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Hyperemesis, Is it All in Your Head?

Until the Duchess of Cambridge suffered from hyperemesis gravidarum in both of her pregnancies, most people had never heard of this potentially life threatening complication of pregnancy.

Statistically, one to three percent of pregnant women are diagnosed with hyperemesis gravidarum. These numbers are believed to be extremely inaccurate, as they only record the women who are hospitalized due to life threatening complications.

Researchers believe that the number is closer to ten percent, taking into consideration the many women who are able to manage with outpatient treatment and prescribed home treatments.

Many people confuse hyperemesis gravidarum with morning sickness. Because of this, hyperemesis sufferers are often accused of exaggerating symptoms. Nothing could be further from the truth.

The co-founder of the Hyperemesis Education and Research Foundation, Jeremy King, had this to say regarding the disease, “Calling HG morning sickness is like calling a hurricane a little rain.”

Hyperemesis gravidarum, or HG, leaves no area of it’s victims lives untouched. It is no respecter of race, religion, or economic status. Every year, HG takes the lives of thousands of women and their unborn children. We owe it to them to learn more.

10 How Do I know It’s Hyperemesis?

At first, it may be hard to tell the difference between common morning sickness and hyperemesis, especially in first time mothers. The difference between morning sickness and hyperemesis lies in the duration and severity of the nausea and vomiting.

While morning sickness usually ends after the first trimester, hyperemesis gravidarum can last beyond the first trimester, well into the pregnancy or for the entire duration of the pregnancy.

Hyperemesis is debilitating, where as morning sickness is more of an inconvenience than anything. Hyperemesis sufferers can vomit violently almost non stop throughout the day, exhausting themselves and leaving them unable to work or complete the most basic activities of daily life.

Because morning sickness is a common complaint in early pregnancy, many of the initial complaints of relentless nausea and violent vomiting go ignored by those close to the victim and her healthcare provider alike. 

9 Signs and Symptoms

The signs and symptoms of hyperemesis gravidarum can begin as early as implantation occurs. Food aversions, nausea, and vomiting become evident at four to six weeks gestation. The illness hits full force between nine and thirteen weeks gestation.

Most women see improvement in their conditions by 14 - 21 weeks. Ten to twenty percent remain severely ill for their entire pregnancy and generally require inpatient or outpatient hospital care.

Some of the symptoms of hyperemesis gravidarum are:

  • body odor, from metabolic issues
  • dehydration
  • anemia
  • dizziness
  • confusion
  • fainting
  • rapid heart rate
  • jaundice or pale waxy skin
  • scanty urine output
  • vomiting bile,blood, or mucous
  • low blood pressure
  • super sensitive gag reflex
  • headache
  • visual disturbances
  • loss of 5% of total prepregnancy body weight
  • depression and anxiety

8 Diagnosis

There are quite a few conditions that a health care provider must first rule out that can mimic hyperemesis before a diagnosis can be made. Here are some things that your healthcare provider will check for before a diagnosis of hyperemesis gravidarum is made:

  • bacterial infection
  • asthma
  • separation of the placenta from its normal location
  • appendicitis
  • ovarian tumor or cyst
  • adrenal issues
  • bowel obstruction
  • digestive issues
  • preeclampsia
  • UTI
  • peptic ulcer
  • pancreatitis
  • influenza
  • migraine
  • IBS
  • Crohn’s disease
  • excessive amniotic fluid

By the time an accurate diagnosis is made, most women and their unborn babies have already been compromised by the symptoms of hyperemesis.

7 Are Certain People More Likely to Suffer from Hyperemesis?

Research has shown that the majority of women who suffer from hyperemesis have one or more of these factors in common:

  • women who have had hyperemesis in previous pregnancies
  • women who are non white
  • women who have a sister or mother who suffered from hyperemesis
  • women carrying multiples
  • women carrying a female baby
  • women who suffer from pregestational diabetes, migraines ,hyperthyroidism, digestive issues, and motion sickness
  • women carrying a baby with excessive fluid on one or more body areas (hydrops fetalis), Trisomy 21, or a current or previous molar pregnancy
  • first time mothers

Having one or more of these risk factors doesn’t guarantee that you will suffer from hyperemesis gravidarum, it simply means that you are more prone to the disorder. Early prenatal care can drastically affect the overall outcome of your pregnancy.

Hyperemesis is a very serious complication, but with proper medical care, the majority of mothers and babies have a positive outcome. 

6 Causes

Finding an exact cause for hyperemesis gravidarum is difficult due to difference in the overall health, body chemistry, and genetics of sufferers. Most researchers support the idea that the disorder is caused by a combination of factors vs. just one thing.

Narrowing down the exact cause of hyperemesis is further exacerbated by the fact that it is extremely hard to measure how sick a woman is until she shows signs of dehydration, malnutrition, or has a certain percentage of weight loss. At this point, there are complications involved that make HG harder to treat.

Initially, hyperemesis was believed to be caused by ulcerations, or infection. It was also theorized that a dysfunction in the reproductive system was to blame.

By the 20th century, a psychological link was explored. There is absolutely no evidence to support a causal relationship between hyperemesis and a psychiatric disorder. Unfortunately for the 60,000 plus women who suffer from hyperemesis annually, this mindset is prevalent today, even in medical textbooks. This causes a delay in diagnosis and treatment, costing many mothers and babies irreparable damage or their lives.

Because funding for hyperemesis research is extremely limited, modern researchers have made very little progress in finding the exact cause of hyperemesis gravidarum. Researchers have several theories that show promise, but have been unable to arrive at a concrete cause.

A few of the modern theories revolve around the body’s response to the normal changes of pregnancy, such as hormonal and physical changes.

Finding a cause for hyperemesis will save the lives of thousands of mothers and babies each year. One way to combat the lack of funding that has hindered hyperemesis research, is to bring awareness to the disorder and educate women and the general public about this life threatening complication.

5 How is Hyperemesis Gravidarum Treated?

After thorough testing, you and your healthcare provider will be able to map out a plan of treatment that will ensure the best outcome for you and your baby.Hyperemesis is a very real physiological problem and needs to be addressed as such.

The outdated theory that hyperemesis is “all in your head”, has delayed treatment for millions of women over the years. When treatment is delayed, there are more issues for the mother and baby, not to mention the additional medical costs that come with allowing hyperemesis to go unchecked.

Some women have gone so far as to terminate a pregnancy to end their struggle with hyperemesis gravidarum. This is a senseless tragedy, as hyperemesis rarely reaches the most severe stages with aggressive, early treatment.

Because the exact cause of hyperemesis has yet to be determined, there is no one method of treatment that works for all women. Because of this, healthcare providers have to treat patients on a trial and error basis, often trying a variety of things before treatment is successful.

4 IV Fluids and Rest

IV fluids and rest are some of the most basic and successful treatments to combat dehydration and malnutrition. The IV fluids generally contain vitamins to boost nutrition levels and combat the complications that can arise from extreme dehydration. Fluids can be given in the emergency room, or in an outpatient setting.

While IV fluids provide some relief from the symptoms of HG, the results don’t usually last. Most women find themselves back where they started just days later due to the return of violent vomiting. The best solution is to have the patient receive at home IV fluids. This is the best way to put an end to the dehydration cycle that increases the severity of the disorder.

Complementary Treatments

Additional treatment for hyperemesis may be warranted. Healthcare providers generally combine IV therapy with one or more of these treatments:

  • prescription medicines ( anti vomiting )
  • alternative medicine, used along with traditional medicine
  • nutritional therapy such as, IV fluids or a feeding tube
  • behavioral treatment, used in mild cases
  • bed rest
  • psychotherapy to treat anxiety and/or depression
  • sensory deprivation therapy (isolating the mother from all outside stimulation, this has been proven to increase the likelihood of depression and/or anxiety)
  • treatment to address specific symptoms common to hyperemesis sufferers

3 Complications for the Mother

The complications of hyperemesis vary with the duration and severity of the disease. Ideally, hyperemesis should have run it’s course by 21 weeks gestation. For mothers who deal with hyperemesis for a longer period of time, the complications are more severe and last longer. Some women have permanent issues due to their battle with HG.

The complications of mild hyperemesis can be numerous and extremely debilitating. Here is a listing of some of the complications that may accompany a mild case of hyperemesis:

  • constipation
  • fatigue that makes it impossible to perform basic daily activities
  • wasting or loss of muscle tissue due to inactivity or underuse
  • ulcers or stomach irritation
  • depression and/or anxiety
  • difficulty sleeping
  • heartburn and acid reflux

Early intervention can help minimize the severity of these complications. The difficulty lies in the fact that many healthcare providers fail to recognize hyperemesis gravidarum until it has reached its advanced stages and becomes harder to treat.

The complications of severe hyperemesis can include any or all of the complications of mild hyperemesis, in addition to the following:

  • loss of the kidney’s ability to eliminate wastes, make urine, and conserve electrolytes
  • bleeding in the throat
  • damage to the heart muscle
  • bleeding in the retinas of the eyes
  • injury or pain in the jaw
  • complete exhaustion
  • neurological difficulties
  • jaundice
  • PTSD due to the trauma of the illness

The effects of these complications can be long term or even fatal. Early diagnosis and treatment can help minimize the severity of the effects of these complications.

2 Complications for Babies

Data regarding the effects of hyperemesis on babies born to mothers who suffer with the disorder is very rare. To date, there are no studies concerning the long term effects of hyperemesis on babies.

The severity of the mother’s symptoms, timing of treatment, and the effectiveness of the treatment given all play a part in determining the severity of the complications found in infants.

Women who are diagnosed with HG after they become malnourished generally have babies with complications of some kind. Again, early diagnosis and treatment by healthcare providers could prevent many of the complications in mothers and, as a result, babies.

Some of the complications for babies born to mothers suffering from hyperemesis are:

  • premature birth
  • nervous system issues
  • emotional and behavioral issues
  • skin issues
  • low birth weight
  • shorter stature than other babies
  • neural tube defects
  • hip dysplasia
  • undescended testicles or testicular cancer
  • congenital heart disease
  • large for age infant
  • death

Support

Hyperemesis gravidarum has far reaching effects in the lives of the women and their families that are impacted by this disorder. The physical, emotional, and financial stress on families can be overwhelming.

Families have to adapt to a “new normal” and need support to be able to cope with this transition.There may be a need to hire temporary childcare, or a cleaning service to help things run smoothly.

Family and friends can offer support in the form of child care, meal preparation, and other household chores. Just offering a listening ear can help tremendously.

Parents need to be sensitive to the needs of other children in the household who may be worried or afraid at the changes that are taking place.

Many families benefit from professional counseling from clergy or a licensed professional to help them cope with the changes that have taken place. It’s never easy to see a loved one suffering for an extended period of time, and your entire family may need some help sorting out your emotions.

Depression and/or anxiety is very common among women with hyperemesis. Hyperemesis is an isolating disorder, and a woman can feel alone and misunderstood. The mental health of the mother is just as important as her physical health. If depression and/or anxiety becomes an issue, please seek professional help.

1 Future Pregnancies

One of the biggest questions hyperemesis survivors ask is, “ Should I even try to get pregnant again?”

For many survivors, the physical and emotional toll of hyperemesis gravidarum makes considering another pregnancy out of the question. For others, the desire to have more children outweighs the risks and fear of another bout of hyperemesis.

Chances are, that if you have severe HG with one or more pregnancies, you will have it again. The risk of recurrence is increased if you have a mother or sister that suffered from hyperemesis.

You have to decide if you and your family are able to go through the stress and physical complications that come with hyperemesis. It is important that you consult your healthcare provider before trying to conceive, especially if you have long term effects from your previous bout with hyperemesis.

It is important to go into any pregnancy mentally and physically ready for the task at hand. This goes double for a mother who, most likely, will be facing hyperemesis gravidarum and all of the issues that go with it.

Your healthcare provider can give you an idea of what to expect as far as the protocol he or she will follow with a new pregnancy. The good news is, that once you have been diagnosed with hyperemesis, healthcare providers are more likely to act quickly if signs and symptoms of the disorder begin to appear.

Deciding not to conceive again doesn’t mean that you will never have the experience of welcoming more children into your family. Many families who have endured hyperemesis opt to adopt when it comes time to expand their families.

Hyperemesis gravidarum is a potentially life threatening complication of pregnancy that can affect both mothers and babies. Early diagnosis and treatment can not be stressed enough. If you are concerned that you may have hyperemesis and feel that your healthcare provider isn’t taking your concerns seriously, get a second opinion. Remember, you are your own best advocate. 

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