Hyperemesis Gravidarum in pregnancy is reported to impact ~1-3% or pregnnacies. Nausea and vomiting (N&V) in early pregnancy is unfortunately very common with data suggesting N&V impacts 70-80% of all pregnancies.
N&V is more commonly known as ‘morning sickness’ -you can’t see me, but I am rolling my eyes right now-, because as anyone who has had N&V in trimester 1 will tell you, it’s actually ‘anytime’, or ‘all-the-time‘ sickness.
Now Hyperemesis Gravidarum in pregnancy or HG in pregnancy, is a severe form of nausea and vomiting. In pregnancy, HG is not to be confused with morning sickness. Symptoms look similar at onset, but they are very different conditions. In saying that, N&V severity ranges from mild to severe and is different person to person. This makes even self-diagnosis really challenging.
HG is chronic nausea and vomiting which can last for weeks, months, and up to birth.
Hyperemesis gravidarum in pregnancy can be life-threatening, leading to malnutrition, dehydration, weight loss, health complications for mum and baby, long-term mental health concerns and it will severely impact a pregnant person’s quality of life.
HG requires a whole team approach to treat and monitor which can involve but is not limited to regular IV fluids, medications and additional hospital or homecare support.
What causes Hyperemesis Gravidarum in pregnancy?
Like many things to do with pregnancy, we don’t exactly know. But exciting new research released in 2023 has identified a genetic component to the onset of HG.
Growth Differentiation Factor-15 (GDF15) is a hormone acting on the nausea and vomiting part of the brain -the hind brain causing emesis, or vomiting.
Evidence comparing saliva samples from pregnant women with HG, compared to pregnant women who did not have HG, found higher circulating levels of this hormone in those suffering from HG. Data further suggests the placenta releases high doses of GDF15 through pregnancy.
Geneticist Marlena Fejzo discovered this, and went on to discover these women with HG also had variants in their genetic code coding for the hormone GDF1. You can read the paper here
So while we are now starting to understand the cause, there is hope for preventative therapy or targeted treatment for suffers. Marlena reports some success sensitising mice to GDF1, however this research is very much in its infancy – but is very exciting.
HG v. N&V
Diagnosis for HG can be tricky because in early pregnancy the symptoms look similar to pregnancy nausea/’morning sickness’.
Healthcare providers can use tools to screen for HG and will assess weight loss, dehydration, vomiting frequency and dietary intake. It’s always important to speak to your team about your symptoms, get the support and information you need.
Hyperemesis Gravidarum Treatment
Medications can be prescribed to reduce nausea and IV fluids may be recommend throughout pregnancy. I also advocate strongly for mental health support as HG can be utterly debilitating physically and emotionally.
Diet is really tough to address in this group.
No one likes to eat when they are nauseous, yet alone vomiting multiple times a day. Many foods are off the menu and a tailored approach needs to be put in place as what works for one, will not work for another.
I strongly recommend seeking a dietitian’s input in treatment to find any available gaps to improve nutrition status.
These are a few key things I look for in clinic – but this is not personalised advice for you, dear reader. Please please please see your OB/GP/Midwife if you think you may have or be at risk of HG.
1. Prepare by addressing nutrient gaps before pregnancy
While the risk of HG is small, it is still a risk. N&V will impact most pregnancies anyway, so this advice is helpful for anyone planning pregnancy.
Your dietary choices in early pregnancy will be impacted by nausea, so screening for deficiencies and addressing them by optimising your diet before pregnancy is one of the best things you can for yourself.
2. Prenatal supplement
Priorising taking your prenatal supplement will help to fill nutrient gaps. I know this is tough.
If capsule forms are not an option for you, liquid forms are available. Chat to your dietitian about which is right for you. Thiamin (B1) (as just one example), is crucial in HG, if you are not able to take your prenatal, and are not able to keep any food down you will need IV fluids which can contain vitamin B1.
3. Hydration
Hydration drinks may become your best friend. Stock up on a variety of flavours so you always have one you may tolerate one hand.
And while the more traditional N&V treatment modalities (like ginger and vitamin B6) seem to have minimal impact relieving HG symptoms, ice-block hydration drinks can be helpful.
4. Support hyperemesis Gravidarum
Surround yourself with support. Your medical treating team can prescribe anti-nausea medications, organise fluids, monitor you and baby.
Friends and family can provide meals, look after older children, drive you to appointments, help around the house, grab groceries and so forth.
Seeing a psychologist can be incredibly beneficial in helping to navigate the emotions of pregnancy with HG.
Postpartum
Evidence suggests once the baby and placenta are born, HG begins to reduce. This process can be immediate, or take a few weeks or months. However, appetite and eating patterns may be altered and most people are coming out of pregnancy depleted of many key nutrients.
While postpartum may be seen as the end of HG, it can mark the one-set of postnatal depletion related to limited nutrition during pregnancy coupled with birth and new parenthood.
Assess the quality of your diet for nutrient gaps and a blood test to check nutrient levels like iron, folate, vitamin B12, vitamin D and so forth is highly recommended.
Supplementing where necessary and optimising the diet sooner rather than later can have a profound impact on recovery.
If you have had or think you may be at risk of HG, reach out here and we can discuss if a 1:1 session may be helpful for you.
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