When the British Royal Family announced that Kate Middleton, the Duchess of Cambridge, was expecting her first child in 2017, every part of her pregnancy was reported by the media. This included her diagnosis of hyperemesis gravidarum, a condition that occurs in up to 2% of pregnancies.
Hyperemesis gravidarum (HG) is a “potentially life-threatening pregnancy disease that may cause weight loss, malnutrition, dehydration, and debility due to severe nausea and/or vomiting, and may cause long-term health issues for mother and baby(ies),” said the HER Foundation, a nonprofit organization committed to research and education for HG.
Since so many pregnant women (between 50-70%) experience some form of nausea, or “morning sickness,” during their pregnancy, it’s important for women and their obstetricians to be able to distinguish between typical morning sickness and HG. According to the American Pregnancy Association, the key differences between the two conditions are that HG always involves severe vomiting that does not subside past 12 weeks, the inability to keep food down and severe dehydration.
For those women suffering with HG, 20% are afflicted for their whole pregnancy. This was the case for local mom Stevie Doyle, Director of Communications and Engagement for Partnership for Strong Families. When she was pregnant with her first son in 2017, she began getting sick at eight weeks and lasted all the way through delivery. In fact, she threw up six to seven times during her delivery. Although she was very sick, she was never officially diagnosed with HG until her second pregnancy in 2020.
“Since I was able to manage the condition much better the first time, I think that is why it was never officially diagnosed,” Doyle said. “With my second pregnancy, it was way worse. I once threw up 26 times in 72 hours, and I was sent to the emergency room two to three times in the middle of the COVID-19 pandemic.”
After her obstetrician diagnosed her with HG, she worked with her OB to learn what anti-nausea medications worked best for her. Her OB was most worried about severe dehydration and the effect it could have on her and the baby. That is why her OB arranged to have a home health nurse visit her two times a week to administer IV fluids “which made such a huge difference,” Doyle said. Combining that with medication is what helped her manage her condition.
If not properly treated, HG can cause adverse effects for both mom and baby like organ failure, premature birth and low birth weight. If women can’t keep down food, they may not be able to meet their nutritional needs and will make it difficult to keep on weight, said Johns Hopkins Medicine. Dehydration and the buildup of stomach acid can cause an imbalance of electrolytes.
Severe cases of HG may lead to required hospitalization in order to administer IV fluids to restore the proper vitamins and nutrients as well as hydration, says the American Pregnancy Association. Tube feeding may also be needed if a mom is too sick to ingest any food or drink orally. Close monitoring of the baby is also recommended. Doyle said that she got ultrasounds almost every week during the third trimester.
Thankfully, most HG cases can be managed at home through a variety of interventions including IV fluid treatment, medications and other home health remedies like a bland diet and smaller meals spaced throughout the day. HG may also lead to anxiety and depression so speaking to a therapist may help.
It may be difficult to understand how a mother with HG can continue their daily life with such a harmful affliction. Doyle learned how to “get really good at throwing up and moving on with [her] day.” Once she was on a steady plan with IV fluid treatment and medications, just eating a little bit of food helped tremendously.
“For moms diagnosed with HG, you need to work with your OB to gure out what works best for you and your baby,” Doyle said.