2024-01-28 16:35:04
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Hyperemesis gravidarum: extreme nausea and vomiting during pregnancy
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75 to 80% of pregnant women experience nausea and vomiting. In 1-3% of cases, the symptoms are so severe that they can lead to significant weight loss and dehydration in the expectant mother. This condition is called hyperemesis gravidarum.
Symptoms of HG
The symptoms of HG usually occur between 4-6 weeks of pregnancy and may peak between 9-13 weeks. Most women get some relief between weeks 14-20, although up to 20% of women may require care for hyperemesis for the remainder of their pregnancy.
Signs and symptoms of hyperemesis gravidarum include:
- Severe nausea and vomiting
- Aversion to food
- Weight loss of 5% or more of pre-pregnancy weight
- Decrease in urination
- Dehydration
- Headache
- Confusion
- Pass out
- Jaundice
- Extreme fatigue
- Low bloodpressure
- Fast heart rate
- Loss of skin elasticity
- Secondary anxiety/depression
In contrast to ‘normal’ pregnancy sickness, in which vomiting does not always occur, HG involves severe vomiting, in which you cannot keep any food down at all. The nausea also does not go away around 12 weeks of pregnancy, which is usually the case.
Why do some pregnant women suffer from nausea?
Whether a pregnant woman experiences nausea is related to her sensitivity to a hormone produced by the fetus: the GDF15 protein.
“We now know that women get sick during pregnancy when they are exposed to higher than normal levels of the hormone GDF15,” said Marlena Fejzo, a researcher at the Center for Genetic Epidemiology at the University of Southern California. She and her team discovered that the severity of symptoms was directly linked to the amount of hormone a woman was exposed to before pregnancy and to the amount of hormone produced by the fetus.
What causes nausea and hyperemesis gravidarum?
The scientists managed to identify a rare mutation in the gene encoding GDF15 in women suffering from hyperemesis gravidarum. This mutation causes abnormally low levels of the hormone throughout the body before pregnancy. Once pregnant and exposed to the GDF15 protein, these women are at greater risk of hyperemesis gravidarum. Unless the fetus also inherits the low-level GDF15 mutation, in which case it is slightly less likely to develop hyperaemesis gravidarum.
Treatment of hyperemesis gravidarum
Women with hyperemesis gravidarum are currently prescribed dietary modifications, rest, and antacids. In serious cases, the expectant mother is admitted to hospital to receive fluids and nutrition (intravenously, via tube).
Some women benefit from herbs (ginger or peppermint) or hypnosis, and acupressure can also help. The pressure point to reduce nausea is located in the center of the inner wrist, three finger lengths away from the wrist crease and between the two tendons. Find the point and press firmly, one wrist at a time for three minutes.
But there may be hope for the future, as Marlena Fejzo and her team will now try to determine whether exposing women to GDF15 before pregnancy can prepare them for high levels of the hormone in question once they become pregnant, and thus may reduce the onset of symptoms of hyperemesis gravidarum. Metformin, a drug prescribed to increase GDF15 levels, could be used in patients with a history of the disease.
Another hope lies in a treatment that would prevent the GDF15 protein from binding to receptors in the brains of patients suffering from hyperemesis gravidarum. Several of these drugs are already in clinical trials for cachexia (a complex metabolic disease that leads to extreme weight loss) and for cancer patients suffering from nausea and vomiting.
Sources:
https://www.nature.com
https://keck.usc.edu
https://www.eurekalert.org
https://americanpregnancy.org
Last updated: January 2024
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