We’ve written before about pregnancy nausea and vomiting, colloquially known as morning sickness, which affects an estimated 70-80% of pregnant women. We’ve highlighted the newly uncovered conexión between morning sickness and the hormone Growth differentiation factor 15 (GDF15), and have also shared ten natural and/or pharmaceutical remedies for náuseas matutinas [1]. But for 1-3% of pregnant women, according to the Hyperemesis Education and Research Foundation (HER Foundation), nausea and vomiting are so pronounced and severe that they constitute “a debilitating and potentially life-threatening pregnancy disease that may cause weight loss, malnutrition, and dehydration due to severe nausea and/or vomiting with potentially adverse consequences for the patient and the newborn(s).”
To get an inside look at the reality of hyperemesis gravidarum, including its far-reaching impacts on real-life women, I spoke to Katrina Talty. Katrina is a psychiatric mental health nurse and the proud mom of a 19-month-old son. Like her mom and younger sister, Katrina experienced hyperemesis gravidarum (HG).
As soon as they were married, Katrina and her new husband were eager to conceive right away. She was excited when a pregnancy test turned positive on what should have been the first day of her first period after their wedding. Without knowledge of the specifics of her mom’s five HG-affected pregnancies, she did recall that “every time [Mom] was pregnant, we needed people to help us,” and she wondered if she too would suffer HG. She didn’t have to wait long to find out.
Hyperemesis gravidarum manifests early in pregnancy
At week four, just two weeks after her positive pregnancy test, symptoms hit with a vengeance. Katrina recalled, “It’s crazy how you go from one day being perfectly fine, to the next day you’re on the floor with nausea and vomiting that won’t stop.” For Katrina and many other women she’s encountered through HG support groups on Facebook, their experience involved vomiting 20 or more times every single day. Katrina’s younger sister, who had conceived several months before Katrina did, once put pictures of herself with bloodshot eyes in the family group text, because her HG-related vomiting was so forceful that it caused blood vessels in her eyes to burst.
For Katrina and many other women she’s encountered through HG support groups on Facebook, their experience involved vomiting 20 or more times every single day.
While HG may improve by about the halfway point of pregnancy for some women, for others, hyperemesis gravidarum lasts until the baby’s birth. Katrina herself suffered HG from week four until she went into labor with her son at 38 weeks. “Debilitating” and “life-changing” are understatements in the extreme.
Many women with HG perder weight during pregnancy
Far from gaining weight, many women with HG lose 5, 10, or 20 pounds during their pregnancies, Katrina reported (though this was fortunately not her personal experience). Weight loss typically happens for two reasons. First, nothing, absolutely nothing, sounds appealing to women with HG. Katrina noted, “The smell of food, even just seeing ads on the TV for a Burger King burger, the idea of food was enough to make me throw up.”
Secondly, even if women with HG pruebe to eat or drink, they often cannot keep “even an ounce of water” down. Consequently, “it’s common for women with hyperemesis gravidarum to be hospitalized once a week or once a month” with symptoms of severe dehydration and/or malnutrition. They require IV fluids and “banana bags,” an IV version of crucial vitamins, minerals, and electrolytes lost through vomiting. Some will require placement of a nasogastric (NG) tube to put food and fluids into their stomachs, and some will go home with an NG tube that’s cared for by a home health nurse. Asked whether she’d ever required hospitalization, Katrina responded “just once. I blacked out in the shower because of dehydration and had to go get IV fluids for that.”
How is HG treated?
Medical treatment of HG-related dehydration and malnutrition, usually via IV, is vital.
Medical treatment of HG-related dehydration and malnutrition, usually via IV, is vital. Certain medications are intended to reduce the nausea that leads to dehydration and malnutrition. The most well-known medication for HG is Zofran, an antiemetic (anti-vomiting) drug that can be given orally, in a dissolvable form that is placed under the tongue, or via IV (either dosed every 6-8 hours, or given continuously via a PICC line, either in the hospital or at home with home health nursing care). Katrina found Zofran to be relatively effective “in keeping me functional,” so long as she took it every 6-8 hours without fail. To deviate from that schedule, she found, led to cyclical vomiting for hours.
The HER Foundation maintains an extensive list of all the classes of medications plus individual nutrients such as B vitamins and alternative substances like marihuana that may be prescribed or used for hyperemesis gravidarum. This list includes potential side effects and other notes for use as well as links to research, when available, on the use of that medication or class of medications for HG specifically. Medications do not “cure” HG, Katrina pointed out, but hopefully they can make the condition livable until it resolves on its own via the birth of one’s baby.
HG often requires psychological and medical treatment
Unsurprisingly, HG and the resultant loss of ability to work and otherwise function during the day over the course of an entire pregnancy is a significant mental health challenge. A Estudio 2021 of 5,000 women with HG found that over half of the survey respondents considered abortion, and 5% went through with it, even though they wanted their pregnancies, because their mental distress was so severe [2].
A 2021 study of 5,000 women with HG found that over half of the survey respondents considered abortion, and 5% went through with it, even though they wanted their pregnancies, because their mental distress was so severe.
Tragically, more than a quarter of women considered suicide and 6.6% thought of it regularly. One respondent noted that she eventually felt “so ill that I considered termination, when I couldn’t bring myself to do that, I contemplated taking my own life.”
Katrina testified to the darkness that threatens to swallow HG sufferers whole, saying “even though I’m highly trained in mental health for my job as a psychiatric mental health nurse, there was a period of time where I required suicide precautions at home. My husband had to remove or hide all the sharp objects in the house, etc.” In the support groups of which she’s a member, other members “regularly” urge other members, “You need to call 911 right now” or “You need to go to the ER” for mental health crises.
The #1 question women ask in HG support groups
Katrina has found that the single most common question other members ask inside hyperemesis gravidarum support groups has to do with having another child or children [2]. Indeed, this is a question Katrina herself considers often. Coming from a family of five, with a husband who was one of seven children, they had hoped for 5-7 children. But she vividly remembers the trauma she endured for nine months, and is committed to “not lie to myself” about how tough it was. The question of whether or when to have another child has no easy answers, as hyperemesis gravidarum recurs in over 75% of survivors, according to the HER Foundation.
How to help when a woman you know suffers HG
Looking back now, Katrina recognizes “I was not exaggerating, I was not alone, and I was not crazy.” Yet women with HG may come to believe each of these lies, especially if their experience is invalidated by (often well-meaning) friends or relatives who say things like “Have you just tried (fill-in-the-blank)?” Unfortunately, Katrina added, some OB/GYNs are themselves not well-versed in identifying and treating hyperemesis gravidarum, either suggesting that the situation “isn’t as bad” as a pregnant woman says it is, withholding medications until a specific trimester due to misplaced safety concerns, or just generally lacking knowledge of the condition.
Katrina stressed that the single most important thing to do to help a woman suffering from HG is to validate her experience. If you learn that a pregnant woman is experiencing severe nausea and vomiting of pregnancy, listen without judgment to her experience. If you yourself have had HG, you can offer her solidarity. Otherwise, you can simply say, “I have no idea what that’s like, and I can’t imagine how difficult what you’re going through is. I’m here for you.” You can also encourage her to seek medical treatment immediately, and to switch healthcare professionals if she’s not being listened to and treated in a respectful, timely, and appropriate manner.
Do the research for her
Finally, since she may not be in a mental headspace to do research herself, you can point her to specific articles on hyperemesis gravidarum web pages like the HER Foundation’s site (not just the whole website, which may feel overwhelming), or you can find support groups she may appreciate. Even better, if you are able, step in to help with house-, pet-, and/or child-care (if applicable). Your support might be what makes it possible for her to get the help she needs to take care of herself, or make the thought of having another child someday (if she desires more children) seem less daunting.
The bottom line on HG
Women who suffer from HG need support, validation, and timely care for this serious condition. If you know someone suffering from HG, walk beside them and help them get treatment. And if you might be suffering from HG, do not downplay your situation to yourself, your spouse, or anyone else, and seek respectful care immediately–for your health and for your baby’s.
Dear Anne Marie, you continue to produce excellent articles. Keep up the good work and thank you for offering your knowledge and talents in this way.