Although “morning sickness” is typically considered a normal side effect of pregnancy, for some women, nausea and vomiting can be severe and life-altering, even life-threatening.
A woman is considered to have hyperemesis gravidarum (HG) if her vomiting is so severe that she loses over a kilogram (2.2 pounds) weekly or 5% of her body weight over time, experiences electrolyte imbalances or dehydration requiring hospitalization for IV fluid or electrolyte replacement, or finds that her symptoms are so severe that she is too tired to work or perform her duties at home. Sometimes, she may even notice bile or blood when she vomits.
HG is more common in first pregnancies and may be more likely to happen if a woman has emotional concerns about her pregnancy or has poor social support. It is also common with twins or triplets and may be worsened by other medical conditions, such as thyroid dysfunction or diabetes.
Effective treatment is available, however, so women suffering from this devastating condition should be encouraged. Your obstetrician may begin by checking labs to see if other exacerbating medical conditions are present.
Frontline oral medications include:
- doxylamine/pyridoxine (combination of an antihistamine and vitamin B6),
- promethazine (which can also be given as a rectal suppository),
- or ondansetron (which can also be given as an IV infusion by home health).
Sometimes, these meds can even be given as patches or creams absorbed through the skin. Steroids may be used if the initial medications fail to resolve the symptoms. Treating heartburn (reflux) with antacids or anxiety/depression with medications that address these symptoms may also help.
If a woman feels unsupported in her pregnancy by her baby’s father, pregnancy help centers often have counseling and other forms of support available.
If your current obstetrician has been unable to help, there are many resources available at the HER Foundation.
A woman suffering from hyperemesis gravidarum can be reassured that there are multiple effective treatment options available, and perseverance through these trials will bring joy at the birth of her child.
By Ingrid Skop, M.D.
