Hyperemesis gravidarum: severe nausea and vomiting during pregnancy

The expert: Doctor Nadia Berkane, obstetrician and gynaecologist

Hyperemesis gravidarum is a pathology that, according to estimates by the Association for Combating Hyperemesis gravidarum, affects 1% of pregnant women, that is an average of 9,500 women per year.

What is hyperemesis gravidarum or hyperemesis gravidarum?

Many women experience nausea early in pregnancy. Unfortunately, this is one of the “sympathetic signs” of pregnancy, such as B. Increased breast tenderness and pain in the lower abdomen! But hyperemesis gravidarum or hyperemesis gravidarum (HG) differs by very severe and constant uncontrollable nausea and vomiting during pregnancy, resulting in a weight loss of 5% of his body mass. Princess Kate Middleton has suffered from it on several occasions and conveys a little of this phenomenon, which is still too little known, including doctors.

Hyperemesis gravidarum: what are the symptoms?

Hyperemesis gravidarum is characterized by various symptoms, the main ones being nausea and uncontrollable vomiting of bile, sometimes with bloodstains, day and night. The pregnant woman can no longer eat or drink anything and vomits ten, twenty, even thirty times a day. Causes this disease Weight loss of at least 5% of body weight. This weight loss is then quickly visible.

The pregnant woman also suffers from extreme tiredness, which of course has to do with the fact that she can no longer eat, is losing weight and is dehydrated. The slightest effort is difficult for him.

What are the causes of this pathology?

The causes of hyperemesis gravidarum are still unclear. “Hyperemesis gravidarum has long been associated with depression. We imagined that these women would throw up their pregnancy or that they would not be happy to be pregnant … But this is not the case »emphasizes Doctor Nadia Berkane, obstetrician and gynecologist at the Hirslanden Clinique des Grangettes in Geneva and co-author with Marie-Hélène Westphalen of Pregnant, what if we told each other everything?published by Eyrolles.

But there could be a hormonal cause of this vomitingaccording to the expert: « Beta HCG hormone(Chorionic gonadotropic hormone measured in a pregnancy test, editor’s note.) has the peculiarity of increasing about 6 weeks of amenorrhea, that is often when vomiting begins, and it falls at the end of the first trimester. Many of these patients stop vomiting at the same time.”. Studies suggest that higher-than-normal beta-HCG hormone levels or abnormal hCG receptors may be involved in hyperemesis gravidarum. This can lead to twin pregnancies higher beta hcg levels more likely to cause hyperemesis gravidarum.

Other studies point to a genetic predisposition in families where women are affected from mother to daughter. Finally, a history of hyperemesis gravidarum (that is, during a previous pregnancy) appears to be an additional risk factor. Studies have shown two genes, GDF15 and IGFBP7, which would be involved in the occurrence of these hyperemes. These genes play a role in producing the placenta, appetite and fatigue. They would tell the placenta to overproduce protein. These would meet in the blood of pregnant women and cause nausea and vomiting.

Helicobacter pylori, a bacterium that infects the lining of the stomach and causes stomach ulcers, may also be involved in HG, according to some studies. But there is no certainty here either. The gender of the baby also plays a role. Carrying a female fetus would thus be a factor favoring hyperemesis gravidarum. In addition, and even though any woman can suffer from hyperemesis gravidarum, being from the Middle East, North Africa, sub-Saharan Africa, or Asia appears to be a risk factor.

What are the consequences of hyperemesis gravidarum?

Through regular vomiting and inability to eat, the pregnant woman is at risk of being deficient and dehydrated, which will lead to vitamin deficiency and potassium loss, leading to a state of significant fatigue. Dehydration can also lead to the formation of thrombosis – small blood clots in the veins. in hypermesis gravidarum, HCG can also overstimulate the thyroid and interfere with thyroid hormone production, promoting hyperthyroidism. This pathology hampers and affects the quality of life, as well as social and professional ties. The women have trouble sleeping, are exhausted and no longer have the strength to take care of themselves.

This disease therefore has a strong psychological impact. The risks of anxiety, nervous breakdown and postpartum depression are increased. « It plays on morale to puke all day, recognizes Nadia Berkane. A patient recently told me that she never left the toilet and was throwing up all afternoon. Some women even come to abortion because the condition is so difficult to endure.. The misnomer of “psy” patients regularly attributed to these women due to apoor knowledge of pathology by caregivers and the misunderstanding of those around them does not help. According to a survey of 808 women suffering from hyperemesis gravidarum from 23 countries, 15.2% of them have had an abortion.

In general, hyperemesis gravidarum does not affect the child, but if the pathology persists throughout pregnancy, hyperemesis gravidarum may be compromised fetal growth in a low birth weight child. If nausea or vomiting stops after delivery, post-traumatic shock may be ongoing.

Vomiting during pregnancy, is it dangerous?

Vomiting at the beginning of pregnancy is quite traditional and does not cause any consequences. On the other hand, in the case of HG, we face a for a long time Risk of anemia and vitamin deficiency.
Be careful not to confuse a woman who vomits throughout pregnancy with one who starts or starts vomiting again during or at the end of pregnancy. ” We must look for pregnancy pathologies in these situations because it is not normal.adds the obstetrician-gynecologist.

Duration: when does hyperemesis gravidarum start and how long does it last?

Hyperemesis gravidarum usually occurs from the 6th week of amenorrhea and ends towards the end of the first trimester of pregnancy, about 12 or 13 weeks of amenorrhea. But sometimes it can take several months or even until the end of pregnancy.

The pregnant woman initially has symptoms of pregnancy with nausea and vomiting without knowing that she is specifically suffering from hyperemesis gravidarum. We therefore start with simple treatments to relieve these symptoms.

How to stop vomiting during pregnancy? Natural solutions and remedies

The simplest treatment is ingestion 1 gram of ginger per day because of its proven antiemetic properties. It can be in the form of a food supplement, especially in powder form to pour it into yoghurt, for example.

You can also try to breathe lemon essential oil by placing two drops on a cotton ball. Essential lemon oil has a regulating effect on the liver system and helps against nausea.

Food: what can we eat?

Eating with hyperemesis gravidarum is difficult. A simple smell or sight of a fridge can be a bad experience. Of course we avoid acidic foods and we eat in small amounts everything that the body can tolerate. For some it’s liquid foods, sweet drinks, for others it’s potatoes, peas, fish, biscuits, rusks, herbal tea, compotes…

If the pregnant woman vomits a lot and stops eating, she may be deficient in sugar, protein, and lipids… ” She then draws from her fat reserves, which promote the synthesis of ketone bodies, substances produced when fats are broken down in the body and which make you vomit. So it’s a vicious cycle.”, explains Dr. Nadia Berkane. To get out of this state of ketosis and get sugar into the body, you can drink in small sips a “Coca” or other sweet and cool equivalent, shake beforehand to remove the bubbles.

What medication to take?

Nevertheless, these dietary hygiene rules, similar to classic vomiting in early pregnancy, are rarely sufficient in patients with hyperemesis. antiemetics, like metoclopramide (Primpéran® and generics) are then prescribed by the doctor. These neuroleptics have an inhibitory effect on the nerve centers of nausea in the brain. On the other hand, they have undesirable side effects (fatigue, muscle contractures, etc.) and contraindications. These antiemetics come in suppositories.

Another drug: Cariban®, an antiemetic that combines a sedative antihistamine (which calms and fights spasms) and Vitamin B6. It is also prescribed by prescription. “ This complex of active ingredients seems to work well against vomiting in pregnant women.notes the obstetrician-gynecologist.

Hospitalization, in which cases is it relevant?

When medication is not enough to stop vomiting and prevent dehydration, hospitalization is essential. The decision is often made from the point at which the mother-to-be is sufferinga weight loss of more than 10% of the initial weight. The medical team then puts a drip on the expectant mother to rehydrate her with physiological serum and gives an injection of vitamin B1 to make up for any deficiency. “If we infuse someone with vitamin B1 deficiency with sugar, there is a risk of Gayet-Wernicke encephalopathy and damage his brain”, alerts the doctor. Depending on the results of the biological tests, a potassium infusion may also be done. Then the patient can receive a sugar infusion. Generally, within two or three days, the pregnant woman will stop vomiting, resume oral feeding, and go home. However, depending on the case, the length of hospital stay may be longer. The table can also start over, resulting in a re-hospitalization.

Associations to combat hyperemesis gravidarum

There are various associations, such as the association for combating hyperemesis gravidarum or Neuf mois avec ma bassine. They make it possible to support future mothers and their families through discussion groups, the exchange of information and testimonies. You can also guide to doctors who are familiar with this diseaseas medical attention is essential to stop the vomiting and nausea, but also to feel less alone.

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