Hyperemesis gravidarum is a serious and debilitating disease. Recently, Duchess Kate brought to light this disease with her pregnancy.
Hyperemesis gravidarum or HG is a condition that typically peaks during the late first trimester. HG is characterized by persistent and excessive nausea, and vomiting that far surpasses the frequency of morning sickness. With both nausea and frequent vomiting, weight loss of more than 5%, dehydration, dizziness, fainting and metabolic imbalances are common, including increases in liver enzymes, increased hematocrit and abnormal thyroid levels. Women with HG often have nutritional deficiencies, altered sense of taste and sensitivity of the brain to motion. Physical and emotional stress of HG is added to the physical/emotional stress of pregnancy. Mullin et al site postpartum implications of PTSD, motion sickness, muscle weakness and infants with irritability, severe colic and growth restriction.
According to the HER Foundation, the Hyperemesis Education and Research Foundation (www.helpher.org), thiamine deficiency has been documented in women with HG and may lead to Wernicke’s Encephalopathy. In the May 2002 issue of Obstetrics and Gynecology, Spruill and Kuller stated that Wernicke’s Encephalopathy can be positively impacted by early thiamine replacement, which may decrease the chances of miscarriage. Women who have had visual loss due to HG induced Wernicke’s Encephalopahy have been treated with thiamine replacement and their vision has been restored.
In May of 2012, the HER Foundation held their first annual Hyperemesis Gravidarum Awareness Day. The purpose of the Day was to further the goals of their organization: finding a cure for HG, helping to develop a universal treatment protocol with proactive components, eradicating maternal/fetal mortality due to HG, and the complications; provide education and support and resources. HER works along side many entities to further research and disseminate information. The University of Southern California has an excellent professional information page titled “Symptomatology and Outcomes of Women with Hyperemesis Gravidarum as Reported in a Large Registry”. To access this pdf, click here. USC also has a pdf titled “Secular Trends in Treatment of HG” – click here to access.
Not only is HG devastating, but so are the statistics. According to www.motherisk.org, NVP or nausea and vomiting during pregnancy afflicts more than 80% of the pregnant woman population with 0.5%- 2.0% of pregnant women having HG. This translates into an estimated 285,000 annual hospital discharges for US women with HG. An estimated 36% of women quit their job due to HG, and only 28% return to the workforce. The cost of an inadequately managed HG woman is estimated at $88,000.
Treatments for HG may include a multitude of therapies including both complementary/alternative therapies and traditional therapies. These therapies may include accupressure, psychological counselling, IV hydration at home or in a hospital setting, Vitamin B-6, Ginger, antiemetics, sea sickness bands. If additional nutritional support is needed, a PICC line (peripherally inserted central catheter used for prolonged therapies) may be used.
|The Duchess of Cambridge|
While doulas and childbirth educators may see expectant mothers after the incident of HG has passed, the psychosocial impact may continue throughout the pregnancy and well into motherhood. Meighan found that women suffering from HG may not benefit from regular prenatal education efforts and so postpartum follow-up by the doula, childbirth educator or a postpartum doula may be needed. However, in our classes or in prenatal meetings with clients, mentioning HG might be an opening for helping with postpartum issues or even helping friends/relatives of that woman who may encounter HG. Spreading evidence-based education plays a vital role in dealing with HG.
Chitra & Lath. Wernicke’s Encephalopathy with visual loss in a patient with Hyperemesis Gravidarum. Journal of the Association of Physicians in India. 2012 May; 60:53-6.
Meighan & Wood. The impact of Hyperemesis Gravidarum on Maternal Role Assumption. JOGNN 2005 Mar-April; 34 (2): 172-9.
Mullin, P. M., Ching, C., Schoenberg, F., MacGibbon, K., Romero, R., Goodwin, T. M., & Fejzo, M. Risk factors, treatments, and outcomes associated with prolonged hyperemesis gravidarum. Journal of Maternal-Fetal and Neonatal Medicine. 2012 June 25(6), 632-636.
Spruill & Kuller. Hyperemesis gravidarum complicated by Wernicke’s Encephalopathy. Obstetrics and Gynecology 2002 May: 99 (5 Pt 2): 875