Hyperemesis Gravidarum Medical Course
What Is Hyperemesis Gravidarum?
Morning sickness is a common symptom of pregnancy, with 70 to 80 percent of pregnant women experiencing some form of it, according to the American Pregnancy Association (APA).
However, when the sickness is so extreme that it causes severe nausea, vomiting, and weight loss during pregnancy, it may be diagnosed as hyperemesis gravidarum.
Hyperemesis gravidarum usually continues beyond the first trimester and may stop by 21 weeks of pregnancy, but it can last the entire pregnancy in some women who experience the condition, according to the Hyperemesis Education & Research (HER) Foundation.
According to the APA, around 60,000 cases of hyperemesis gravidarum are treated in U.S. hospitals each year. But the number of diagnosed cases could be even higher, since some women may be treated at home or in a doctor's office.
While there is no proven cause of hyperemesis gravidarum, there are new theories that emerge each year.
Possible causes or contributing factors include the following:
- Rising levels of hormones, such as human chorionic gonadotropin (HCG), estrogen, and progesterone early in pregnancy
- Increase in blood thyroxine levels, which has been documented in 70 percent of hyperemesis gravidarum cases, according to the HER Foundation
- A multiple pregnancy (twins, triplets, etc.)
- Abnormal tissue growth in the uterus, called a hydatidiform mole
- Regurgitation of the contents of the duodenum (upper small intestine) back into the stomach
- Abnormalities of peristalsis (the way the gastrointestinal tract moves content along)
- Liver abnormalities
- Abnormalities of fat in the blood
- Inner ear problems
- Infection with Helicobacter pylori, or H. pylori (the organism that causes stomach ulcers)
- Deficiency of the nutrients pyridoxine and zinc
Hyperemesis gravidarum may lead to the following symptoms and conditions:
- Severe nausea and vomiting
- Dizziness, lightheadedness, and fainting
- Increased salivation
- Yellowing of the skin and eyes (jaundice)
- Low blood pressure
- Rapid heart rate
- Overactive thyroid or parathyroid
- Dehydration and production of ketones (sometimes leading to breath that smells "fruity")
- Nutritional deficiencies
- Metabolic imbalances
- Increased sense of smell
- Distorted sense of taste
- Loss of skin elasticity
- Loss of over 5 percent, and usually over 10 percent, of pre-pregnancy body weight
- Difficulty with daily activities
- Psychological issues — many women with hyperemesis gravidarum also experience depression, mood changes, anxiety, or irritability
The following factors may increase your chances of getting hyperemesis gravidarum:
- Having the condition during a previous pregnancy
- Being overweight
- Having a multiple pregnancy
- Being pregnant for the first time
- Having trophoblastic disease (abnormal growth of cells inside the uterus)
- Family history of other women developing the condition
If you have severe symptoms of hyperemesis gravidarum, you may need to be hospitalized. Otherwise, you may be able to seek treatment at home or at a doctor's office.
While the course of treatment for hyperemesis gravidarum varies from person to person, your doctor may recommend one or more of the following:
- Preventive measures, such as vitamin B6, ginger, peppermint, or a pressure-point wristband to help with nausea
- Small, frequent meals that include dry, bland foods such as crackers
- Intravenous fluids to help with dehydration
- For severe cases, total parenteral nutrition, in which an intravenous (IV) solution of nutrients is given as a substitute for food
- Medicine to prevent nausea, such as Phenergan (promethazine), Antivert (meclizine), or Inapsine (droperidol), doxylamine-pyridoxine (Diclegis), or metoclopramide (Reglan) which may be taken orally, by IV, or as a suppository
- Complementary and alternative therapies, such as massage, acupuncture, acupressure, and hypnosis
The main risks to women with hyperemesis gravidarum are dehydration and electrolyte imbalances.
Women with prolonged hyperemesis gravidarum are at greater risk for preterm labor and preeclampsia, according to the HER Foundation.
Long-term complications to the baby may occur if the condition is left untreated, if the mother does not gain sufficient weight during the second half of pregnancy, and if the baby becomes malnourished.
Video: Two genes likely play key role in extreme nausea and vomiting during pregnancy | UCLA Health News
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