This piece was published on May 14, 2018 on the Healthy Newborn Network.
On May 15, we mark Hyperemesis Gravidarum International Awareness Day. Hyperemesis Gravidarum (HG) is currently a topic that is relatively unexplored in global maternal health forums. However, this pregnancy complication merits attention because of the host of dangers it presents to both mothers and newborns.
Below I will provide a brief overview of HG, its risks for women and their babies, and discuss strategies to help mothers manage their condition.
What is Hyperemesis Gravidarum (HG)?
HG is a pregnancy complication typified by extreme nausea and vomiting. While 70-80% of pregnant women experience some ‘morning sickness’ during their first trimester, HG affects anywhere between 0.5 to 2% of pregnant women. Depending on the severity, women may often struggle with excessive nausea for the entirety of their pregnancy. HG sufferers may vomit more than 20 or more times per day.
While there are two genes may play a role in HG occurrence, the etiology of the condition is still not well understood. Some risk factors for HG can include multiple gestation, a diet high in saturated fat, untreated asthma, and more.
What are the risks of HG to mothers and newborns?
If left untreated, HG can lead to dehydration, malnutrition, electrolyte imbalances, weight loss, production of ketones, esophageal trauma, dental problems, Wernicke’s encephalopathy, miscarriage, and maternal death. HG is currently the second leading cause of hospitalization during pregnancy.
But the physical symptoms are not the only consequence. HG sufferers are more likely to suffer from depression, anxiety, and stress disorders that may persist into the postpartum period. One study found that mothers who experienced post-traumatic stress symptoms related to their HG were less likely to breastfeed their infants, more likely to go through marital challenges, and less able to care for themselves postpartum. Some mothers may also experience financial stress due to their inability to work while they are ill. To limit their misery, some mothers may elect to terminate or avoid subsequent pregnancies.
Babies born to mothers of HG are at increased risk of being born at low birth weight or prematurely. Some newborns may have lower Apgar scores five minutes after birth. Infants of mothers who experience post-traumatic stress disorder may be at higher risk for poorer developmental outcomes.
How can HG be managed?
Outlined below are some of the strategies that can be employed to manage HG. Please note that methods described may not be appropriate for every patient or available in every setting.
- Screen for tell-tale signs of HG (e.g., dehydration, weight loss, etc.) during routine and emergency care. Click here for diagnostic and assessment tools.
- Provide intravenous fluids where they are needed. (Warm fluids are preferred to avoid further caloric loss and discomfort.)
- Offer information on appropriate care-seeking behaviors to avoid extreme dehydration or weight loss.
- Prescribe medications when and where the prescriber and mother both agree that the benefits outweigh the risks. (For information about suggested prescription protocols, please click here.)
- Educate family members on the dangers of HG so that they will help pitch in with housework. Emphasize that avoiding stress and getting rest are crucial for the successful management of HG.
- Screen for psychological needs and link at-risk mothers into psychological care when needed.
- Suggest that pregnant women with HG eat little meals as often as tolerated. Recommend expectant mothers focus on protein-rich foods. Suggest that patients avoid foods or smells that cause nausea and vomiting where possible.
- Support prenatal vitamin consumption and emphasize the need to take vitamins on a full stomach. Consider prescribing thiamine (B1) supplements to mitigate nausea.
- Promote increased dental care practices as excessive vomiting may damage teeth.
- In extreme cases where mothers require ongoing hospitalization to manage their condition, consider offering total parenteral nutrition (TPN) or nasogastric feeding.
- A suggested protocol for the treatment of HG created by the HER Foundation is available here.
Lastly, while HG sufferers may benefit from the treatment methods and support described above, what they need perhaps most of all is hope that there will be an end to their ever-present nausea.
Through awareness, compassion, and a mix of the strategies above, healthcare workers can help keep HG sufferers healthy until they can obtain a cure: a safe delivery.
For more HG information and free resources, please visit the HER Foundation at www.hyperemesis.org