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Just the facts: HG

Today is HG World Awareness Day.  As you know, I have had HG 3 times.  After my first bout of HG, I swore I would never get pregnant again.  I had no idea that my first pregnancy would turn out to be me easiest.  My second pregnancy almost killed me, and it did kill my baby.  During my third pregnancy I had better, pro-active care, but I still spent months on being fed via an IV and almost lost my child because the force and frequency of my vomiting was causing my placenta to separate. At 19 weeks they told me they were sorry, my baby was not going to make it.  She did make it, my little miracle, but after 3 years spent barely surviving, almost dying, and throwing up more than 1,000 times, I knew that there would be no more children for me.
You see, you remember that time when you got food poisoning so bad and you threw up all day and night and became so dehydrated you could barely lift your head off your pillow.  The next day you went back to work and told everyone it was the most horrible experience of your life and you hoped to never be that sick again.  Yeah, that’s what HG is like – except it is 24/7 for 9 long, torturous months.  In several of our HG World Awareness Posts we have talked about the emotions of HG, today an ob/gyn talks about some of the medical facts and highlights the need for better research and health care protocols.  The only thing that helped me in my last pregnancy is the fact that my new doctor had some experience treating HG and was willing to give me the medications that my first doctor wouldn’t. Well, that, and the liquid nutrition that came from home health care.

Most women will have some nausea in pregnancy. Even normal nausea in pregnancy will often force women to change their routine in order to cope with it. For about 1% of women, the nausea and vomiting of pregnancy becomes so severe that it can cause weight loss and dehydration. This condition is called HG gravidarum (HG).

Before the age of modern medicine, it was common for women to die from HG if their babies did not die first. While maternal death is very rare now, it still does occur, and other complications such as kidney failure, esophageal tears, malnutrition, ulcers and neurologic complications are still seen far too often. There are consequences for the baby as well. Traditionally, it was assumed that the baby takes what nutrition it needs from mom and does not suffer any consequences from HG. However, newer research has shown that there is a higher risk of miscarriage in the second trimester of pregnancy when the HG is most severe. There may also be a higher risk of certain neurodevelopmental disorders. Termination of pregnancy occurs in 10% of pregnancies, often in desperation when effective care isn’t offered.

The good news is that good medical care can prevent most of these complications for both mom and baby. Prevention is the first step. When women come in very early in pregnancy, I will ask them about nausea and vomiting.  Even if they only have mild symptoms at that visit, I will recommend more rest, changes in their vitamins, discuss over the counter medications that are safe and effective, and instruct them to call if symptoms get worse. Studies have shown that doing these things will prevent some of them from developing HG. If they do have weight loss, or show signs of dehydration, then other treatments that can be used are prescription medications (often the same medications people receive for nausea associated with cancer chemotherapy), IV hydration, IV nutrition, and tube feedings. Women who have had HG before need the aggressive treatment even with the mildest symptoms. Without it, about 80% will get HG again.

If there is effective and safe care available, why do we still see so many of these complications? While some women are unable to get care before complications arise because of lack of medical coverage or cost, many do seek care, and yet don’t get treatments that we know are safe and effective. Why not? One reason is that doctors see many women with normal nausea and vomiting in pregnancy and very few women with HG, many of them will become complacent and ignore HG as well. Also, some doctors (and many well meaning family, friends, and patients themselves) are concerned about potential risks to the developing fetus from using medications even when the medications we use are clearly safer than the alternative. And last, for some women the medications that we have available are not enough to keep them from vomiting and allow them to stay hydrated and nourished on their own. For these women, the lifesaving treatments that are used also have the chance of severe and life threatening or life changing complications.

There is still very little research in to HG, and we desperately need more in order to learn better ways to treat all women with HG safely and effectively in the future. We also need to educate those medical providers that see women with HG so that we do a better job treating women today.
Some symptoms of HG:
  • Ketosis
  • Vitamin/electrolyte deficiency
  • Anemia
  • Liver enzyme elevation
  • Gall bladder dysfunction (stones)
  • Dehydration
  • Low blood pressure
  • Jaundice
  • Rapid heart rate
  • Overactive thyroid
  • Weight loss of 5% or more (from pre-pregnancy weight) – I lost 30 lbs in about a week
  • For more information, please visit the Hyperemesis Education and Research Foundation (HER Foundation) at www.helpher.org

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