Pregnancy Concerns: Hyperemesis Gravidarum (Extreme Morning Sickness)

Pregnancy was a challenging experience for Ms Jacelyn Pan who battled hyperemesis gravidarum, an extreme form of morning sickness that was widely publicised when it afflicted the Duchess of Cambridge during her pregnancy.

Ms Pan, 31, an administrative assistant, first started experiencing symptoms such as fatigue, nausea, vomiting and loss of appetite six weeks into her pregnancy. The symptoms persisted during the day and became so severe that they upset her daily routine. Once, she was unable to stop throwing up for 15 minutes.

She could not go to work or get out of the house, and was even hospitalised. “With such severe symptoms, I couldn’t function normally. I couldn’t work, meet my friends or go out. My social life was affected. I was also always tired and could not concentrate,” she said.

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Ms Pan was diagnosed with the condition at KK Women’s and Children’s Hospital (KKH) and hospitalised for three days. She was given a strong dose of anti-vomiting medication.

Not all pregnant women are hit so hard by morning sickness

Although most pregnant women experience some form of morning sickness, Ms Pan’s case is quite rare. Only a small fraction of women experience such severe morning sickness. Most have mild symptoms that go away after the first trimester.

Ms Lynn Toh, 25, an administrative executive and mother of a five-year-old girl, is one of those lucky ones. She gave birth to her second child, a baby boy, in August 2013.

During her first pregnancy, she vomited about three times during her first trimester but had no other symptoms. During her second one, she had no appetite throughout the first trimester, but did not vomit. She coped by eating small snacks or meals.

Dr Hong Sze Ching, Associate Consultant at the KKIVF CentreKK Women’s & Children’s Hospital (KKH), a member of the SingHealth group, explained that morning sickness, which is nausea and vomiting in pregnancy, is very common in the early weeks of pregnancy.

Causes and symptoms of morning sickness

Dr Hong said while the exact cause of morning sickness is not fully understood, it is thought to be caused by a combination of factors, including hormonal changes during pregnancy, genetics, overall health, as well as psychological and socio-cultural factors.

Increased levels of beta human chorionic gonadotropin – known as the pregnancy hormone – in the first trimester and high oestrogen levels throughout the rest of the pregnancy contribute to nausea and vomiting, she added.

The severity and duration of symptoms varies with individuals – from very mild symptoms which do not need treatment to severe, intractable vomiting that needs to be treated with intravenous fluids and medication, and may even require hospitalisation.

Patients with hyperemesis gravidarum tend to have more severe symptoms that may last longer. When it strikes, there is excessive vomiting and nausea before 20 weeks of gestation.

Dr Hong said that while it does not pose any severe risks to the pregnancy in most cases, and usually clears up later, severe hyperemesis can lead to serious maternal malnutrition and maternal complications like Wernicke’s disease (brain disease caused by vitamin B1 deficiency) and Mallory-Weiss syndrome (bleeding from a tear in the lower oesophagus).

If there is excessive maternal weight loss, there is also a risk that the baby will be smaller than average.

Seven in 10 women experience morning sickness in pregnancy

About seven in 10 women have symptoms of nausea or vomiting, which start between the sixth and ninth weeks of pregnancy, said Dr Hong. It can affect the mother at any time of the day, but usually improves as the pregnancy progresses. In nine out of 10 women, the symptoms disappear by the third month of pregnancy.

However, some women, or one in 10, continue to have nausea and vomiting after 20 weeks, said Dr Hong. There is also a tendency for this condition to recur in subsequent pregnancies.

Although morning sickness cannot be entirely prevented, there are ways to reduce the severity of the symptoms. Ms Pan overcame hers by drinking fruit juice or honey water instead of plain water, which she cannot stomach. Her supportive husband helps by preparing fruits for her when she has hunger pangs at night.

Despite the challenges, Ms Pan has not been dissuaded from having more children. She said: “My husband and I love children and we intend to have two. I will be more experienced and better prepared next time since I already know what to expect.”

Tips to cope with morning sickness

  • Ensure adequate hydration by taking small sips of water (about 30ml hourly) or small amounts of fluids containing electrolytes between meals.
  • Avoid lying down flat after food, and use extra pillows to prop yourself up when sleeping.
  • Minimise situations that can cause nausea, such as removing sources of unpleasant odours.
  • Have small frequent meals of dry or easily digested foods such as porridge or boiled eggs, or fluids such as fruit juices and milk.

The above article is reproduced with permission from HealthXchange.sg: Trusted health tips tailored for Asia, by Singapore’s largest academic medical centre, SingHealth.

Click here for diet tips to ease nausea and cramps while pregnant.

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