Know About Hyperemesis Gravidarum - A Disorder Related To Pregnancy

Every woman experiences a sense of happiness when she first hears that she is pregnant and longs to see her young one. Unfortunately, some women loose this happiness soon when they encounter some complications related to pregnancy; like-Hyperemesis gravidarum. Nausea and vomiting during pregnancy, also known as morning sickness, is very common and affects 70% to 85% of pregnant women. Hyperemesis gravidarum is a severe form of morning sickness. This disorder affects various areas of women health, like homeostasis, electrolyte balance, and kidney functions, and leads to many adverse fetal consequences. The frequency of pregnant women suffering from this disease is very low (0.3% and 2%) and in many cases, leads to hospitalizations and associated increased medical expenditure. Many women take a decision to terminate the pregnancy ignorantly. This article tries to focus on different aspects of Hyperemesis Gravidarum like symptoms, causes, complications, currently available treatment options, etc, so that the reader has the knowledge about this disease and is able to take a rational decision rather than going ahead for abortion.

Studies have attributed various reasons to be the causes behind this disease, but the exact etiology (causes) remains unknown even today. Some factors which might lead to Hyperemesis gravidarum include:

• Hormonal imbalance (an increase in the levels of hCG or human chorionic gonadotropin)
• Raised levels of liver enzymes
• General gastrointestinal dysfunctions associated with pregnancy
• Raised levels of steroid hormones
• Psychological factors like stress
• Consumption of high fat diet
• Prior infection by Helicobacter pylori which cause stomach ulcers, etc.

A strong correlation between the thyroid functioning and Hyperemesis gravidarum has been detected. The hormone hCG stimulates thyroid activity due to which the levels of the thyroid hormones are raised. Almost 60 % of these patients have been detected with transient hyperthyroidism. However, these patients did not have a previous history of hyperthyroidism and did not show the presence of goitre. A direct relationship has been found between the severity of vomiting and the degrees of thyroid stimulation. Generally, transient hyperthyroidism gets resolved by 18 weeks of pregnancy but, in some patients, this condition of clinical thyrotoxicosis continues during the later stages of pregnancy also.

Hyperemesis gravidarum is destructive to the health of pregnant women, leading to acute weight loss, acidosis from starvation, dehydration, alkalosis due to loss of hydrochloric acid in vomitus and muscle wasting. It also affects the child leading to low birth weight and premature births. However, patients show different combination of symptoms. Generally the symptoms of this disorder are noticed at a peak level during 9 weeks of gestational age and subside when the gestational age is about 20 weeks. But in some women, this problem may persist throughout the pregnancy.

If left untreated, this disease might lead to some serious complications like

• Oesophageal rupture due to severe vomiting
• Wernicke's encephalopathy – A neurological disorder arising due to the deficiency of vitamin B
• Retinal haemorrhage
• Renal damage
• Intrauterine growth retardation

These conditions can claim the life of the mother and the fetus.

When you express the problem, the gynecologist may perform a physical examination and measure the pulse rate and blood pressure. Blood pressure is low and pulse is usually high. In order to detect the presence of dehydration, the doctor suggests laboratory tests like, Hematocrit (which measures the percentage of the volume of whole blood that is made up of red blood cells) and Urine ketone analysis.

The positive side of Hyperemesis Gravidarum is that, this problem can be cured by medical intervention. Even though it requires hospitalization for a short span of time, many times it does not require repeated hospitalization. Medicinal treatment includes administration of intravenous fluids, antiemetics along with vitamin supplementation.

• Intravenous Fluids - Initial treatment option includes intravenous administration of parenteral fluids so that the lost electrolytes can be replenished.

• Antiemetics - Antiemetics like Ondansetron, metoclopramide, or promethazine are prescribed to calm the stomach and control the nausea and vomiting.

• Vitamin supplementation - Thiamine is generally suggested as a routine supplement to patients who suffer from vomiting for a very prolonged period of time.
• Steroids - Steroids which directly act on the vomiting center of the brain like hydrocortisone can be administered.

• Enteral feeding - In severe cases, when the patient fails to tolerate oral feeding, enteral feeding or tube feeding is provided after the initial severe symptoms subside.

Ginger, scientifically known as Zingiber officinale, has been found to be very effective in reducing or eliminating the symptoms without any side effects. Its aromatic and absorbent characteristics, along with its tendency to reduce the formation of gas in stomach, make it very effective in the cure of Hyperemesis gravidarum. Ginger acts on the GI tract by increasing the motility and blocking the responses and consequent nausea feedback.

Alterations in the maternal diet and modulation of the lifestyle habits can reduce the reoccurrence of Hyperemesis Gravidarum to some extent. A pregnant woman can modulate the quantity of meals consumed throughout the day. She is advised to take food and fluids in small quantities distributed over the day. Meals rich in carbohydrates and proteins help to reduce the symptoms. A pregnant woman should avoid foods rich in fats and acid. Good rest and keeping oneself away from stress helps to reduce this problem to some extent. Of course, support of the family members is very essential as it helps women to cope up with such difficult situation and all the family members can welcome a healthy baby.

1. Wegrzyniak, J, L, et al. (2012). Treatment of Hyperemesis Gravidarum. Rev Obstet Gynecol, 5(2): 78–84.

2. Kuscu,K, N. Et al.(2002). Hyperemesis gravidarum: current concepts and management. Postgrad Med J, 78: 76-79.