Treating Severe Morning Sickness

For some women, pregnancy-related nausea and vomiting can take a serious turn. Discover how doctors diagnose -- and treat -- hyperemesis gravidarum.
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It's all over the news: A royal heir is on the way, and the Duchess of Cambridge (formerly known as Kate Middleton) has been in the hospital being treated for morning sickness. Pregnancy-related nausea and vomiting may have dominated the headlines recently, but they're actually incredibly common, although it's rare for the condition to be so severe that it requires medical attention.

"More than 80 percent of women have some degree of nausea during the first three months of pregnancy," says Sharon Phelan, M.D., an obstetrician at The University of New Mexico Health Sciences Center in Albuquerque. "Because it's so generalized across populations, we think it's a condition that evolution selected for over the years." In other words: Morning sickness might just be good for you. It's likely that in caveman times, pregnant women who were totally turned off by the idea of eating unusual food during the first trimester -- when the baby is most vulnerable -- avoided certain toxins that could have lead to miscarriage. That's right: Your morning sickness is trying to protect you!

That probably isn't much consolation to the women who are vomiting several times a day, however. Morning sickness seems to stem from sensitivity to the hormone human chorionic gonadotropin or hCG, which peaks in the first trimester. "Some women will have normal levels of the hormone but will be very sensitive to it, and others will have high levels for some reason," Dr. Phelan says. (In the olden days, before ultrasounds, severe morning sickness served as an early clue that a woman was pregnant with twins -- and, therefore, had plenty of hCG in her system.)

In the vast majority of cases, morning sickness is more bothersome than dangerous. "Women worry that if they're not holding down food, and if they're even losing a little weight, they'll starve the baby," Dr. Phelan says. "This is not the case. The baby is very good at taking what it needs from your system." The bigger concern is Mom's hydration levels -- the body needs fluids to function properly. Plus, the more dehydrated you get, the more nauseated you feel, creating a vicious cycle. (This explains why morning sickness, which can occur throughout the day, is most common in the morning, when the body is dehydrated, Dr. Phelan explains.)

For a minority of women, though, morning sickness isn't just annoying -- it's downright dangerous, a severe condition known as hyperemesis gravidarum (HG). "While there is no single definition of hyperemesis gravidarum, when a patient has lost 5% or more of body weight or has been unable to keep anything down, including water for 24 hours, they have what we consider HG and require intervention," says Sharon Mass, M.D., of the University of Medicine and Dentistry of New Jersey. "Of course, diagnosis is subjective; if a patient has kept down one glass of water but is completely miserable, I might still consider that HG."

If lifestyle changes, like sipping water and avoiding troublesome food, don't help the condition, mothers with HG might be admitted to the hospital. Most women will just get an IV to rehydrate their bodies. Sometimes the IV will contain antinausea medications such as Zofran or Reglan; these prescription drugs can be taken orally, but patients with HG often can't keep them (or anything) down. "These drugs are both Category B, which means they're considered relatively safe to take during pregnancy," Dr. Mass says. "I know many women want to avoid medications in pregnancy, but there are safe treatments out there to avoid dangerous dehydration." In extreme cases, patients who become malnourished as a result of their inability to eat may also be given Total Parenteral Nutrition, or TPN, intravenously.

One more thing to keep in mind: If the nausea and vomiting continue beyond 16 weeks of pregnancy, or the onset is later than that, "it probably isn't garden-variety morning sickness," Dr. Phelan warns. In that case, see a doctor to determine the cause, which might be food poisoning or gallbladder disease.

Copyright © 2012 Meredith Corporation.

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