Hyperemesis gravidarum (HG) is a rare condition characterized by frequent, persistent, and severe vomiting and nausea during pregnancy. As a result, women are often unable to take in a sufficient amount of food and fluids, and thus lose more than 5% of their pre-pregnancy body weight. They become dehydrated, and experience vitamin and mineral deficiencies. Treatment may require hospitalization.
HG is a more severe form of nausea and vomiting of pregnancy (NVP), also called morning sickness . Morning sickness affects anywhere between 50% to 90% of pregnant women. HG is estimated to occur in 0.5% to 2% of pregnancies.
There are many theories about the causes of HG, but none have been confirmed. HG is a complex disease that is likely caused by many factors. Some of these include:
A risk factor is something that increases your chance of getting a disease or condition.
Some researchers have found that the following factors increase your chance of developing HR. If you have any of these risk factors, tell your doctor:
The following list of symptoms are general and may be caused by other, less serious health conditions. However, if you experience any one of them, call your physician to discuss your condition. Symptoms may include:
Your doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include the following:
Treating HG symptoms early in pregnancy can make you less sick in the long run and can decrease recovery time. Because HG is caused by many factors that vary between women, it is difficult to find a treatment that works for everyone. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Frequent small meals, bland or dry foods, high-protein choices.
Reducing nausea, and thus allowing eating and drinking, will hasten recovery. Due to the risk of stating that a drug is safe for use during pregnancy, very few pharmaceutical manufacturers will say that their drugs are intended for a pregnancy condition like HG (examples: promethazine or prochlorperazine ). However, physicians often recommend that women with HG take certain anti-nausea medications, balancing the potential benefits and risks. Talk to your doctor about the right medications for you.
A common and safe remedy is to take supplemental vitamin B6 (pyridoxine). The American College of Obstetricians and Gynecologists recommends that first-line treatment of nausea and vomiting of pregnancy should start with pyridoxine with or without doxylamine. Pyridoxine has been found to be effective in significantly reducing severe vomiting.
In urgent visit situations, HG can be managed by giving the woman fluids and vitamins intravenously. This can sometimes be done without hospitalization. Very rarely, some women require IV fluids throughout the entire pregnancy.
If a woman is unable to tolerate food by mouth, she may need to receive nutrition by vein. This is called parenteral nutrition. A special kind of catheter is placed in a large vein and liquid nutrition is given. This can sometimes be done without hospitalization. Enteral feeding —supplying food through a feeding tube into the intestines—is another option (albeit unpopular).
Acupressure may help to reduce nausea. Acupressure is when pressure is applied to acupuncture points.
In extreme cases, induced abortion may be considered.
If you are diagnosed with HG, follow your doctor's instructions .
Many of the conditions that lead to HG are not preventable, and it is unknown why some women without those conditions develop HG. You can try to reduce your nausea during pregnancy by:
RESOURCES:
The American College of Obstetricians and Gynecologists
http://www.acog.org
Dartmouth-Hitchcock Medical Center
http://www.dhmc.org/webpage.cfm
Hyperemesis Education and Research Foundation
http://www.helpher.org
National Organization for Rare Diseases
http://www.rarediseases.org
CANADIAN RESOURCES:
The Canadian Women's Health Network
http://www.cwhn.ca/indexeng.html
The Society of Obstetricians and Gynaecologists of Canada (SOGC)
http://www.sogc.org/index_e.asp
References:
ACOG issues guidance on the treatment of morning sickness during pregnancy. American College of Obstetrics and Gynecology website. Available at: http://www.acog.org/from_home/publications/press_releases/nr03-29-04-1.cfm . Accessed August 11, 2005.
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Burrow GN, Duffy TP, eds. Medical Complications During Pregnancy . 5th ed. Philadelphia, PA: WB Saunders Company; 1999.
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Gastroenterology Clinics of North America . Philadelphia, PA: WB Saunders.
Hyperemesis Education and Research Foundation website. Available at: http://www.helpher.org.
Hyperemesis gravidarum. US National Library of Medicine and the National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001499.htm . Accessed August 6, 2005.
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, eds. Harrison’s Principles of Internal Medicine . 16th ed. New York, NY: McGraw-Hill Companies, Inc; 2005.
Mahan LK, Escott-Stump S, eds. Krause’s Food, Nutrition, and Diet Therapy . 10th ed. Philadelphia, PA: WB Saunders Company; 2000.
National Organization for Rare Diseases website. Available at: http://www.rarediseases.org.
Quinlan JD, Hill DA. Nausea and vomiting of pregnancy. Am Fam Physician . 2003;68:121-128. American Family Physician website. Available at: http://www.aafp.org/afp/20030701/121.html . Accessed August 12, 2005.
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Last reviewed November 2008 by Jeff Andrews, MD, FRCSC, FACOG
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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