More than morning sickness

by | Jun 12, 2017

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More than morning sickness

by | Jun 12, 2017

When the morning sickness doesn’t go away, hyperemesis gravidarum could be at play. Registered nurse, lactation consultant and childbirth educator Samantha Crompton explains exactly what this condition is and how to treat it.

“I was very excited when I found out I was pregnant with my first daughter. Sadly, that excitement was very soon replaced with nausea and vomiting that lasted all day. It started at about the same time that I began to suspect that I was pregnant and worsened as my pregnancy advanced,” says Donna Matthews. Most pregnant women only experience mild forms of morning sickness during the first trimester of their pregnancy, however there are certain women, like Matthews, for whom the nausea and vomiting can be quite severe throughout the duration of their pregnancy. Hyperemesis gravidarum (HG) is the most severe form of morning sickness and it can be completely debilitating to the pregnant women who suffer from it.

It is a bittersweet moment when you feel that first unmistakable wave of nausea that signals that you are pregnant. No one really likes to feel nauseous but when pregnancy is your ultimate goal, the first signs of morning sickness can be quite exciting. Morning sickness (which, despite its name, is not confined to the morning hours only) usually starts at around four to eight weeks and subsides at around 12 to 14 weeks. About 70 to 90% of pregnant women experience nausea and some vomiting in the first trimester of pregnancy. While the cause of the nausea and vomiting is not completely understood, research suggests that it could be linked to the production of certain hormones such as human chorionic gonadotropin hormone in early pregnancy.

However, while most women get to kiss the pregnancy nausea goodbye at the beginning of their second trimester, there are many women who suffer from a more severe case of morning sickness known as HG that can last for the entire duration of their pregnancy. “HG is debilitating and frustrating. I vomited for a full 39 weeks, and was totally exhausted and despondent by the time my C-section date arrived,” recalls Matthews.

Not only does this condition interrupt day to day functioning, but it can also have serious consequences such as ketosis (when your body starts to burn fats instead of carbs for energy), weight loss, dehydration, electrolyte and acid imbalances, and nutritional deficiencies if it is not managed. “In both my pregnancies I suffered terribly from nausea and vomiting. It started around eight weeks and continued throughout the pregnancies. With my first I lost 10kg from it all, and with the second it was 7kg. I felt nauseous all the time, and certain smells and foods would send me running to the toilet. I tried everything, but nothing worked. I would have tried anything to stop it,” explains Meagan Mansell, another mother who suffered from HG during her pregnancies.

Who is at risk?
Your risk of developing HG during pregnancy increases if you have developed these symptoms in previous pregnancies, experience menstrual migraines when not pregnant, develop similar symptoms when taking oestrogen (hormonal birth control), experience motion sickness, and have gastrointestinal problems such as ulcers or reflux.

What does this mean for you?
If you’re struggling with HG, your obstetrician or midwife will usually start trying to relieve your discomfort with natural nausea prevention methods such as vitamin B6 and ginger, eating smaller frequent meals, and chewing on dry foods like crackers. Drinking plenty of fluids to stay hydrated is also key.

Medication is also necessary when the resulting side effects of vomiting become a threat to the mother or child. The majority of mothers try to avoid medications at all costs during pregnancy, so when a pregnant mom asks for something to help with the nausea, she really is desperate.

When medication is a must
If your HG reaches a point where medication is required, your doctor will look at a few options. Medications that are commonly used include antihistamines such as diphenhydramine or meclizine (these commonly cause drowsiness), and anti-nausea medications such as promethazine and metoclopramide. Zofran (the brand name of a medication with the active ingredient ondansetron) is commonly used to help with HG. Zofran blocks the actions of the chemicals in the body that trigger nausea and vomiting.

Whatever your doctor prescribes, be sure you use the correct dosage and follow the instructions. The way that medications are used can also improve their efficacy:

  • Changing medications abruptly and frequently is counterproductive – stick to what has been prescribed and give it time to work.
  • Scheduled dosing improves response, rather than taking when needed, so take your mediation at the same time every day.
  • Wean yourself off the medication slowly after a few weeks of stability and adequate
    nutritional intake.
  • Medication may be necessary until delivery.
  • Complementary treatments such as acupuncture, acupressure, and hypnosis can also be used provided that they are deemed safe for pregnant women by a medical professional.

In severe cases, pregnant women who are unable to keep any fluids or food down due to constant nausea or vomiting may need to be admitted to hospital and put on a drip.

Is baby okay?
Many moms worry about how the HG will affect the baby. Although pregnancy with HG is a long and tedious time, it is typically not associated with adverse pregnancy outcomes in the absence of severe malnutrition or weight gain under 7kg. If there is anything to cause concern, your doctor will tell you. There is strong evidence that women with nausea and vomiting in early pregnancy have a lower rate of miscarriage than women without these symptoms. Larger follow-up studies are needed to determine whether HG has long-term effects on babies.

If you’re diagnosed with HG, it may help to find other pregnant women or moms who are also experiencing HG. They can be your best resource, even if it is just to know that you will survive this period… and you will survive it!

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