Hyperemesis gravidarum: things to know

Fonte: shutterstock

Kate Middleton, Duchess of Cambridge, allegedly suffered from three pregnancies. We are talking about the hyperemesis gravidarum.

It is a condition characterized by repeated episodes of vomiting which can lead to dehydration, weight loss and metabolic imbalance and Kate isn't the only one affected by it.

Pregnancy hyperemesis affects about 3 to 30 pregnant women out of 1000

In this article

  • what is it
  • the causes
  • whoever hits
  • symptoms
  • possible consequences for the child
  • useful strategies
  • drugs, therapy
  • hospitalization

1.What it is

We know it well: nausea and vomiting in pregnancy they are very common and, taken individually or in combination, can be of interest three out of four pregnant women starting from the first weeks of pregnancy.

Read also: Nausea in pregnancy, things to know according to the US guidelines

As annoying as they are, these symptoms are generally not incompatible with activities of daily living, nor do they compromise the mother's overall health. Sometimes, however, the vomiting can become so intense that not only proper nutrition, but also a normal life is impossible. We then speak of hyperemesis pregnant.

who suffers from this condition vomits very often: at least three or four times a day, but there can be a dozen or more. This obviously increases the risk

  • di dehydration,
  • significant weight loss (over 5% of the starting weight)
  • and alterations of nutritional and metabolic balances.

If the simple precautions that can be used against nausea and vomiting, and possibly the use of drugs do not allow to keep the situation under control, it may be necessary to hospitalization.

Hyperemesis gravidarum is the main cause of hospitalization in the first trimester of pregnancy. However, it remains an uncommon condition

2. The cause

We do not yet know with certainty what are the causes of hyperemesis gravidarum, just as we do not know them for nausea: it is probably a complex combination of factors genetic, biochemical, psychological and cultural.

At stake, for example, there may be hormonal changes typical of pregnancy, in particular the increased levels of chorionic gonadotropin and estrogen which, in turn, could affect the gastrointestinal function. Some studies seem to indicate a correlation with Helicobacter pylori infection, a bacterium that can live in the stomach, but it is a phenomenon that has yet to be investigated.

For a long time, moreover, hyperemesis gravidarum has been attributed to apsychosomatic origin. The idea is that nausea and vomiting (even in less violent and more common forms) may be the reflection of a pre-existing psychological distress, or a response of the organism to a new stressful situation. However, there is insufficient scientific data to support this hypothesis.

Indeed: if on the one hand it is possible that, in some very rare cases, hyperemesis in pregnancy is a manifestation of a psychiatric illness, such as severe depression, on the other hand it is in general more likely to constitute a cause of psychological stress rather than a consequence of it.

Some recent studies also suggest that there is one hereditary component, therefore genetic, in the onset of hyperemesis gravidarum. In fact, it has been seen that those who have a mother or a sister who have suffered from it run a greater risk of suffering from it.

3. Who hits

There is no typical identikit of the woman who, in pregnancy, will surely suffer from hyperemesis gravidarum. However, we do know that there are some conditions more frequently associated with this condition, and in particular:

  • young maternal age;
  • first pregnancy;
  • obesity;
  • multiple pregnancy;
  • presence of hyperemesis in previous pregnancies;
  • family component (if the mother or a sister, during pregnancy, has suffered from it).

4. Other symptoms

Sometimes, the repeated vomiting typical of hyperemesis gravidarum may be associated with other symptoms. For example:

  • hypersensitivity to odors
  • excessive saliva production;
  • dehydration headache;
  • urinary incontinence

The British Health Service's document on hyperemesis gravidarum also points out that this condition can lead to significant emotional and psychological distress. We may feel anxious about the daily management of vomiting, confused about its cause, worried about how the rest of the pregnancy will go.

5. Possible consequences for the child

During pregnancy you already have a lot of anxieties about the health of your baby, and if you suffer from hyperemesis gravidarum, one more is added. Is it possible that this condition puts the fetus at risk? The available data seem to suggest that any effects on the fetus are unlikely.

It is not excluded, however, that there may be an increased risk of low birth weight or premature birthespecially if the mother lost a lot of weight during pregnancy.

6. Hyperemesis gravidarum, useful strategies

There is no definitive cure for hyperemesis in pregnancy (as there is no for nausea). However, there are strategies and treatments that can mitigate symptoms and reduce the risk of complications.

The first line of intervention to try to get better, particularly valid for the milder forms, concerns some simple behaviors that can be implemented at home. For example:

  • prefer small and frequent meals;
  • separate the intake of solid foods from liquid ones (drink little when eating);
  • prefer dry food and cold drinks, which cause less nausea;
  • avoid strong odors.

The assumption of ginger could help out (we always talk about milder cases), while for acupuncture and the so-called acupressure point P6 (for example with special bracelets), the studies conducted have given conflicting and not definitive results. The same goes for the psychotherapy, while there are some more positive results (but also in this not definitive) for thehypnosis. In practice: you can try, they might work, but it doesn't necessarily happen.

7. Medicines, therapy

According to the guidelines for physiological pregnancy of our Ministry of Health, the antihistamines such as promethazine, they are the most effective drug category against pregnant nausea and vomiting.

As for other drugs sometimes used for nausea and vomiting in pregnancy, such as ondansetron e metoclopramide, both the website on Drugs and Pregnancy of the Agenzia Del Paesena of the drug and the American guidelines recommend some extra caution of use, because there are no definite and definitive data on safety and efficacy and because of some side effects.

Read also:
Drugs for nausea in pregnancy
Vitamin B6 plus doxylamine: can it be used for hyperemesis?
From February 2022, a new drug is also available in the country specifically indicated for the treatment of nausea and vomiting in pregnancy: it is aassociation between pyridoxine (vitamin B6) and doxylamine, an antihistamine, which has been available for several years in other countries such as Canada, Spain, the United States and considered extremely safe.

The new drug certainly represents an additional tool to counteract nausea during pregnancy, but we remember that it has never been studied for the treatment of hyperemesis.

8. Hospitalization

If vomiting cannot be controlled even with medication, hospitalization may be required, particularly to manage complications of the condition such as dehydration and nutritional imbalances. In these cases we intervene for example with the administration of hydrating drips or nutritious.

Additional sources for this article: review on hyperemesis gravidarum published in the journal Pharmacology; information material in the Medscape magazine; informative material on Wemd; document on hyperemesis gravidarum of the English Health Service.

Questions and answers

What is hyperemesis gravidarum?

It is a condition that can affect pregnant women. Sufferers vomit very often: at least three or four times a day, but there can be a dozen or more. 

How many women does hyperemesis gravidarum affect?

Pregnancy hyperemesis affects about 3 to 30 pregnant women out of 1000.

  • pregnancy nausea
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