Hyperemesis Gravidarum: Early Signs and  Effective Management

What is Hyperemesis gravidarum?

Hyperemesis gravidarum (HG) is a severe and persistent form of nausea and vomiting during pregnancy that is much worse than regular morning sickness. It can cause electrolyte imbalances, nutritional deficiencies, and dehydration, and people often need to be hospitalized to get treatment like IV fluids and antiemetics. Extreme symptoms include vomiting all the time, feeling worn out, and getting dizzy. It can get in the way of daily life, but with the right care, it can be managed.  

Important signs: 

• Severe, uncontrollable sickness and vomiting, often all day (not just in the mornings). The inability to hold down drinks leads to dehydration. More than 5% of their pre-pregnancy body weight has been lost. 
• Electrolyte imbalances and ketonuria (ketones in the urine) are two typical signs. This condition can be debilitating, necessitating bed rest and making it challenging to perform daily activities. 

Causes and Risk Factors: 

• The cause is unknown, but it may be linked to pregnancy hormones, especially rising HCG levels. 
• Some things that put you at risk are having multiples (twins, etc.), a history of motion sickness, headaches, or a family history of these conditions. 
• For most women, the first signs show up between 4 and 6 weeks into pregnancy. 
• It usually gets better between 16 and 20 weeks, but in some cases it can last the whole pregnancy. 
• The treatment focuses on rehydrating (IV fluids), treating sickness (antiemetics), and providing nutritional support.

Importance: 

Early diagnosis and treatment are essential to keep both the mother and the baby from having serious problems. With the right care, results are usually satisfactory.

Why do some women have hyperemesis gravidarum

1. Effects of hormones

• HCG (human chorionic gonadotropin): High levels of hCG are highly linked to HG, especially in the early stages of pregnancy. When women are pregnant with twins or moles (trophoblastic disease), their hCG levels are often higher, and their symptoms are worse.
• Estrogen and progesterone: These hormones slow stomach emptying, which can cause nausea and vomiting.
• The placenta makes a hormone called GDF15, which may play a key role, according to a new study published in 2023.

2. Genetic and family history of disease

• A history of HG in the family raises the risk. 
• Differences in genes that affect hormone sensitivity may explain why some women have serious symptoms, and others don't.

3: Risk Factors

• "Primigravida" means "first pregnant."
• There were multiple pregnancies, such as twins or triplets.
• Weight gain.
• The patient had a history of HG before pregnancy.
• Trophoblastic diseases, such as molar pregnancy, have been identified as contributing factors to weight gain.

4. Other Factors That Contributed

• Issues with the pituitary gland can lead to excessive hormone production.
• Stress in the mind may make symptoms worse, but it's not thought to be the main reason.
• The thyroid may be involved: High levels of thyroid hormones can mimic or exacerbate the symptoms of HG.

Also, read https://www.breathethroughhg.org/hyperemesis-gravidarum

Important Signs of Hyperemesis Gravidarum

• Severe sickness and throwing up (often more than three times a day)
• Loss of weight (usually more than 5% of pre-pregnancy weight)
• Dehydration (because they can't drink enough)
• Imbalances in electrolytes (low potassium, sodium, etc.)

Ketosis occurs when the body breaks down fat for energy, which can be detected in urine.

• Feeling dizzy, faint, or lightheaded; 
• Being worn out and weak from not getting enough food or water;
• Headaches and confusion (from being dehydrated and having chemical changes)
• In severe cases, individuals may experience low blood pressure and a rapid heart rate.

The video explains how hyperemesis can be cured

How to treat heavy periods during the first stage of pregnancy

Different ways to treat hyperemesis gravidarum in the first trimester

1. Care that helps

• Hydration: liquid given through an IV to treat dehydration.
• Replacing electrolytes: potassium, sodium, and other ions are checked and fixed.
• Nutritional support: extra vitamins, especially thiamine to keep Wernicke's encephalopathy from happening.
• Getting enough rest and lowering your stress can help ease your symptoms.

2. Measures of diet and lifestyle

• Increase the frequency of small meals.
• Avoiding triggers such as strong smells and fatty or spicy foods is also recommended.
• Wristbands with ginger and massage may help a little.
• Some people can handle cold foods better than hot ones.

3. Treatment with drugs (safe in the first trimester)

• In the first place, vitamin B6 (pyridoxine) and doxylamine (an antihistamine) are used.
• Antihistamines (diphenhydramine, meclizine) are the second line of defence.
• Pentazocine and prochlorperazine are phenothiazines.
• If the previous treatments are ineffective, the third-line option is Ondansetron; however, caution is advised when using this drug, as some studies indicate a small risk of birth defects, although it is typically prescribed when the benefits outweigh the risks.
• Metoclopramide is a dopamine blocker that is usually safe.

4. Cases That Won't Go Away

• Patients may need to stay in the hospital and receive water and medicines to help with vomiting.
• In cases where other treatments don't work, corticosteroids like methylprednisolone may be considered. However, this should only be done after 10 weeks of pregnancy because of the risk of cleft palate.
• Enteral or parenteral nutrients if the person can't eat or drink.

How to treat heavy periods during the second trimester

How to Treat Hyperemesis Gravidarum During the Second Trimester

1. Care that helps

• IV water and electrolytes: fix imbalances and dehydration.
• Giving extra thiamine stops Wernicke's encephalopathy, especially before giving glucose through an IV.
• Nutritional support: oral intake is recommended if it can be managed; if not, enteral feeding (nasogastric or nasojejunal tube) or parenteral nutrition should be used in the worst cases.

2. Treatment with drugs

• As a first step, keep giving pyridoxine (Vitamin B6) and doxylamine.
• Antihistamines (diphenhydramine, meclizine) and phenothiazines (promethazine, prochlorperazine) are used as a second line of defence.
• Third-line: Ondansetron and metoclopramide are still commonly used if the first two don't work.

"Corticosteroids: Methylprednisolone or prednisolone can be given after 10 weeks of pregnancy for HG that doesn't get better. This is because the risk of cleft palate is highest in the first three months of pregnancy."

3. Hospital stays and advanced medical care

• Enteral feeding is better than parenteral nutrition because it keeps the gut healthy.
• Parenteral nutrition: This is only used in grave, long-term cases where enteral feeding is not possible.
• Monitoring involves regularly checking your weight, urine, ketones, electrolytes, and thyroid function.

Problems with hyperemesis gravidarum

Problems for mothers

• Electrolyte imbalance and dehydration:  Loss of water and electrolytes (sodium, potassium, and chloride) can make you weak, cause irregular heartbeats, and make you confused.
• Vitamins and minerals can be lost when you vomit for a long time, especially thiamine, folate, and B12.
• Wernicke's encephalopathy (confusion, weakness, and problems with eye movement) can happen if you don't get enough thiamine.
• Loss of weight and muscle
• It is normal to lose more than 5–10% of your pre-pregnancy weight.
• Metabolic acidity can happen when your body breaks down fats for a long time.
• Problems with the intestines and liver
• Extreme cases may result in elevated liver enzymes and jaundice.
• Anxiety, sadness, and being alone because of a long illness are some of the psychological effects.

Fetal Complications: 

• Low birth weight, a poor diet, and dehydration in the mother can slow the growth of the fetus.
• Early Birth  
• Severe HG raises the chance of giving birth early.
• SGA (Small for Gestational Age): Babies may be smaller than expected for their gestational age.
• Possible Effects on Neurodevelopment
• Some studies show that if a mother is severely malnourished, there may be long-term risks, but the evidence is still growing.
• Stopping excessive vomiting during pregnancy

Ways to avoid getting hyperemesis gravidarum

1. Steps to Take Before and During Pregnancy

• Prenatal medicines before getting pregnant: starting folic acid and multivitamins early may lower the risk of feeling very sick.
• Please identify the factors that may put women at risk. For example, women who have had HG, repeated pregnancies, or molar pregnancies in the past should be closely watched.

2. Changes to your diet

• Small meals more often: This keeps your stomach from being empty, which can make you feel worse if you're feeling sick.
• Don't use triggers: Foods with strong smells or that are hot, fatty, or greasy tend to make symptoms worse.
• High-protein snacks: Protein helps keep blood sugar stable and may also make you feel less sick.
• Some people can handle cold or bland things better than hot ones. 
• Hydration: Drinking lots of water and clear or ginger-based drinks throughout the day.

3. Changes in lifestyle

• Rest and less stress: Being worn out and stressed can make you feel sicker.
• Wristbands with acupressure may help with motion sickness.
• Ginger drinks or supplements have been shown to help with mild nausea caused by pregnancy.

4. Health Care Prevention

• Taking antiemetics early: Women who are at a high risk (for example, who have had HG before) may be given vitamin B6 and doxylamine early in their pregnancy.
• Taking extra thiamine: stops Wernicke's encephalopathy if puking gets severe.
• Close monitoring: HG can't get worse if it's treated early with IV water and medicines.

Conclusion

Hyperemesis gravidarum (HG) is a major problem that can happen during pregnancy.  It is difficult to predict and completely avoid because it is caused by many things, including changes in hormones (mainly HCG, estrogen, and GDF15), genetics, and pregnancy-specific risk factors.

HG isn't just "bad morning sickness"; it's a real illness that can put both mom and baby in danger. Early intervention, care from a team of experts, and patient teaching are all essential for lowering risks and improving outcomes.