What is Hyperemesis Gravidarum during pregnancy ?

Although still little known, hyperemesis gravidarum is the second leading cause of hospitalization for pregnant women. This pathology, characterized by uncontrollable nausea and vomiting, requires rapid treatment.

Hyperemesis gravidarum is a pathology which affects, according to estimates from the association for the fight against hyperemesis gravidarum, 1% of pregnant women.

Many women experience nausea early in their pregnancy . Unfortunately, this is one of the "sympathetic signs" of pregnancy, like having more sore breasts and lower abdominal pain! But hyperemesis gravidarum, or hyperemesis gravidarum (HG), is characterized by very intense and constant nausea and uncontrollable vomiting during pregnancy, which leads to a weight loss of 5% of body mass. Princess Kate Middleton has suffered from it on several occasions, bringing a little media attention to this phenomenon that is still too little known, including by doctors.

Hyperemesis gravidarum is characterized by various symptoms, the main one being nausea and uncontrollable vomiting of bile, sometimes with streaks of blood, during the day and night. The pregnant woman can no longer eat or drink, and vomits ten, twenty, or even thirty times a day. This disease causes a weight loss equivalent to at least 5% of her body weight . This weight loss is then quickly visible.

Pregnant women also experience extreme fatigue, which is of course due to the fact that they can no longer eat, they are losing weight and they are dehydrated. The slightest effort becomes difficult for them.

The causes of hyperemesis gravidarum are still unclear . "For a long time, hyperemesis gravidarum was associated with depression. We imagined that these women were vomiting their pregnancy or that they were not happy to be pregnant... But that is not the case". 

There could, however, be a hormonal cause for this vomiting , according to the specialist: "  The beta-HCG hormone (chorionic gonadotropin, the one measured in a pregnancy test, editor's note) has the particularity of increasing around 6 weeks of amenorrhea, which is often when vomiting begins, and it drops at the end of the first trimester . Many of these patients stop vomiting at this same time ." Studies suggest that a higher than average level of beta-HCG hormones or an abnormality of HCG receptors could be involved in hyperemesis gravidarum. Thus, twin pregnancies that cause a higher level of beta-hCG would be more likely to cause hyperemesis gravidarum.

Other studies highlight a genetic predisposition with families where women are affected from mother to daughter. Finally, having a history of hyperemesis gravidarum (during a previous pregnancy) seems to be an additional risk factor. Studies have highlighted two genes, GDF15 and IGFBP7 , which are involved in the occurrence of these hyperemesis. These genes play a role in the production of the placenta , appetite and fatigue. They would tell the placenta to produce too many proteins. These would end up in the blood of pregnant women and cause nausea and vomiting.

Helicobacter pylori, a bacterium that infects the gastric mucosa and causes stomach ulcers, may also be involved in HG, according to some studies. But again, there is no certainty. Furthermore, the sex of the baby may also matter. Carrying a female fetus may be a factor that promotes hyperemesis gravidarum. In addition, and even if any woman can suffer from hyperemesis gravidarum, being from the Middle East, the Maghreb, sub-Saharan Africa or Asia appears to be a risk factor.

By vomiting regularly and not being able to eat, the pregnant woman risks being deficient and dehydrated , which will eventually induce vitamin deficiencies and cause her to lose potassium, leading to a state of significant fatigue. In addition, dehydration can cause the formation of thromboses - small clots in the veins. In the case of hypermesis gravidarum, HCG can also hyperstimulate the thyroid and disrupt thyroid hormones , promoting hyperthyroidism. This pathology is disabling and affects the quality of life and social and professional ties. Women have difficulty 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 affects morale, vomiting all day long ," admits Nadia Berkane. A patient recently told me that she did not leave the toilet and vomited all afternoon. Some women even end up terminating their pregnancy because this state is so difficult to bear ." The erroneous label of "psychiatric" patients regularly attributed to these women, due to poor knowledge of the pathology by caregivers and the incomprehension of those around them, does not help matters. According to a survey conducted among 808 women suffering from hyperemesis gravidarum and coming from 23 countries, 15.2% of them had had an abortion.

Hyperemesis gravidarum usually has no impact on the child, but if the condition lasts throughout the pregnancy, fetal growth may be affected, resulting in a low birth weight child. If there is no more nausea or vomiting after delivery, post-traumatic shock may persist.

Vomiting at the beginning of pregnancy is something quite traditional and does not cause any repercussions. On the other hand, in the case of HG over a long period, there is a risk of anemia and vitamin deficiency .

Be careful not to confuse a woman who vomits throughout her pregnancy with a woman who starts or starts vomiting again during or at the end of her pregnancy. "  We must look for pregnancy pathologies in these situations, because it is not normal ," adds the obstetrician-gynecologist.

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

At first, the pregnant woman 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 alleviate these symptoms.

The simplest treatment is to take 1 gram of ginger per day because of its proven antiemetic properties. It can be found in the form of a food supplement, particularly in powder form, to be added to yogurt for example.

You can also try inhaling lemon essential oil by placing two drops on a cotton pad. Lemon essential oil has a regulating effect on the liver system and helps fight nausea.

Eating when you suffer from hyperemesis gravidarum is difficult. A simple smell or the sight of a refrigerator can be unpleasant. Of course, we avoid acidifying foods and eat in small quantities whatever the body tolerates . For some, this will be liquid foods, sugary drinks, for others potatoes, peas, fish, biscuits, rusks, herbal tea, compotes, etc.

If the pregnant woman vomits a lot and stops eating, she risks lacking sugar, proteins, lipids , etc.   She will then draw on her fat reserves, which will promote the synthesis of ketone bodies, substances produced from the breakdown of fats in the body and which make you want to vomit. It is therefore a vicious circle .

If medication is not enough to stop vomiting and prevent dehydration, hospitalization is essential. The decision is often made when the mother-to-be suffers from a weight loss greater than 10% of her initial weight. The medical team then puts the mother-to-be on a drip to rehydrate her with saline solution and gives a vitamin B1 injection to compensate for any deficiency. "If we give someone a sugar drip when they have a vitamin B1 deficiency, they risk developing Gayet-Wernicke encephalopathy and damaging their brain ". A potassium drip can also be given depending on the results of the biological tests. Then the patient can receive a sugar drip. Generally, in two or three days, the pregnant woman stops vomiting, resumes eating orally and can go home. But the hospital stay can be longer depending on the case. The picture can also start again, leading to a new hospitalization.