Hyperemesis gravidarum: your questions answered

What if your morning sickness was so severe it had you vomiting 30 times a day, caused internal bleeding, and made you drop two dress sizes? That’s the reality for Kate Middleton, and thousands of other mums-to-be suffering from hyperemesis gravidarum. We asked Dr Sebastian Winckler from online doctor service DrEd some questions about the condition.

1. What is hyperemesis gravidarum and what causes it?

Hyperemesis gravidarum (HG) is very severe nausea and vomiting that affects around 9,000 pregnancies per year. It’s caused by excess production of chronic gonadotrophin (hCG) – a hormone produced by your body to help your uterus to support a baby during pregnancy.

2. When does it happen?

HG usually starts at around 4-7 weeks and then eases off at 14-16 weeks, but some women experience it throughout pregnancy.

3. How can I tell it’s hyperemesis gravidarum and not just ordinary morning sickness?

70-85% of women will experience morning sickness – it’s actually a sign of a healthy pregnancy. But if your symptoms are particularly severe and impact on day-to-day life, it may be HG.

4. Dr, what are the general signs of HG?

Severe food aversions or feel nauseated at the slightest things (like an open window or watching TV).

Vomiting several times a day, or being unable to eat or drink anything without vomiting.

Nausea and vomiting that has extended well beyond the first 12 weeks of pregnancy. Losing, rather than gaining weight.

Light-headedness or fainting, headaches, confusion, severe fatigue, infrequent urination or jaundice.

Vomiting that has led to gastric ulcers and bleeding of the oesophagus.

5. Will it harm the baby?

No, if treated properly, HG is unlikely to cause any lasting damage to your baby. If you’re losing a lot of weight, there’s a chance (but only a chance) that your baby may be born with a low birth weight, but this isn’t really anything to worry about.

6. Who is most at risk?

You’re more likely to suffer from HG if:

You are pregnant with twins or triplets.

Your mother or sister has had the condition.

You’re pregnant with a girl.

You’ve had HG in an earlier pregnancy.

You have a history of motion sickness or migraines.

7. How do I treat it?

Early action is key; if symptoms are left to progress for too long, then treatment can get tricky.

Talk to your doctor or midwife: They can advise on a proper pregnancy diet for severe morning sickness and can prescribe medication. Some doctors and midwives may be dismissive of your condition so keep a record of your symptoms and the number of times you have vomited so you have something concrete to tell them.

Multivitamins: Taking a multivitamin shortly after conception has been known to prevent morning sickness. Taking Vitamin B6 or Vitamin B6 plus doxylamine (an antihistamine) throughout pregnancy is also effective, and perfectly safe for the baby.

Acupressure: There is a pressure point on your body that relieves nausea. Pressing here firmly for about three minutes on each wrist can ease symptoms. Locate your pressure point.

Herbal remedies: Peppermint and ginger can provide relief to milder cases.

Diet: Eat small, frequent meals that are high in carbohydrate and low in fat. Avoid any foods or smells that trigger symptoms.

Hospitalisation: With an IV to restore hydration, electrolytes, vitamins and nutrients. This is only in very severe cases at the discretion of your doctor.

8. Can I work through it?

It depends on how severe your symptoms are. It’s definitely possible to work through milder cases.

Tips for work:

Speak to your boss: First and foremost you should make your boss aware of what you’re going through – in order for you to continue working with HG, your boss may need to be a little flexible regarding some issues.

Carry something to eat at all times: this can be crackers, bananas or whatever you’re able to keep down. You’re likely to feel nauseated most of the time with a few, short windows where you feel hungry. Eating during this time is essential.

Suck on ice: Try sucking on frozen fruit-juice cubes, or sip on a bottle of half frozen water.

Keep a vomit survival kit: Including a sick bag, wipes, tissues and a bottle of water for rinsing your mouth afterwards.

Try to avoid anything that triggers nausea: Keep a record of your triggers and see if you can come to some sort of arrangement with your boss. Perhaps switching desks so that you’re further away from the staff room or closer to an open window for instance.

Work from home: This way you can be in complete control of your working environment. However, some women complain say that the isolation of being home alone intensifies their symptoms.

*Sebastian Winckler is a DrEd Doctor. For more information, visit DrEd.  

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