Royal pregnancy calls attention to hyperemesis

Hyagriv Simhan

Britain’s royal family made headlines earlier this month when it announced that the Dutchess of Cambridge, Kate Middleton, was expecting her third child. At that time, it was also revealed that the future queen was suffering from hyperemesis, just as she had in her earlier pregnancies.

According to the American Pregnancy Association, hyperemesis is distinguishable from the more common form of morning sickness in that the nausea does not go away, is accompanied by severe vomiting, and vomiting that causes severe dehydration. In addition, women with hyperemesis cannot keep their food down.

Hyagriv N. Simhan, MD, MS, medical director of obstetrical services at Magee-Womens Hospital at the University of Pittsburgh Medical Center tells Healio Family Medicine the condition “complicates” about 1 to 3 percent of all pregnancies.

Though the condition is rare, it can be severe, according to the Hyperemesis Education and Research Foundation. This group also states that diagnosis is typically made by looking for ketones, measuring weight loss, and evaluating how well the mother can perform her normal daily activities.

As a service to its readers, Healio Family Medicine consulted several experts for additional information about hyperemesis. Here’s what you need to know:

Why it happens

“Hyperemesis is thought to occur because of the brain’s response to the pregnancy hormone, hCG. Conditions where the hCG level is very high (eg, twins or triplets) can make hyperemesis more likely,” Simhan said, adding that some women are more sensitive to hCG than others. “We don’t understand why that may be, but some women experience much more severe nausea and vomiting than others, despite having a comparable hCG level.”

Risk factors

There are a number of factors that place a woman at higher risk for hyperemesis, according to the Hyperemesis Education and Research Foundation. This group states that these include, but are not limited to: untreated asthma, high saturated fat diet and posttraumatic stress disorder. In addition, patients who have a history of kidney disease, gall bladder disease, allergies and motion sickness are also among those at risk for hyperemesis.

Questions to ask patients

Simhan suggested that medical professionals query patients regarding how many times they are vomiting, as well as the trajectory of weight loss/gain to distinguish between hyperemesis and the more common form of morning sickness.

Signs it’s not morning sickness

According to the Hyperemesis Education and Research Foundation, women who lose five to 20 pounds or more, have nausea that keeps them from wanting to eat or drink, vomit often and vomit bile or blood if the nausea is left untreated may have hyperemesis.

Treatment

“Treatment of hyperemesis focuses on therapies to reduce the feeling of nausea, treatment of associated conditions (such as reflux), correction of dehydration and electrolyte abnormalities with oral or IV hydration, and nutritional replacement therapy,” Simhan said. “To alleviate the nausea, we generally start with behavioral therapy – altering food choices and timing of meals, as well as strategies like acupressure. When necessary we move on to anti-nausea medications or to other forms of feeding, some of which avoid the stomach.”

Disclosure: Healio Family Medicine was unable to determine Simhan’s relevant financial disclosures prior to publication.