," remembers Price. "It was my son's first birthday, and I really tried to make it through the day. I remember lying on the couch trying to put my son's tricycle together, and I couldn't get up. It was such a miserable, miserable experience. I'd be throwing up and my son would come in and pat my head and say 'Poor Mommy, poor Mommy.' He still remembers how sick I was."

© 2000 by Medscape Inc. All rights reserved.

Beth Kanter is a writer based in Washington, DC. Her work has appeared in the Chicago Tribune, the Washington Business Forward, the Illinois Times, the New York Jewish Week and the Washington Jewish Week.

Reviewed for medical accuracy by physicians at Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School. We do not endorse any products or services advertised on this web site.

Updated on: Apr. 18, 2013

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