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Hyperemesis is a Rare but Treatable Complication of Pregnancy
By Nancy Kennedy

Hyperemesis gravidarum is a rare and serious complication of pregnancy, characterized by extreme nausea and vomiting. Usually referred to simply as hyperemesis, it is a severe form of morning sickness – the nausea and vomiting that is common in early pregnancy and actually can last all day, well beyond the morning. A majority of pregnant women (approximately 80%) will experience morning sickness, while just 0.3 to 2.3% will have hyperemesis.

“Hyperemesis comes from the brain’s response to the hormones of pregnancy,” explains Hyagriv Simhan, M.D., M.S., chief of the division of Maternal-Fetal Medicine at Magee-Womens Hospital of UPMC. “It can have severe consequences. We treat it by providing fluids and medication that will counter its effects. It’s not unusual for women with hyperemesis to have to make several trips to the Emergency Room. When a woman presents with these symptoms, of severe nausea and vomiting, we have to make sure that it isn’t something else, such as an intestinal virus or a urinary tract infection that may become a blood infection.”

Hyperemesis may lead to significant dehydration, electrolyte imbalance, and weight loss, and can even cause problems with kidney function. The loss of electrolytes through vomiting means that blood levels of sodium, potassium and other essential chemical substances are depleted, and this can have adverse consequences for the heart, muscles, kidneys and other organs. It may be severe enough to require hospitalization for restoration of hydration and electrolyte balance. 

Treatment of hyperemesis consists of the administration of intravenous fluids; anti-emetic medications; monitoring of blood chemistry; and in some instances, steroids. Small, frequent meals are recommended, with an emphasis on liquids like soup. Dieticians suggest eating more carbs and protein and avoiding fatty, spicy and acidic foods. Some women have had improvement of symptoms with acupuncture.

Risk factors associated with hyperemesis include underlying gastrointestinal problems. It is more common with the first pregnancy and occurs more often in multiple pregnancies. Unfortunately, it does tend to recur in subsequent pregnancies. Hyperemesis tends to peak at around nine weeks of pregnancy and for most women, it will resolve completely by 20 weeks. In very rare instances, it lasts throughout pregnancy.

Dr. Simhan encourages women who are having nausea and vomiting that seems to be excessive to contact their prenatal care provider, especially if they are becoming dehydrated. “It’s important to get ahead of it and begin treatment before it becomes extreme,” he says.

Women with hyperemesis naturally are concerned about the well-being of the fetus. Dr. Simhan says that they don’t generally need to worry as long as the condition is treated. “Hyperemesis mostly occurs in the first trimester, when the amount of nutrition the fetus needs is very small. In general, the fetus will take what it needs, no matter what.” When hyperemesis is untreated, and there is low maternal weight gain, there can be consequences for the fetus, particularly low birth weight, which can mean a host of problems for the newborn and may require special care in the Neonatal Intensive Care Unit.

Another consequence of hyperemesis for the pregnant woman is depression. The pernicious nature of the nausea and vomiting and its effect on daily functioning and quality of life can take an emotional toll and lead to maternal depression. In addition, there may be the added stress of being unable to work, resulting in a loss of income, at a time when a young family most likely cannot afford the loss.

Dr. Simhan is a graduate of Boston University School of Medicine. In addition to serving as chief of the Division of Maternal-Fetal Medicine at Magee, he is a professor of Obstetrics, Gynecology and Reproductive Medicine at the University of Pittsburgh School Of Medicine and a research scientist at Magee-Womens Research Institute.

For more information about prenatal care at Magee, visit www.upmc.com/locations/hospitals/magee/services

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