Hyperemesis gravidarum, also called HEG, is severe nausea and vomiting during pregnancy. It results in dehydration, weight loss, and a disturbance in the acid-base balance in the body.
In most cases, nausea and vomiting during pregnancy is mild and does not last long. When it becomes so severe that it interferes with getting enough fluids and nutrients, the woman may need to be treated.
Symptoms of HEG are at their peak at 8 to 12 weeks of pregnancy. They usually resolve by the 16th week.
The main symptoms of HEG are severe and long-lasting nausea and vomiting. Other common symptoms include: ptyalism, which is excess production of salivaweight lossfatiguelightheadednessfainting, also called syncopeweakness
HEG can also cause the following in some women: loss of appetitedecreased concentrationdepression and anxietyirritabilitymood changestrouble sleepingextreme sensitivity to smellsimpaired sense of taste
There is much that is not known about the causes and risks related to HEG. Much more study is needed before experts will have definite answers.
Causes
The exact cause of pregnancy-related nausea and vomiting remains unclear. Some studies suggest the following: There may be a link between high levels of estrogen or human chorionic gonadotropin, a hormone that helps the unborn baby to develop.There is a link between overactive thyroids, a lack of Vitamin B-6, also called pyridoxine, and psychological factors.A link between bacteria calledand HEG may exist.
Risks
No one race seems to be at risk for HEG, but it iscommon in the following races: American IndianEskimoAfrican nativesAsian natives, other than Japan
The risk for HEG seems to decrease as women grow older. Cigarette smoking also seems to lower the risk. However, smoking presents other risks to the unborn baby, so should not be used as a preventive factor!
Experts believe the following factors may increase the risk for HEG: being pregnant for the first timebeing pregnant with twins, triplets, or morehaving HEG with a previous pregnancybeing overweighttrophoblastic disease of the womb
There is no known prevention for this condition.
Diagnosis is based on a history of the woman's symptoms and a physical exam. Lab tests are also done to look for signs of dehydration and electrolyte imbalances. These tests may include: amylaseblood calcium levelserum electrolytes, which can show low potassium or sodium levels in blood. Low levels can mean dehydration or acid-base imbalance.hematocrit, part of a blood count, which may become high due to dehydrationliver enzymes and bilirubinurinalysis for ketones and specific gravity. Ketones are a sign of starvation. Specific gravity can show dehydration.
An ultrasound may also be done to check the condition of the baby and the womb. If a woman has abdominal pain or vomits blood, the doctor may do an endoscopy. This is a test where a small tube is passed through a woman's mouth and throat down to her stomach. The tube has a light at the end, which helps the doctor to look for problems in the stomach.
Extreme nausea and vomiting in pregnancy may also mean there are other more serious disorders going on. These include: hydatidiform mole, which is an abnormal tumorous growth of the placentaviral gastroenteritisflufood poisoninghepatitis Ahepatitis Bhepatitis Curinary tract infectionappendicitischolecystitis, which is an inflammation of the gallbladderulcers
Tests that may help to rule out other disorders include: serum for hepatitis testingliver function testsultrasound to look at gallbladderurinalysis and culture to test for bacteriaultrasound to look for twins or a tumorous growth of the placenta
Hyperemesis gravidarum usually goes away by the second half of pregnancy. If treated, it should not present serious long-term problems for most mothers or infants.
The primary treatment for HEG should focus on diet and replacing fluids, if the woman has become dehydrated. Dietary changes that may help include: eating frequent small meals rather than three large oneseating when hungry, even if it is not mealtimeavoiding foods that do not appeal to the pregnant womanavoiding foods high in fat and proteinstaying away from spicy foodseating more foods that have dry carbohydratesdrinking more carbonated drinksdrinking teas made from peppermint or gingereating soothing foods such as soup, soda crackers, unbuttered toast, gelatin, or frozen dessertsavoiding milk products, which may be hard to digest for some womenstopping prenatal vitamins and iron until nausea and vomiting go awaydrinking plenty of fluids to stay hydrated
In severe cases, a woman may need to enter the hospital for IV fluids, vitamins, and electrolytes. Medicines such as antiemetics, antihistamines and sedatives can also be used to calm the nausea. These include: promethazine (i.e., Phenergan)hydroxyzine (i.e., Atarax, Vistaril)trimethobenzamide (i.e., Tigan)prochlorperazine (i.e., Compazine)diphenhydramine (i.e., Benadryl)dimenhydrinate (i.e., Dramamine)meclizine (i.e., Antivert)
The Natural Medicines Comprehensive Database lists vitamin B6 (pyridoxine) as "possibly effective" for severe nausea in pregnancy at a dose of 25 mg every 8 hours.
The side effects depend upon which medicines are used to control nausea.
In most women, HEG clears up by the second trimester. If a woman is not gaining enough weight, she may need to be given IV fluids and nutrients again.
