Tuesday, December 4, 2012

What Is Hyperemesis Gravidarum ?

HG is no picnic   (picture:  i-am-pregnant.com )

      Thrust into the news once again, is the medical issue Hyperemesis Gravidarum.   Newspapers and the internet have announced that the Duchess of Cambridge, the former Kate Middleton has been hospitalized with this ailment in England.
                  Hyperemesis Gravidarum is not the "normal" morning sickness that most women experience in early pregnancy. It is felt to be a response to newly circulating and unfamiliar hormones in response to a developing placenta.  Women who experience this may not simply have "morning sickness" but the severe nausea may afflict them throughout the day, and the vomiting may persist following all meals or snacks. It may be so severe that the woman may develop dehydration and fluid and electrolyte imbalance. The wretching can be so significant that it may cause her to rupture blood vessels in her eyes or have pinpoint vessel ruptures in and around her face and eyes. ( Also known as petichiae) My chest and abdominal myuscles were sore from so much wretching.   Physicians estimate that only 1-2% of pregnant women experience this severe an early complication to pregnancy, but if you do, that's not much comfort.  Women may also be unable to tolerate certain smells. They may be unable to cook, and they may be unable to drive or ride in a car without vomiting.  Of course, this makes working outside the home rather difficult also.
                  Prior to the 1950s, before we had so many wonderful hormonal radioimmunoassay tests which could better demonstrate hormonal upheavals, some  physicians thought that a woman experiencing hyperemesis gravidarum may have been psychologically rejecting her pregnancy. Now, it is known that this is not true. This is a gastrointestinal complication of pregnancy of hormonal origin.   Also prior to the 1950s, before we had really excellent intravenous replacement capability and could replace not only fluid but the correct complement of lost electrolytes, some women were actually delivered of their fetus in order to save their lives. (Yes, therapeutic abortion has been performed a long time in order to save a woman's life.) A few women died of renal failure following a failure to adequately treat this sometimes challenging complication.  Some women experience some degree of HG with each pregnancy, and others are bothered by it only in one pregnancy.   Sometimes, women who carry multiple babies are troubled by this, because they may have multiple placentae which translates to additional hormone levels.
                 When I was 24, and pregnant with my first child, I too developed hyperemesis gravidarum.  It was a bewildering time. Prior to the pregnancy, I think I had vomited perhaps five times in my entire life, and I absolutely hated to.   I thought of myself as a nurse with an iron stomach who could see anything, and not wretch.  Then, all of a sudden, my joy about a new baby was dashed with worry.  I was about seven weeks pregnant when I couldn't keep anything down.  I tried not eating until I got to work, and vomited anyway.  I tried crackers on arising. (Those are hard to vomit !)   I could vomit water with no trouble at all.  In those days I was fairly slim, and I lost five pounds in no time.  I was hospitalized for a first time, within the first week of my hyperemesis.  Finally, I was hydrated and they had a dietician come to see me to make some suggestions as to how to work with this, and I was released.  A week later I was back in just as dehydrated as I had been before.  This revolving door of hydration, feeding me bananas, releasing me, and my becoming dehydrated and ketotic again and again, happened a total of 11 times that pregnancy.  My doctor, trying to be efficient and thorough, did a lot of other testing in order to make sure that nothing else was going on with me.  He never did establish any additional diagnoses.   It ceased for me, only somewhere in the mid second trimester.  I was one of the lucky ones though.  Some women continue to have the symptoms of HG throughout their entire pregnancy. There are several drugs that have been used to slow vomiting, and they work with some degree of effectiveness.  Still, great care needs to be taken while taking any drug, especially in early pregnancy.
             I went on to have three more full term pregnancies, and only two of those had a small amount of normal levels of morning sickness. In my case, when my body finally became accustomed to the hormones being produced by a functioning placenta, I didn't react by vomiting anymore.
              Recent studies indicate that at least some women who have HG also suffer from Helicobacter pylori.  Since I had myself tested for this when I returned from Russia, where it afflicts 90% of people, and I did not have it, it was not a factor in mine.
             If you ever have a daughter, a daughter-in-law, a friend, a neighbor or anyone else who has this nasty complication, please offer any support you can.  Sending some ginger ale is a nice gesture, whether she will be able to drink it or not.
             I hope Katherine the Duchess of Cambridge is feeling better soon.  She has my sincerest sympathy with regard to her HG.

In the end, it's all worth it.   (Photo: hgkaren.blogspot.com     This is a baby who is a product of a pregnancy with HG)


Kathy Felsted Usher said...

I had no idea what this was called. I had this with both my pregnancies and had to go on compazine or be hospitalized! The poor thing.

JaneofVirginia said...

Kathy, I am so sorry you had it with both. Having it with only one pregnancy was bad enough for me. I have compassion for anyone who has it because it is all consuming enough to take the focus off planning for a blessed event.

Linda said...

With all three of my children I was sick from a week after I became pregnant until delivery, morning, noon, and night. However, I only threw up once with the first two pregnancies. With the third pregnancy, I threw up sometimes 10 times each day, up to seven times after dinner. I ate each time I threw up because I was also starving each time, quite hypoglycemic. I was happy and tried to smile in pictures. Looking at the pictures now, I just have a sick miserable look on my face...no wonder!

A few years ago, the daughter-in-law of a friend was pregnant and deathly ill all the time. No one wanted me to keep talking about my experience in front of her and to her because it would just make her more sick, that she had to just not think about it. I knew better. We went off to a corner of the yard and I told her my extreme unhappiness with the throwning up. She thanked me then and later when the baby was born. She said I was the first person who said they understood and had gone through anything so horrid. She felt like people thought she was malingering and did not want the baby.

JaneofVirginia said...

Yes, the old thinking was that HG was a psychological reaction to a pregnancy which was unwanted. Fortunately, we know that this is not the cause. I think many women, and men whose wives did not have HG, think that it might be an exaggeration of what sounds to them like normal morning sickness. HG is nothing approaching normal morning sickness, and it can be a real barrier not only to life, but to the proper planning, decoration and nesting that should accompany a normal pregnancy.
There is definitely a hypoglycemia component as you mention. I used to get very hypoglycemic at intervals during that pregnancy.
Interestingly, my mother and the other women in my family never had this. In fact, my mother never vomited, even once, with either of her pregnancies. This was something that just hit like a ton of bricks. I still remember a neighbor baking homemade bread and homemade jam bringing these to me, in the hope that I could keep something down.

Linda said...

Mama assured me it would go away around three months. Just before that first child was born, I pleaded with her, asking her why I was so sick for so long. She said with all five pregnancies, she was sick for all nine months. So, right then I decided my mother thought it was all in her mind and tried to normalize my experience for me. She did not want me to expect the worse, so she really isolated me. There is no way to keep even favorite foods down. The smell of fresh bread would have turned me inside out.

JaneofVirginia said...

My mother had never been sick, even one time during either of her pregnancies. She thought I was exaggerated the number of times I vomited and never came to see me in multiple hospitalizations. Eventually, for me, it did pass, but I realized that my mother had some very odd ideas about childbearing, and her lack of support while I was ill created a wedge which began then, and sadly endured for the rest of our time together on Earth. I am different. I support my daughter, no matter what.

agirlandhergun said...

I too had this condition with both my pregnancies. I was in the hospital as I lost 20lbs, which for me was quite significant. I was a very sick gal.

JaneofVirginia said...

Real HG is no joke. With eleven hospitalizations with my pregnancy with Stephanie I gained only 23 pounds total in that pregnancy, and all of it was gone four weeks after the pregnancy. I did not experience it with the three later pregnancies. I have nothing but absolute compassion for anyone who experiences this, AND their poor husband.