There is a kind of morning sickness that makes you vomit to the point of doubting your life. It is called hyperemesis gravidarum. How should it be treated?

Author: Zou Liying, Chief Physician, Beijing Obstetrics and Gynecology Hospital, Capital Medical University

Reviewer: Teng Xiuxiang, Chief Physician, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University

It is very common to experience nausea, vomiting and loss of appetite in early pregnancy. Most pregnant women can get through this period safely through dietary adjustments, family support and self-overcoming. Only a small number of pregnant women will vomit to the point of doubting their lives and need to go to the hospital for treatment, or even have to terminate the pregnancy. This type of morning sickness is called hyperemesis gravidarum.

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1. What is considered hyperemesis gravidarum?

Under normal circumstances, there will be symptoms of nausea and vomiting after pregnancy, but you can still eat after vomiting, and your weight will not drop significantly. Your normal life will not be affected too much. This is a normal pregnancy reaction after pregnancy.

Less than 10% of pregnant women will develop hyperemesis gravidarum, unable to eat or drink. Their weight will drop significantly in a short period of time, with a drop of more than 5%. For example, if they weighed 100 pounds, they will lose 5 pounds or even more. Their mental state may also become abnormal, affecting their normal life. If ketone bodies are found in the urine during examination, or if there are signs of acidosis, they are considered hyperemesis gravidarum.

Hyperemesis gravidarum can occur at six or seven weeks, or even later. Generally speaking, hyperemesis gravidarum usually occurs in the early pregnancy, which is most common before the twelfth week of pregnancy.

2. Why does hyperemesis gravidarum occur?

The specific pathogenesis of hyperemesis gravidarum is still unclear, and its occurrence is related to many factors. For example, changes in estrogen and progesterone levels after pregnancy are the most common cause of hyperemesis gravidarum. If the reaction to taking estrogen and progesterone is particularly strong, then the early pregnancy reaction after pregnancy will be more obvious. In addition to estrogen and progesterone, there is another hormone called human chorionic gonadotropin, or HCG. HCG will rise rapidly after pregnancy, and changes in HCG levels are also related to early pregnancy reactions.

There is also a view that if certain nutrients are lacking, such as vitamin B1 deficiency, it may cause more severe early pregnancy reactions and lead to severe vomiting during pregnancy.

The occurrence of hyperemesis gravidarum is also related to personal factors. For example, if you are nervous after pregnancy and feel the early pregnancy reaction very strongly, the vomiting may be more severe. For example, if you are prone to motion sickness, your morning sickness may be more severe after pregnancy. In addition, if the pregnant woman has certain diseases, such as loose cardia and easy acid reflux, the vomiting may be aggravated after pregnancy. For example, if the pregnant woman suffers from chronic gastritis, hepatitis, cholecystitis, migraine, etc., combined with the early pregnancy reaction, it will manifest as hyperemesis gravidarum, especially severe vomiting in the early pregnancy.

If you experience hyperemesis gravidarum, you must go to the hospital for a complete examination and intervention and treatment based on the cause. Because when hyperemesis gravidarum develops, it is difficult to relieve it through self-regulation, and medical intervention is usually required. If it is not treated in time, the condition will gradually develop and cause many complications.

3. What are the dangers of hyperemesis gravidarum?

The most serious complication of hyperemesis gravidarum is Wernicke's encephalopathy, which manifests as apathy, eye muscle paralysis, and even loss of consciousness, which is life-threatening.

Hyperemesis gravidarum may cause esophageal and cardiac tears during frequent vomiting.

Severe vomiting during pregnancy and inability to eat may cause electrolyte imbalance, leading to dehydration, which may be life-threatening in severe cases.

Hyperemesis gravidarum may also affect liver and kidney function. The impact on liver function will in turn aggravate nausea and vomiting. Insufficient fluid in the body will affect kidney function, which will manifest as oliguria or anuria.

The thyroid function of pregnant women with hyperemesis gravidarum may sometimes be affected, causing hyperthyroidism.

When hyperemesis gravidarum endangers the life of the pregnant woman, the pregnancy may have to be terminated. In fact, the proportion of this happening is very, very low, and this situation generally will not occur as long as it is treated in time.

The above are the effects and harms on the mother. Many pregnant mothers are worried about whether hyperemesis gravidarum will affect the development of the fetus. Foreign studies have shown that severe hyperemesis gravidarum may lead to fetal growth restriction, but in fact, after hyperemesis gravidarum is corrected and treated in time, the impact is not significant, so don't worry. Generally, hyperemesis gravidarum that can be corrected through treatment will not affect the baby's growth and development.

In addition, vomiting alone will not lead to fetal growth retardation and spontaneous abortion. Some current research evidence shows that pregnant women who have severe reactions such as nausea and vomiting during pregnancy are less likely to have spontaneous abortion and fetal growth retardation than pregnant women who do not have severe early pregnancy reactions. This may be because their hormone levels are relatively high and they can better maintain pregnancy.

4. How to treat hyperemesis gravidarum?

The safest drug for treating morning sickness is vitamin B6. Generally, multivitamins contain vitamin B6, and a certain amount of vitamin B6 is also consumed in the diet. Vitamin B6 has a preventive and therapeutic effect on morning sickness, but it does not mean that additional vitamin B6 supplementation will definitely solve the problem of morning sickness. Sometimes other antiemetic drugs are needed, such as diphenhydramine, dimenhydrinate, metoclopramide, doxylamine, etc. It is not recommended for pregnant women to take antiemetic drugs on their own, and they must take them under the guidance of a doctor. In addition, sometimes severe vomiting during pregnancy cannot drink water, and taking medicine becomes a problem. At this time, hospitalization and infusion treatment are required.

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If the nausea and vomiting is so severe that you vomit even when you drink water and cannot eat anything, then don't eat anything and fast first to avoid losing more body fluids due to vomiting. After fasting, you can replenish fluids and nutrients through infusion, and infuse some antiemetic drugs to improve the situation of severe vomiting. In this process, you should also improve your sleep condition, as poor rest will also aggravate morning sickness.

After intervention treatment corrects the vomiting, you can gradually resume eating. After the most sensitive period, the symptoms of morning sickness will gradually disappear.

So, will severe vomiting occur again after the treatment improves? The recurrence rate reported in clinical reports varies greatly, ranging from more than 10% to 70-80%. This difference may be related to the self-adjustment after returning home. If you do not pay attention to your diet and do not change your lifestyle, the recurrence rate may be higher. Generally speaking, you can get through this period smoothly with a maximum of 2-3 hospitalizations. Most pregnant women with severe vomiting during pregnancy can get through this period with a maximum of one hospitalization, and only a small number of them need multiple hospitalizations.

When experiencing hyperemesis gravidarum, pregnant mothers should not be afraid of it first. They should despise the enemy strategically and take the enemy seriously tactically. They should relax, divert their attention, eat their favorite foods, and with the help of a doctor, they will be able to safely get through this "worst" period.