Printed on: “The Rising Nepal-Friday Suppliment” 13th March 2009
By: Sampurna Lata Tuladhar
Mariah and Frank were happily married. Theirs was a love marriage. Soon God had graced them and Mariah became pregnant. But she suffered from hyperemesis gravidarum (HG) and Frank couldn’t cooperate with the situation. The result was Mariah aborted the baby and finally they divorced.
HG means an excessive vomiting during pregnancy. It is a severe form of nausea and vomiting in pregnancy which is very difficult to deal with. It is generally described as unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids. HG is considered a rare complication of pregnancy and there is often not a good diagnosis between common morning sickness and hyperemesis. Only from 0.3% to two per cent of pregnant women face this. It is typically associated with loss of greater than five per cent of pre-pregnancy body weight (usually over 10%); dehydration and production of ketones; nutritional deficiencies; metabolic imbalances; difficulty with daily activities; altered sense of taste; sensitivity of the brain to motion; food leaving the stomach more slowly; rapidly changing hormone levels, stomach contents moving back up from the stomach; physical and emotional stress of pregnancy on the body.
HG usually extends beyond the first trimester and may resolve by 21 weeks; unfortunately, it may last the entire pregnancy period in less than half of these women. Complications of vomiting like gastric ulcers, esophageal bleeding, malnutrition, etc. may also contribute to and worsen ongoing nausea.
There are numerous theories regarding the etiology of hyperemesis gravidarum. Diagnosis is usually made by measuring weight loss, checking for ketones, and assessing the overall condition of the mother. In case of meeting the standard criteria and having difficulty performing daily activities, medications and/or other treatments are offered.
Treating HG is very challenging and critical. It is a multifaceted disease that should be approached with a broad view of possible etiologies and complications. Those with more severe symptoms that lead to complications, severe weight loss, and/or prolonged nausea and vomiting are at greatest risk of adverse outcomes for both mother and child. The risk increases if medical intervention is inadequate or delayed.
The list of potential complications due to repeated vomiting or severe nausea is extensive, all of which may worsen symptoms. Common complications from nausea and vomiting include debilitating fatigue, gastric irritation, ketosis, and malnutrition. Aggressive care early in pregnancy is very important to prevent these and more life-threatening complications such as renal failure, central pontine myolinolysis or Wernicke’s encephalopathy, atrophy, Mallory-Weiss syndrome, hypeglycemia, jaundice, deconditioning, splenic avulsion and vasospasms of cerebral arteries and depression.
Children born to such women appear to have no greater risk of complications or birth defects than the general population. However, recent research in fetal programming indicates that prolonged stress, dehydration and malnutrition during pregnancy can put the fetus at risk for chronic disease, such as diabetes or heart disease, later in life, or neurobehaviourial issues from birth. This underscores the importance of aggressive treatment of the condition.
Hyperemesis Gravidarum impacts societies, families and individuals. Recent, conservative estimations suggest HG costs nearly $200 million annually just for inpatient hospitalization. Considering many women are treated outside the hospital to save costs, the actual cost is likely to be many times greater. Women often lose their employment because of HG, and women are frequently undertreated and left feeling stigmatized by a disease erroneously presumed to be psychological.
Unfortunately, HG is not fully understood and conclusive research on its potential cause is rare. New theories and findings emerge every year, substantiating that it is a complex physiological disease likely caused by multiple factors.
It is not understandable to those who doesn’t undergo with HG but partners are important to cooperate properly. Therefore, one who is facing HG is also suggested not to expect everyone to understand their problem. As long as your partner understands you is more than enough.