By: Lila Bennett
Updated: Feb. 26, 2020
Originally Published: Oct. 1, 2019
When I first discovered I was pregnant, I envisioned a journey filled with cute maternity outfits and blissful weekends preparing a nursery. Instead, my reality swiftly transformed into a harrowing nightmare: hyperemesis gravidarum (HG).
Initially, I believed HG was merely an extension of morning sickness. However, it quickly became clear that this condition is far more severe. Hyperemesis gravidarum is an incapacitating, demoralizing, and potentially life-threatening illness that disrupts every facet of a pregnant woman’s life, rendering daily functioning nearly impossible. If I had to endure one more suggestion of ginger candies or crackers, I might have lost my mind.
My new, grim reality consisted of uncontrollable vomiting—15 to 25 times a day—until all that remained were bile and blood. I endured ruptured blood vessels in my eyes, bruises from relentless vomiting, and was often physically carried to the bathroom by my husband. Hospitalizations became routine, and I grappled with starvation and extreme dehydration, living in constant fear of losing my baby. This torment lasted a staggering 36 weeks.
Fortunately, discussions around HG have gained traction in popular culture, thanks in part to celebrities like Maya Thompson, Claire Evans, and Sarah Jenkins, who have shared their own experiences. For instance, Thompson’s candid portrayal of her struggles on social media has been invaluable for raising awareness. While Evans is undoubtedly the most recognized HG sufferer, Thompson has played a significant role in increasing visibility and understanding of this condition.
Awareness is crucial. The Hyperemesis Education and Research Foundation reports that nearly one-third of HG pregnancies end in miscarriage. Moreover, severe cases can lead to organ rupture, retinal detachment, blindness, eardrum and jaw damage, rib fractures, esophageal tears, Wernicke’s encephalopathy, or even death.
Having encountered HG in two separate pregnancies, I was astounded by the public’s lack of knowledge regarding this condition. To gain more insight, I spoke with Dr. Clara Mendez, an associate researcher in the medicine and obstetrics departments at a leading university, who has dedicated nearly two decades to researching HG and its associated risks.
Home Insemination Kit:
First off, what drew you to study hyperemesis gravidarum specifically?
Dr. Clara Mendez: My interest in women’s health deepened after I lost a baby during the second trimester due to HG. The lack of understanding around this condition motivated me to investigate further.
How do we explain why some women develop HG while others do not?
Dr. Mendez: Current evidence suggests a robust genetic link to HG. Our latest research indicates that significant genetic risk factors include placental and appetite-related genes such as GDF15 and IGFBP7. I’ve also found associations between the GDF15 hormone receptor (GFRAL) and the progesterone receptor (PGR) with increased HG risk. If you carry these risk genes, your likelihood of developing HG rises significantly. However, these genetic variants are common, meaning many who possess them may not experience HG.
It’s clear that additional factors, beyond genetics, contribute to HG, although we have yet to fully understand them. These findings direct us toward new therapeutic pathways. Historically, the focus has been on the pregnancy hormone hCG, but surprisingly, we found no genetic variants linked to hCG or its receptor in relation to HG.
What percentage of women in the U.S. experience this condition?
Dr. Mendez: Estimates vary, but HG affects approximately 0.3-10% of pregnancies. About 20% of pregnant women in the U.S. are prescribed ondansetron (Zofran) for nausea and vomiting—indicating a high prevalence of pregnancy-related nausea. Emergency department visits for this issue have risen, with over 274,000 recorded in 2014.
How can women differentiate between typical morning sickness and HG?
Dr. Mendez: If you’re unable to conduct your daily activities and have lost more than 5% of your pre-pregnancy weight due to prolonged nausea or vomiting, it’s essential to consult your healthcare provider.
Is there an increased risk of miscarriage for those with HG?
Dr. Mendez: Our study revealed that out of 1,555 women without HG, 13% experienced miscarriage. In contrast, 32% of 771 untreated women with HG miscarried, while only 6% of the 1,070 treated with ondansetron miscarried. Thus, there appears to be a correlation between HG and miscarriage risk, which can depend on treatment.
When should women seek medical attention for HG symptoms?
Dr. Mendez: Women should seek help if they lose over 5% of their pre-pregnancy weight due to nausea and vomiting, are unable to keep fluids down, feel dizzy, or can’t maintain a balanced diet rich in thiamine.
Is there any preventive advice for women prior to pregnancy?
Dr. Mendez: The truth is, we don’t have definitive answers yet. However, if you have had HG previously, it’s vital to establish a treatment plan with your healthcare provider and arrange for support in case you need assistance.
Is HG hereditary?
Dr. Mendez: Yes, our research indicates that one-third of women with HG reported their mothers experienced severe nausea or HG. If a sister has HG, the risk increases by 17 times, and there’s also evidence that it can be inherited from the father’s side. Genes likely play a role, but we are still piecing together the complete picture.
Can women with a history of HG take measures to prevent it in future pregnancies?
Dr. Mendez: Preliminary evidence suggests that preemptive treatment may lessen severity, but further studies are needed to confirm this.
If diagnosed with HG, what lifestyle changes should a woman consider?
Dr. Mendez: Women suffering from HG often cannot maintain their daily routines due to severe nausea and vomiting. They need to prioritize resting, steer clear of triggers (like the kitchen), and ensure they receive adequate fluid and nutritional support.
Why do symptoms of HG vary among women, as seen with the experiences of celebrities like Claire and Maya?
Dr. Mendez: The reasons behind the varying duration of symptoms remain unclear. Our research indicates that an IGFBP7 variant is associated with prolonged symptoms, but this finding requires confirmation from additional studies.
Is there anything else you’d like to add?
Dr. Mendez: I recommend seeking support from organizations like Helpher.org, bringing an advocate to appointments, and utilizing our free iPhone app to share symptoms with your doctor. This app has been shown to improve communication and care.
For those newly pregnant and interested in contributing to research on improving outcomes, you can find more about this initiative.
In summary, hyperemesis gravidarum is a complex and often misunderstood condition that has a significant genetic component. Awareness and understanding can empower women to seek the care they need.