What to Know About Hyperemesis Gravidarum (HG) in Pregnancy

Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting that affects a small but significant number of pregnant women. Unlike the common morning sickness that many expectant mothers experience in the early stages of pregnancy, HG can be debilitating, leading to dehydration, malnutrition, and weight loss. This condition can profoundly affect a woman’s physical, emotional, and mental health, and it requires careful management during pregnancy. Understanding HG, its causes, symptoms, treatment options, and the importance of antenatal care is essential for any expectant mother facing this challenge. In this article, we will explore what HG is, its causes, how it is diagnosed, the available treatment options, and how antenatal support plays a critical role in managing this condition. We’ll also touch on coping strategies, lifestyle changes, and when to seek professional help. By understanding HG, you can better navigate your pregnancy journey and find the support you need. What is Hyperemesis Gravidarum (HG)? Hyperemesis Gravidarum is an extreme and persistent form of nausea and vomiting that occurs in pregnancy, usually in the first trimester. While nausea and vomiting in early pregnancy (commonly known as morning sickness) are quite normal, HG goes beyond typical discomfort. Women suffering from HG may experience vomiting multiple times a day, often rendering them unable to eat or drink, which can result in dehydration, weight loss, and an imbalance in electrolytes. Unlike morning sickness, which tends to subside around the 12-week mark, HG can last for the entire pregnancy in some cases. It is a serious condition that may require hospitalisation to manage the symptoms and ensure the health of both the mother and the baby. What Causes Hyperemesis Gravidarum? The exact cause of HG is not fully understood, but several factors are believed to contribute to its development:

1. Hormonal Changes: Pregnancy leads to a surge in hormones, particularly human chorionic gonadotropin (hCG) and oestrogen, which are thought to play a role in nausea and vomiting. These hormones help to support the pregnancy, but they can also trigger HG in some women, especially when hormone levels are higher than normal.
2. Genetic Predisposition: Studies suggest that a family history of HG may increase the likelihood of developing the condition. If a close relative, such as a mother or sister, has experienced HG, you may be at a higher risk of experiencing it yourself.
3. Previous History of HG: If you have had HG in a previous pregnancy, there is a higher chance that you will experience it again. Women who had severe morning sickness in their first pregnancy may also be at risk of developing HG in subsequent pregnancies.
4. Multiple Pregnancies: Women carrying twins or multiples are at a greater risk of developing HG due to the increased production of pregnancy hormones. The additional hormonal load can lead to more severe nausea and vomiting.
5. Underlying Health Conditions: Certain pre-existing health conditions, such as thyroid problems or gastrointestinal issues, can increase the likelihood of developing HG. Furthermore, women with a history of depression or anxiety may also face an increased risk due to the added stress of pregnancy.
6. Placental Factors: The placenta plays a critical role in pregnancy, and abnormalities or dysfunction of the placenta may contribute to HG. Some researchers believe that the development of HG could be linked to how the placenta interacts with the body. Symptoms of Hyperemesis Gravidarum The symptoms of HG are much more severe than typical morning sickness and can significantly disrupt daily life. Common symptoms of HG include:

• Severe nausea and vomiting: Vomiting can occur multiple times a day, often leading to dehydration.
• Inability to keep food or liquids down: Many women with HG find that they cannot eat or drink without immediately vomiting, which can result in a lack of essential nutrients.
• Dehydration: Frequent vomiting leads to fluid loss, which can cause dehydration, making it difficult for the body to function properly.
• Weight loss: Significant weight loss (more than 5% of pre-pregnancy weight) is common in women with HG.
• Electrolyte imbalances: Prolonged vomiting can cause a loss of important electrolytes like potassium and sodium, leading to complications like muscle cramps, dizziness, and fatigue.
• Fatigue and weakness: The constant vomiting and lack of proper nutrition can lead to extreme fatigue and weakness, affecting daily activities.
• Increased heart rate: Dehydration and electrolyte imbalances can cause the heart to work harder, leading to an elevated heart rate. How is Hyperemesis Gravidarum Diagnosed? HG is typically diagnosed based on the symptoms, a detailed medical history, and sometimes the results of lab tests. If you experience persistent nausea and vomiting that goes beyond typical morning sickness, your doctor may recommend blood tests to check for dehydration, electrolyte imbalances, and liver or kidney function. An ultrasound may also be performed to rule out other causes of nausea, such as a molar pregnancy or ectopic pregnancy. Diagnosis often involves confirming that the vomiting and nausea are severe enough to cause weight loss (typically 5% or more of pre-pregnancy weight) and dehydration. Your doctor may also assess your ability to keep food or fluids down, as well as any signs of malnutrition. Managing Hyperemesis Gravidarum: Treatment and Care Managing HG is a multi-faceted approach, and treatment may vary depending on the severity of the condition. The goal of treatment is to ensure that both the mother and baby remain healthy and that the symptoms of nausea and vomiting are managed effectively.

1. Hospitalisation: In severe cases, women with HG may need to be hospitalised for rehydration and nutrition support. Intravenous fluids and electrolytes may be administered to treat dehydration and replenish vital nutrients.
2. Medications: Several medications may be prescribed to help control nausea and vomiting in women with HG. These include anti-nausea medications such as ondansetron, metoclopramide, and promethazine. In some cases, doctors may also prescribe corticosteroids to reduce inflammation and help control symptoms.
3. Antiemetic Drugs: Anti-nausea medications may be used to reduce the severity of symptoms and help women maintain adequate nutrition. These medications are typically safe for pregnancy but should be taken under the guidance of a healthcare provider.
4. Nutritional Support: Nutritional support is crucial for women with HG. A balanced diet, as well as supplements such as prenatal vitamins, can help ensure that the woman is receiving the nutrients necessary for a healthy pregnancy. If oral intake is not possible, nutritional support may be provided via a feeding tube or IV fluids.
5. Antenatal Care and Support: Regular antenatal care appointments are essential for monitoring the health of both the mother and the baby. Antenatal appointments can help track weight gain, hydration, and any other potential complications. During these visits, your doctor will also assess your emotional wellbeing, as dealing with HG can be mentally and emotionally taxing. Coping with Hyperemesis Gravidarum: Lifestyle and Emotional Support Living with HG can be challenging, and emotional support is just as important as physical care. Coping strategies include:

• Seeking antenatal support: Attending antenatal yoga or fitness classes can help manage stress and anxiety, as well as keep the body physically healthy.
• Relaxation techniques: Practices such as prenatal massage, meditation, or breathing exercises can help reduce the stress and anxiety that often accompany HG.
• Support groups: Talking to other women who have experienced HG can provide emotional support and understanding. Online communities or in-person groups can be a valuable resource. When to Seek Medical Help If you are struggling with severe nausea and vomiting that is affecting your ability to eat or drink, seek immediate medical help. Dehydration and weight loss can have serious consequences for both you and your baby, so timely intervention is crucial. Hyperemesis Gravidarum is a serious condition that requires careful attention and management. Antenatal care plays a key role in monitoring the health of both the mother and the baby, ensuring that any potential complications are addressed promptly. While managing HG can be challenging, it is important to remember that with proper treatment and support, most women can recover and go on to have healthy pregnancies.