Hyperemesis gravidarum – Causes, Risk factors, Symptoms, Diagnosis, Treatment, Prevention

(morning sickness; persistent vomiting during pregnancy; HG)

What is Hyperemesis gravidarum

Hyperemesis gravidarum (HG) is a rare condition characterized by intense, persistent and frequent vomiting and nausea during pregnancy. As a result, women can not ingest an adequate amount of food and fluids, which causes a decrease of more than 5% of body weight prior to pregnancy. They become dehydrated and suffer deficiencies of vitamins and minerals. The treatment may require hospitalization.

HG is a severe form of nausea and vomiting during pregnancy, it is also called morning sickness. Morning discomfort affects between 50 and 90% of pregnant women. It is estimated that HG occurs between 0.5 and 2% of pregnancies.

Hyperemesis gravidarum Causes 

There are many theories about the causes of HG, but none was confirmed. HG is a complex disease that is probably caused by several factors. Some of these include:

  1. Vitamin B deficiency
  2. Human chorionic gonadotropin (hyperemesis is more severe during periods of high concentrations of HCG)
  3. Hyperthyroid (may be a result of high concentrations of chorionic gonadotropin)
  4. Endocrine imbalances (high levels of estrogen)
  5. Multiple pregnancy (two fetuses or more)
  6. Changes in the sensitivity of the nausea control center located in the brain during pregnancy

Hyperemesis gravidarum Risk factors 

A risk factor is something that increases your chance of getting a disease or condition.

Some researchers found that the following factors increase the likelihood of developing GH. If you have any of these risk factors, tell the doctor:

  • History of HG in previous pregnancies
  • Mother or sister who suffered HG
  • Multiple pregnancy
  • Young maternal age
  • Not having lived previous pregnancies that came to term
  • First-time pregnancy
  • Obesity

Hyperemesis gravidarum Symptoms 

The symptoms indicated below are general and may be caused by other conditions of lesser severity. However, if you experience any of them, consult your doctor. Symptoms may include:

  1. Severe and persistent vomiting, which begins between weeks 4 and 6, reaches its peak between weeks 9 and 13 and, usually, improves and ends between weeks 14 and 20
  2. Progressive weight loss greater than 5% of body weight prior to pregnancy

Dehydration, which can lead to the following signs:

  • Ketones in the urine
  • Increased hematocrit (percentage of red blood cells in the blood)
  • Increase in pulse
  • Reduced blood pressure
  • Rapid heartbeat (tachycardia)
  • Excessive salivation (ptyalism)
  • Breath of distinctive smell (ketone smell)

Hyperemesis gravidarum Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

  • Weight measurement: to determine if you lost weight
  • Electrolytes in blood: to identify alterations in blood concentrations of salts or other minerals due to vomiting
  • Ketone: to determine if there is dehydration
  • General condition: assessment of the ability to perform daily activities, and psychological state

Hyperemesis gravidarum Treatment

If the symptoms of HG are treated early in pregnancy, it is possible that the vomiting slows down later and that it takes less time to recover. Since HG is caused by many factors that vary for each woman, it is difficult to find a treatment that works in all cases. Ask your doctor about the best treatment plan for you. Treatment options include:

Diet of Hyperemesis gravidarum

Several small meals, with dry or soft foods and high in protein.

Anti-nausea drugs for Hyperemesis gravidarum

Reducing nausea to allow better nutrition and hydration speeds recovery. Because of the risk of declaring that a drug can be used safely during pregnancy, very few pharmaceutical manufacturers claim that their medications are used to treat a condition such as HG (eg, promethazine or prochlorperazine). However, doctors often recommend women with HG to take certain anti-nausea medications after an evaluation of the potential benefits and risks. Talk to your doctor about the right medication for you.

A common and risk-free remedy is the supplement of vitamin B6 (pyridoxine). The American College of Obstetricians and Gynecologists recommends starting the first line treatment for nausea and vomiting during pregnancy with pyridoxine, with or without doxylamine. It was discovered that pyridoxine is effective in significantly reducing intense vomiting.

Hydration IV and anti-nausea drugs for 

In emergency visits, HG can be controlled by intravenous administration of fluids and vitamins. In some cases, it can be done without hospitalization. Some women need to receive IV fluids throughout the pregnancy, although this situation is rare.

Nutrition by vein for Hyperemesis gravidarum

If a woman can not keep food ingested by mouth, she may need to be fed by vein. This method is called parenteral nutrition. A special type of catheter is inserted into a large vein and a nutrient fluid is administered through it. In some cases, it can be done without hospitalization. Another option (although not very popular) is enteral feeding, in which nutrients are administered through a probe that goes directly to the intestines.

Alternative therapies for Hyperemesis gravidarum

Acupressure can help reduce nausea. Acupressure involves applying pressure on acupuncture points.

Interruption of pregnancy

In some extreme cases, the option of inducing abortion may be considered.

If you are diagnosed with HG, follow your doctor's instructions.

How to Prevent Hyperemesis gravidarum

Many of the conditions that cause HG can not be prevented, and it is unknown why some women who do not have them develop HG. You can try to reduce nausea during pregnancy as follows:

  1. Avoid odors, foods or other factors that stimulate nausea
  2. Eat meals in small portions and frequently
  3. Avoid feeling very hungry or feeling very full

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