Hyperemesis Gravidarum - Severe form of nausea

If you suffer from nausea and vomiting in an extreme form, this is called Hyperemesis Gravidarum (HG). Hyperemesis Gravidarum occurs in about 0.5% to 2% of pregnancies and women with this pregnancy disease are barely able to get or retain anything from fluid or food and sometimes have to give up a sip of water. Such an extreme form of vomiting and nausea leads to dehydration, weight loss and other complications. Often a hospital admission is inevitable.

Cause Hyperemesis Gravidarum unknown

HG often reduces or disappears for 21 weeks of pregnancy, but in just under half of all cases HG lasts the entire pregnancy.
How and why HG arises is not known, there is a multitude of theories, but for sure it is not done. The treatment of HG is therefore only symptomatic, you get an infusion against drying out, anti-allergy medication against nausea and vomiting and possibly tube feeding if you can not take any food at all.

Common symptoms Hyperemesis Gravidarum

Weight loss: sometimes up to 10% of the body weight.
Dehydration: you can notice this because you urinate little more and the urine is often very dark, because you get dry mouth and dry lips and because you get ketones in your urine. The latter can determine the GP, midwife or gynecologist with a simple urine test.
Sensitivity to movement, light and sound.
Extremely strong perception of odors; this often leads to vomiting.
Extreme fatigue and weakness.
Dizziness and confusion.

If you experience these symptoms, it is wise to call the GP or the midwife.

Research on hyperemesis gravidarum

Hyperemesis gravidarum (HG) is extreme nausea and vomiting in pregnancy. Unfortunately, too little is known about HG. There are many theories, but none of them seems to contain the truth. The only theory of which we are almost certain that this is not true is the theory that HG would have a psychological cause. Studies that indicate this are generally old and poorly designed.

Norwegian research

Norwegian research (3) shows that HG occurs in 0.5% to 3% of pregnancies. Results from research of historical data over the past 40 years from various Norwegian institutes show this. From this research also comes the remarkable result that HG in Norway is not equally common among all population groups. In women who live in Norway but are born in India or Sri Lanka, HG occurs at 3.2% of pregnancies. Women born in Africa (except North Africa) or Pakistan, HG grows at 3.1% and 2.1% of pregnancies for women and women born in Norway, North America or Western Europe, HG only in 0.9% of pregnancies before.

Difficult to explain

The difference in occurrence of HG is difficult to explain, it only succeeded to indicate where it is not: the difference in occurrence of HG can not be explained by socio-demographic characteristics (marital status, education et cetera), differences in diet or a history of infections.

Canada

In Canada, the Motherisk organization is conducting research into HG. A small study (4) among 24 women shows that preventive treatment with the drug Diclectin © (pyridoxine and doxylamine) can help to keep the severity of nausea within limits. All 24 women in the study had HG in previous pregnancies. In the experimental group, the 12 women were treated with Diclectin®, sometimes before conception but in any case before the 7th week of pregnancy and before symptoms of nausea occurred. In the control group, the 12 women were treated according to the normal protocol and only when symptoms of nausea and vomiting occurred.

Not available

In the experimental group, 9 out of 12 women indicated that the severity of their symptoms had diminished compared to their previous pregnancies. In the control group only 1 woman indicated that her symptoms were reduced in severity. A preventive treatment for HG therefore seems to be useful.
Motherisk uses this study as the basis for a larger study to see if it also appears that a preventive treatment with Diclectin © can help to reduce the symptoms of HG. Diclectin © is unfortunately not available in the Netherlands, also the component doxylamine is not available in the Netherlands.

America

In America Marlena Fejzo of the University of Southern California is working on an investigation into HG. She is doing a study on the identification of genes and risk factors in HG. This study started in 2007 and will continue until 2012. Identifying these issues will lead to a better understanding of HG's reasons and may even be a first step towards developing a more effective treatment and perhaps even a cure from HG. High expectations!

Would you like to know more about HG, seek support during a pregnancy with HG or would you like to talk to HG patients about HG? Then check the website of Steunpunt Hyperemesis Gravidarum (www.steunpunthg.nl). This site offers information about HG, experience stories of women who have HG and a forum where you can talk to others about HG.

(1) Munch S, Chicken or the egg? The biological-psychological controversy surrounding hyperemesis gravidarum. Soc Sci Med. 2002 Oct; 55 (7): 1267-78.
(2) Simpson SW, Goodwin β„’, Robins SB, Rizzo AA, Howes RA, Buckwalter DK, Buckwalter JG. Psychological factors and hyperemesis gravidarum. Journal of Womens Health and Gender Based Medicine 2001 Jun; 10 (5): 471-7.
(3) Vikanes A, Grjibovski AM, Vangen S and Magnus P. (2008) Variations in prevalence or hyperemesis gravidarum by country of birth: A study of 900, 074 pregnancies in Norway 1967-2005. Scandinavian Journal of Public Health 36: 135-142.
(4) Koren, G & Maltepe, C. (2004). Pre-emptive therapy for severe nausea and vomiting of pregnancy and hyperemesis gravidarum. Journal of Obstetric Gynecology, 24, 530-533.

Video: Two genes likely play key role in extreme nausea and vomiting during pregnancy. UCLA Health News

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