Monday, May 16, 2016

HG Awareness Day ~ May 15....and every day!

Hyperemesis Gravidarum Awareness Day was Sunday May 15.  
However, it should be EVERY day!

In 1979, a young twenty-three year old was expecting her first child.  During her first trimester, she experienced the typical morning sickness.  At the cusp between second and third trimester, this young woman developed severe nausea and vomiting.  The severity was overwhelming to the point that she had to bring a “barf bag” with her wherever she went.  When she (a med-surg nurse) brought it to her obstetrician’s attention, he turned a blind eye, said hyperemesis gravidarum didn’t really exist, it was all in her head and handed her “water pills” to relieve the pitting edema in her calves, ankles and feet.  Fortunately, this young woman gave birth vaginally and had a healthy baby girl.  However, on the day of discharge from the hospital, her obstetrician told her that she would not be able to breastfeed because the water pills had dried up all of her milk.

According to Medscape, hyperemesis gravidarum (HG) is the most severe form of nausea and vomiting in pregnancy, characterized by persistent nausea and vomiting associated with ketosis, dehydration and weight loss (>5% of prepregnancy weight). This condition may cause volume depletion, electrolytes and acid-base imbalances, nutritional deficiencies, and even death. Severe hyperemesis requiring hospital admission occurs in 0.3-2% of pregnancies.

The HER Foundation (Hyperemesis Education & Research Foundation: is a non-profit organization that has been dedicated to HG support, education, research and advocacy since 2003.  The HER Foundation says there is no clear etiology for HG and it could even be due to multiple causes. When first recognized several centuries ago, HG was thought to be caused by toxins, ulcerations or an infection.  In the 20th century it was decided that HG was a psychological condition.  Today, lab tests can be done to confirm hyperemesis gravidarum.  These tests include urinalysis for ketones and specific gravity, serum levels of electrolytes and ketones, TSH and free T, and hematocrit levels to name a few. 

The only FDA approved drug for treating nausea and vomiting in pregnancy is pyridoxine or Vitamin B6.  Herbals such as ginger may also be helpful, but not in all cases.  In severe cases, antiemetics, corticosteroids or antihistamines may also be used.  Nutritional supplementations either by IV or directly into the GI system may help with nutritional deficiencies.

There are several handouts available from the HER Foundation and the University of Southern California:

Remember that young nurse from 1979?  She went on to become a childbirth educator so that other mothers could be aware of HG.  She also successfully breastfed her first baby, thanks to the local La Leche League.  That young woman was me. 

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