“Morning Sickness” vs. Hyperemesis Gravidarum

Photo by Mikaela Wapman

Photo by Mikaela Wapman

Pregnancy-related Nausea or “Morning Sickness”

Pregnancy-related nausea is a common enough concept for most of us: nausea and vomiting during the first trimester, food aversions, and beyond.

Morning sickness – a misnomer, as it’s symptoms strike throughout the day for most women –  usually begins around the 6th week of pregnancy and tends to last for the duration of the first trimester (or until around the 14th week), but many women don’t experience relief from the symptoms for another month or so. And some women don’t feel a lessening of symptoms until they give birth, or somewhere around 40 weeks.

Pregnancy-related nausea affects over 70% of all pregnant womenAccording to Baby Center, more than half of pregnant women experience both nausea and vomiting, a quarter experience only nausea, and the remaining quarter are don’t experience any form of “morning sickness”.

Hyperemesis Gravidarum

Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting during pregnancy that is characterized by “unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids”. If HG is severe enough, or untreated, it can be associated with:

  • loss of greater than 5% of pre-pregnancy body weight (usually over 10%)
  • dehydration and production of ketones
  • nutritional deficiencies
  • metabolic imbalances
  • difficulty with daily activities

While the majority of women experience some form of morning sickness, around 1-3% of women are hospitalized for HG. That may seem pretty low, but these statistics offer very limited information, as many of the women who suffer from HG are treated as outpatients with mild to severe symptoms. Helpher.org – a website devoted to raising awareness about HG – goes on to say,

There are reports from hundreds, if not thousands, of women who terminated out of desperation when given the diagnosis of morning sickness and given inadequate treatment. One study by Zhang, et al of 1867 women found a 10.8% incidence of severe vomiting. Many women are not represented in current statistics which only report the number of women hospitalized as inpatients. HG is not a rare disorder.

Like more moderate forms of pregnancy-related nausea and vomiting, symptoms from HG can resolve around 21 weeks, though – for less than half of these women – can last for the duration of the pregnancy. The effects of all forms of HG are severe: considering the cost of additional doctor’s visits, outpatient care, consultations, and treatments for consultations, the annual cost could reach to one billion dollars.

Beyond the financial effects of HG are the emotional and psychological impacts: family relationships are disrupted, women could be “misdiagnosed by a disease erroneously presumed to be psychological”, and women could lose their jobs because of the debility. 

While there is no known prevention of HG, there are many ways to alleviate and manage the symptoms. These include: bed rest, acupressure, herbs (ginger or peppermint), IV fluids to restore lost hydration, electrolytes, vitamins and nutrients, tube feeding, and medications.

Distinguishing between Pregnancy-Related Nausea and HG:

Pregnancy-related nausea is what is commonly referred to as morning sickness. Symptoms of those suffering from Hyperemesis Gravidarum are generally more severe, as is depicted in the chart below (source: www.helpher.orgAmerican Pregnancy).

Why do we have pregnancy-related nausea, anyways?

Theories regarding the etiology of pregnancy-related nausea and HG are inconclusive. This is partially because pregnancy-related nausea and HG are influenced by a number of factors, and may vary among women depending on their biological makeup (genetics), body chemistry, and general health.

Theories regarding the cause of  pregnancy-related nausea and HG center on hormonal changes (increase in estrogen during pregnancy) and physical changes (relaxed esophageal sphincter) during pregnancy, since the time period is restricted to pregnancy.

Other half-witted theories include: one’s psychological state may be related to the development of pregnancy-related nausea and HG. In this vein, women who are frustrated, depressed, isolated, and / or have feelings of helplessness are more likely to experience pregnancy-related nausea or HG. Understandably, others respond by pointing to the fact that most, if not all women experience psychological effects (frustration, anger, depression, isolation, and feelings of helplessness) secondarily to  pregnancy-related nausea and HG.

At present moment, there are no conclusive theories as to the etiology of pregnancy-related nausea and HG. Click here to learn more about the many theories of pregnancy-related nausea and HG’s etiology.

Narratives from HG

To get a sense of what Hyperemesis Gravidarum (HG) can look like, check out Huffington Post ‘s post What It Really Feels Like to Have Hyperemesis Gravidarum”. An account of a third time mom who experienced HG so severe that she was hospitalized for 11 days, and spent the remaining duration of her pregnancy receiving IV fluids and medications for HG through a PICC line and stomach pump. Alexa continues,

One of the worst things about HG is how isolating it is. I cannot go out, cannot even talk on the phone for a long time because it makes me feel sick. I cannot cook, everything smells terrible to me, and even walking to the bathroom makes me vomit most days. I also have ptyalism, which is hyper-salivation, and swallowing it makes me vomit too, so I am constantly spitting into a cup. I feel disgusting.

Her account ends happily, with her giving birth to a 9 pound, 11 oz son (described by her OB as “the world’s most effective parasite”). For her, her HG improved after about 22 weeks of pregnancy, though she is the first to remind us that “far too many sufferers are severely ill until they give birth”. Read the whole thing here

For more information on Hyperemesis Gravidarum, visit www.helpher.org and beyondmorningsickness.com.

Maternal mental illness comes in all shapes and sizes

Pam Belluck of the New York Times published a two-part piece (see part 1, part 2) on the common and varied onset of maternal mental illness. The articles feature a compilation of stories that chillingly portrays the experience and perspective of mothers who encounter diverse manifestations of maternal perinatal depression: depression, anxiety, obsessive-compulsive disorder, and bipolar disorder. Of course, the prevalence of postpartum depression has been well-recognized: the effects of perinatal depression, or depression during the pregnancy or the first year postpartum, is “impressively common and can have devastating consequences” for women, children, and families. However, recent studies challenge the common understanding that symptoms present only in the weeks following delivery. Rather, researchers say that many women begin experiencing depression during pregnancy, and can develop throughout the first year postpartum:

Postpartum depression isn’t always postpartum. It isn’t even always depression. […] In the year after giving birth, studies suggest, at least one in eight and as many as one in five women develop symptoms of depression, anxiety, bipolar disorder, obsessive-compulsive disorder or a combination. In addition, predicting who might develop these illnesses is difficult, scientists say. While studies are revealing clues as to who is most vulnerable, there are often cases that appear to come out of nowhere.

Sometimes cases are mild, resolving themselves without treatment. But a large analysis of 30 studies estimated that about a fifth of women had an episode of depression in the year after giving birth, about half of them with serious symptoms.

Depression in pregnancy can be missed because symptoms like trouble sleeping and moodiness also occur in pregnant women who are not depressed. And doctors have historically been taught in medical school that “women don’t get depressed during pregnancy because they are happy,” said Dr. Katherine L. Wisner, a professor of psychiatry and obstetrics at Northwestern University.

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Holding Hands With a Newborn Baby” by Bridget Coila is licensed under CC BY 2.0

The second NYT article focuses on the story of one mother, Cindy Wachenheim, who, despite repeated assurances from her doctors, became obsessed with the notion that she caused her son irrevocable brain damage. Read the whole story, it is worth it.

Experts say such breaks from reality are likely symptoms of postpartum psychosis, which affects only one or two in 1,000 mothers. About 4 percent of those hurt their children; about 5 percent kill themselves. Flagrant cases usually emerge soon after birth; women may hear voices or feel compelled to inflict harm, like Andrea Yates, who drowned her five children in a bathtub in 2001, or Dena Schlosser, who in 2004 cut off her infant’s arms. Both women were ultimately found not guilty by reason of insanity.

Most other maternal mood disorders do not involve such unshakably unrealistic convictions; most women know something is wrong, and although they fear they will harm their children, they rarely do.

Support for mothers experiencing perinatal depression can be found here, here, here, and here.

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via NYT