When I was pregnant, I had all the run-of-the-mill concerns (you know, everything from will I be a good mom? to Ugh, why does my back hurt?). But mostly, my pregnancy worries were entirely uncommon: Will I ever gain weight? Have I eaten anything this week? Can a fetus survive on iced tea alone?? These are the strange questions I was left with when hyperemesis gravidarum (HG) hit me during pregnancy.
HG is a severe manifestation of frequent nausea and vomiting during pregnancy and affects up to 2 percent of pregnancies, says Jessie Rubin, M.D., an Ob-Gyn in Houston, Texas. Translation: This is morning sickness gone wild, and I was one of the super-few, super-unlucky ones who have to deal with it.
For me, HG meant vomiting about four times per day until the 20th week of my pregnancy (most typical morning sickness, on the other hand, starts to subside by the second trimester) and subsisting for five months on a bizarre diet of iced tea, lemonade, gummy bears, and the occasional avocado. By six months pregnant, I had dropped from 140 pounds to 124 (I'm 5'10")—and I've never felt worse in my life.
I had never heard of hyperemesis while I was growing up, despite closely watching the progression of all my mom's pregnancies. And the condition didn't make much of a mark in the media until Kate Middleton, the Duchess of Cambridge's struggle made headlines in 2014. But for precisely half of my 41-week pregnancy, HG was my entire life. And while it's certainly a horrible condition even for a royal with plenty of staff, having to endure it while working full-time and paying rent and commuting on the NYC subway seemed like cruel and unusual punishment.
Still, I learned a few things along the way. So whether you're struggling with HG, debating a diagnosis, or even just wondering what "HG" means, here are five things you probably didn't know about this condition that you definitely should.
Morning sickness, although zero fun, is pretty much par for the course in pregnancy. It's so common, in fact, that up to 85 percent of pregnant women experience it, explains Dr. Rubin. Compare that with the up to 2 percent who have to deal with HG. I know I wanted to punch every well-meaning, morning-sick pregnant pal who heard about my severe vomiting and weight loss and sweetly suggested I try ginger candy because it had really helped her pre-breakfast nausea. ("You still get to eat breakfast??" is probably how I responded).
So how do you know it's hyperemesis? Often via "a clinical diagnosis of exclusion," Dr. Rubin says. "Common symptoms include severe nausea and vomiting, weight loss below 5 percent of pre-pregnancy weight, ketonuria, electrolyte imbalance, and can even include thyroid and liver dysfunction." I, for one, received the HG diagnosis after reporting the frequency of my vomiting, and also dropping down to what I weighed as a 12-year-old.
Symptoms typically crop up around 9 weeks and tend subside around the 20-week mark, though sometimes they last longer.
Hyperemesis—as well as regular-old morning sickness—"is a result of the circulating levels of HCG, the pregnancy hormone," explains Katherine Hicks, M.D., an Ob-Gyn who practices in Massachusetts. Although certain lifestyle factors (getting rest, staying hydrated, and all those ginger tips) may be able to ease symptoms, rest assured it's not your lifestyle that got you into this mess in the first place.
"Unfortunately, science has not made great strides in understanding or treating this condition, although at least we no longer consider it 'psychological,' as used to be the case," explains Dr. Hicks. (How awful—I imagine the only thing worse than a crippling case of hyperemesis is being told you've just invented it in your mind.)
But although researchers still have a lot to learn about HG, there do exist some medications—such as Diclegis and Zofran, both of which I took at my doctor's advice—that may be able to provide relief. Diclegis is an FDA-approved drug for treating nausea and vomiting in pregnancy. Zofran, while not approved by the FDA, is the most common antiemetic medication prescribed to pregnant women.
And guess what? While lifestyle and dietary changes are the first line of defense when it comes to treating nausea, taking medication for severe nausea during pregnancy is often perfectly fine (check with your doctor first, of course!). There is no Mom Martyr award for suffering through hyperemesis unaided. Surgeon Sarah Ghanta, M.D., explains that "at a certain point, if the mother isn't eating at all, she's not helping the fetus. If the mom is malnourished, the chances of having problems with the baby go up. So you weigh that risk against the risk of a drug doing harm; most people think that as long as the drug isn't being taken frivolously, it's better to keep the mom eating and nourished."
Dr. Rubin adds that currently, clinical studies on the potential teratogenic effects (whether it causes increased birth defects) of Zofran are contradictory. "According to the American College of Obstetricians and Gynecologists, the absolute risk to the fetus is low," she says. "However, all medications should be considered only after an individualized assessment of the potential risks and benefits."
When women get this sick, the biggest medical concern is dehydration and electrolyte imbalance. It's mom we're worried about, not baby, because babies don't require many calories at this point and they'll take whatever they need directly from their mothers.
"I have always been amazed at the ability of the fetus/infant to thrive despite the horrendous symptoms of the mother. The babies are almost always a healthy size—sometimes big! Which means that they have a miraculous talent for robbing nutrients from their mother," Dr. Hicks says.
Of course, if you're going days without keeping down food or hours without liquids, you should absolutely see your doctor, like I did; you may need hospitalization, replenishment with IV fluids, and/or medication. I was lucky that I was usually able to drink water (or at least the blessed savior of my entire pregnancy, iced tea) without vomiting, so I was only hospitalized once. And even though I only gained 12 pounds by 41 weeks pregnant, my son was born weighing 7.5—spot-on average.
The weird thing about hyperemesis gravidarum (also known as HG) is that the more dehydrated mom becomes, the more nauseated she'll become and the more likely she is to vomit. The most important treatment for HG is IV hydration and medications to stop the nausea and vomiting.
Most women feel less miserable and more human by about 20 weeks of pregnancy, though some feel rotten for the entire nine months. Some moms-to-be who can't eat at all need a PICC line (Peripherally Inserted Central Catheter), which is like an IV that's inserted into a vein (usually in the upper arm) and advanced until it reaches a large vein in the chest near the heart. She can get TPN (Total Parenteral Nutrition, a custom-made IV solution) therapy through her PICC line to provide all the nutrients that she and her baby need. This usually requires ongoing hospitalization, though some patients can receive care at home from a home health nurse.
Women with hyperemesis gravidarum in the early stages of pregnancy don't face a higher risk of miscarriage. In fact, it's usually associated with high levels of pregnancy hormones, which indicate a solid pregnancy.
Mom, however, can be at high risk for complications of dehydration including tachycardia (abnormally fast heart rate), low amniotic fluid volume, premature labor — and, in cases where mom receives no medical treatment, dehydration can potentially be deadly. Expectant women who can't keep any nutrition down for a long period of time are at risk for muscle wasting and bone loss.
In more ways than one. Although Her Royal Highness, The Duchess of Cambridge has suffered royally from hyperemesis during all three of her pregnancies, you are not necessarily doomed to face HG during every pregnancy just because you did in your first. About half of women who are diagnosed with HG once find that the symptoms recur in another pregnancy. But that means half of them don't!