The 411 on Hyperemesis Gravidarum

Fun Fact: Women with HG have an extreme sensitivity to smell. It's not just food and cooking smells; it can also be perfumes, cleaning supplies, detergent, shampoos, soaps, or just about anything. This sensitivity to smells can worsen the nausea and vomiting. (So really a “Not So Fun Fact”)

While I’ve got your attention, let’s take a minute to learn the 411 on all things HG. Because HG is rare, not many people have heard of it or even know they have it (aka me in my first pregnancy). Since suffering through HG even worse during my second pregnancy, I’ve done a lot of research and have learned so much that I wish I had known years ago. Plus many of our family and friends have started asking more questions, so I thought I’d try to lay it out as simply as possible.

Behold the Bullet Points Below!

The Basics:

It is defined as a potentially life-threatening pregnancy disease that may cause weight loss, malnutrition, dehydration, and debility due to severe nausea and/or vomiting, and may cause long-term health issues for mother and baby.
HG is the leading cause of hospitalization during early pregnancy, and second to premature labor as the leading cause overall during pregnancy.
Only 1-3% of pregnant women are estimated as having HG.
Significant (>5% of pre-pregnancy weight) weight loss and recurrent dehydration are classic signs of HG.
HG is hard on a woman's body both physically and mentally, and it can interfere with her home, work, and social life. She may feel so sick and wiped out that she stops working and spends the day in bed.
Pregnancy is supposed to be a happy time, but women with HG feel horrible. They may be unable to eat and drink, and they often can't be around other people, which can make it an extremely stressful, depressing, and isolating time for them.
Statistics suggest 50-85% will have HG with every pregnancy and may worsen each time.
About 15% of wanted pregnancies are terminated due to HG, and many more are almost terminated out of desperation.

The Symptoms:

Symptoms include continuous nausea and multiple episodes of vomiting throughout the day with few if any symptom-free periods, especially during the first three months. This may lead to rapid and/or significant weight loss, dehydration, and electrolyte disturbances often requiring hospitalization.
Symptoms begin between the fourth and sixth week of pregnancy. Half of women experience symptom resolution, or at least significant improvement, somewhere around 14-20 weeks; about 20% will continue to have significant nausea/vomiting until late pregnancy or delivery. For some, symptoms continue after delivery for weeks or months and continued treatment is needed.
Morning Sickness vs. HG Symptoms:

The Treatment:

Treatment requires medications and often IV fluids.
Serotonin antagonist medications, bed rest, IV fluids, and nutritional therapy are the most effective therapies for HG.
Early and aggressive medical care often decreases the severity of symptoms and leads to quicker recovery.

The Causes:

Research is limited by lack of funding and priority, so high-quality studies with decisive results are rare.
Recent research has found that hormones such as GDF15, which is a marker for cachexia and affects appetite and taste perception, may cause HG.
This new study provides scientific evidence linking 2 genes, GDF15 and IGFBP7, to HG. The proteins are known to be important in the development of the placenta and in controlling appetite. The proteins are abnormally high in the blood from patients hospitalized with HG. This suggests that the DNA instructions in some HG patients are telling the placenta to make too much GDF15 and IGFBP7 protein, which then gets into the mother’s blood, and causes extreme nausea and vomiting. This information provides strong evidence that these proteins are directly involved in causing HG. It puts an end to the unfortunate misogynistic nonsense that HG is “all in your head.”
GDF15 also causes cancer cachexia which kills 20% of cancer patients. They die because their cancer produces too much GDF15 which causes them to starve. Their GDF15 levels are 1 ng/mL of blood higher than normal, but HG patients have 5 ng/mL of blood higher than the average person. So if cancer patients can feel like they’re dying with 1 ng higher, then you can imagine that HG patients with 5 ng more definitely feel like they’re dying.
- Now that they know GDF15 and IGFBP7 are involved, they can start thinking about the best way to treat it. Of particular interest, a drug blocking GDF15 has successfully restored appetite and weight gain in a mouse model with abnormally high levels of GDF15, so if it is safe in pregnancy, this holds much promise for HG. But making and testing a drug for pregnant women is a very long and difficult process, so knowing whether this strategy will be successful is a long way off.

The History:

HG was recognized several centuries ago, but the first research appears around the 18th century. Then, HG was thought to be related to abnormalities, toxins, ulcerations, or infections in a related organ.
- In 1855 English novelist and poet, Charlotte Brontë died four months into her first pregnancy aged just 38.
- According to her earliest biographer, she was attacked by “sensations of perpetual nausea and ever-recurring faintness.” Although her death certificate gives a cause as tuberculosis, many writers suggest she may have died from dehydration and malnourishment, caused by excessive vomiting from HG.
As late as the early 1900s, the root cause of HG was thought to be psychological: women who were unhappy to be pregnant were thought to be “manifesting” physical symptoms.
At that time, treating HG involved abortion, leeches, the drug thalidomide (which infamously resulted in babies born with limb deformities), cocaine, mercury, and an injection of the woman’s husband’s blood.
In the 1950s, using intravenous fluids to treat HG significantly dropped the death rate. However, the belief that the condition was fabricated still persisted among the medical community.
Women who suffered HG were thought to be those with a “compensated schizoid character formation,” and HG was less likely in women who are “stable, happily married, and desirous of having a child.” During this time period, the treatment was still ineffective and included ideas such as ”use a little psychotherapy,” and “send them home to their mothers.”
As recent as 10 years ago, some doctors were theorizing that HG was a means of “avoiding sex” or “an unconscious wish to orally expel the fetus.”
Some health professionals, researchers and medical texts still suggest HG is a psychosomatic disorder. Consequently, women suffer from inadequate treatment and uncaring health professionals lacking compassion.

The Postpartum Recovery:

Recovering from HG takes an average of 4-6 months but may take a few years if the illness was severe or prolonged.
Some women will have residual issues long-term, sometimes with vague or atypical immune or gastrointestinal symptoms that are difficult to resolve.
Food aversions may persist and take months or even years to overcome.
It will often take 1-2 months of recovery for every month she was malnourished or debilitated by HG.

The Psychological Effects:

After months of illness and complications, many women develop perinatal mood and anxiety disorders (PMADs) or full criteria Posttraumatic Stress Disorder (PTSD).
- Those with severe symptoms or a history of trauma and high levels of stress, HG can lead to post-traumatic stress symptoms that may last for years.
Depression is a natural consequence of being confined to home or bed, and unable to perform even simple daily activities or care for one's self.
Anxiety often results from the thought of vomiting and retching relentlessly, as well as endless nausea.
Many women fear dying and feel guilty that they may lose their unborn child if they don't force feed themselves, despite the inevitable vomiting that follows.
Women who choose abortion do so most often because of
- Debility impairing their ability to work or care for family.
- Delayed, ineffective, or inadequate medical intervention
- Care given by clinicians lacking understanding or compassion.