Hyper means Excessive, Emesis means Vomiting, and Gravidarum means Pregnancy. Therefor hyperemesis gravidarum means severe nausea and vomiting that occurs in pregnancy. A less severe state is simply refered to as ‘Morning sickness’ and it is very common with only a few women being able to say they have gone through an entire pregnancy without ever experiencing it, and even that is debatable.
There has been a lot of research into this topic and some factors have been observed to predispose to hyperemesis gravidarum such as: a prior history of nausea or vomiting from motion sickness,migraines, certain smells or tastes, exposure to oestrogens (eg from use of birth control pills) before pregnancy; history of morning sickness in prior pregnancies, multiple pregnancies (like twins or triplets or more), being pregnant with a girl, or a family history of hyperemesis gravidarum. But it can essentially affect any pregnant woman at any moment during her pregnancy.
Morning sickness commonly occurs in the first 3 months of pregnancy when the pregnancy hormone hcG is highest but can occur at any stage of pregnancy (can even commence as early as 2 weeks after conception). After this time, both incidence and severity usually decreases due to a concurrent fall in the hCG hormonal levels. In fact, the only other times that it doesn’t fall is taken to signal multiple pregnancy (such as twins) or a molar pregnancy (an example of a gestational trophoblastic disease). However other diseases in pregnancy can have features including hyperemesis such as liver and thyroid diseases.
Otherwise, mild to moderate morning sickness can be managed by eating small snacks regularly, increased fluid intake and vitamin B6 supplements.
Women suffering from severe morning sickness or hyperemesis gravidarum often need medication and or hospitalization to prevent and or treat life-threatening dehydration and electrolyte derangements of the mother that could also cause harm to the unborn child sheltering in the womb.
Management
Any case of hyperemesis must be taken seriously as it can be potentially fatal for both mother and child in very severe cases. Other complications include dehydration, kidney failure, poor weight gain or weight loss, electrolyte derangement, and even tearing of the oesophagus of the mother from frequent and severe vomiting. In the baby, it is a reasonable cause of low birth weight babies which challenges the survival of such babies as they are born.
Morning sickness is typically diagnosed based on your signs and symptoms in a regular antenatal clinic. But if hyperemesis gravidarum is suspected, there may be need for some urine and blood tests to assess for vital organ function. An ultrasound scan of the gravid uterus and its surroundings is indispensable and must be done to confirm the number of foetuses, viability of the pregnancy, rule out dangerous chorionic diseases of gestation (which can later become aggressive cancers if care is not taken) and detect any underlying conditions that may be contributing to the nausea.
Treatment
If morning sickness symptoms persist, the doctor may prescribe vitamin B6 (such as our common Navidoxine) supplements, antihistamines and possibly anti-nausea medications.
If it is severe morning sickness, the doctor might want to add extra medication such as doxylamine (which causes drowsiness so please do not drive or operate machinery) to the B6 to treat it.
If it happens to be hyperemesis gravidarum, it may be necessary to admit in a hospital for intensive but careful treatment with intravenous (IV) fluids and anti-nausea medications. If there is an underlying cause such as a molar pregnancy (next week’s topic), management must be aggressive and thorough to prevent a sad tale only months after the pregnancy is over.
In the home, morning sickness can be helped by:
1. Choose foods carefully. Select foods that are high in carbohydrates or protein, low in fat, and easy to digest. Salty foods are sometimes helpful, as are foods that contain a little ginger. However avoid hot, spicy and greasy foods that can encourage reflux (another very common phenomenon of pregnancy).
2. Snack often. Before getting out of bed in the morning, eat a few dry crackers (like cabin biscuit) or a piece of dry toast. Nibble throughout the day, rather than eating three larger meals. An empty stomach usually makes nausea worse.
3. Drink plenty of fluids. Sip water or ginger ale. It may also help to suck on hard candy or ice chips. Some women like natural ‘Zobo’ ice pops.
4. Pay attention to nausea triggers. Avoid foods or smells that seem to make your nausea worse.
5. Breathe fresh air. Weather permitting, open the windows in your home or workplace. Make it a personal achievement to take daily walks outdoors throughout pregnancy.
6. Take care with prenatal vitamins. If you feel queasy after taking prenatal vitamins, take the vitamins at night or with a snack. It may also help to chew gum or suck on hard candy after taking your prenatal vitamin. If these steps don’t help, ask your antenatal clinic about other ways you can get the iron and vitamins you need during pregnancy. If you can get your hands on them, prenatal vitamins now come in gummy flavours and that would be worth trying I tell you.
As for the prevention of morning sickness, no studies have proven of significant benefit. However, earlier studies with prenatal vitamins like folate showed better health of both mother and baby, especially as to relating to decreasing the incidence of spinal problems like spinal bifida in the unborn child.
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