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While morning sickness can occur in up to 70% of all pregnancies, it is usually more troublesome than serious. The more severe and disturbing condition, hyperemesis gravidarum, may complicate up to 0.3% (3 out of 1000) pregnancies, causing physiological changes that may effect the mother and fetus. Maternal weight loss, dehydration, electrolyte imbalances, acid-base disturbances leading to renal and hepatic injury have all been reported in extreme cases. Persistent vomiting can lead to Mallory-Weiss tears and nutritional deficiencies may lead to Wernicke's encephalopathy.
Prematurity, low birth weight and a slight increase of central nervous system and integumentary malformations have been reported in fetuses of mothers affected with hyperemesis gravidarum. An increase risk of testicular cancer in male patients of mothers with hyperemesis gravidarum during their pregnancy has also been reported in the urology literature.
Hyperemesis gravidarum should be considered when all other causes of persistent nausea and vomiting have been ruled out. Pyelonephritis, pancreatitis, cholecystitis, hepatitis, appendicitis, gastroenteritis, peptic ulcer disease, thyrotoxicosis, and hyperthyroidism can present in similar fashions, with intractable nausea and vomiting, and are treatable conditions. Late presenters need also to be ruled out for HELLP syndrome and other causes of hepatic and central nervous system dysfunction.
The etiology of hyperemesis gravidarum is not well understood. Hormonal causes related to human chorionic gonadotropin, estradiol, progesterone, adrenal hormones and pituitary hormones have been proposed, but currently there is no conclusive evidence implicating any specific substance. Psychological and social factors influence this disease, such as in unwanted pregnancies, although this syndrome is not limited to unwanted pregnancies. Young, unwed mothers whom are felt to have "sinned" and therefore harassed by their parents, are common sufferers of this syndrome. Remarkable improvement with hospitalization is often noted in such cases, with rapid relapses once released to the home environment. Hysterical and immature personalities can predispose one to this condition.
The diagnostic work-up must always start with confirmation of a viable, intrauterine pregnancy. Gestational trophoblastic neoplasia can present with hyperemesis gravidarum in up to 30% of cases. Electrolytes, liver function tests, thyroid function tests, creatinine, blood urea nitrogen, urinalysis and a complete blood count are some of the studies that need consideration in the work-up.
Once the diagnosis is made, treatment consists of mainly supportive care. Intravenous fluid, up to 5 to 6 liters per day using the appropriate amounts of sodium, potassium, chloride, lactate or bicarbonate, glucose and water, are primarily used in correcting the hypovolemia, electrolyte and acid-base imbalances, and ketosis. Until vomiting is controlled, these women should be maintained as NPO (nothing per oral). A low dose, continuous infusion of an antiemetic, such as promethazine, can have beneficial effects. Vitamins, including thiamine, can be added to supplement the intravenous fluids. Patients should be maintained NPO for at least 48 hours after all symptoms and vomiting have ceased, to prevent rapid regress. Initiate PO (per oral) intake with neutral fluids and a small, bland, dry, carbohydrate diet, in frequent intervals. Avoid noxious stimuli such as unpleasant odors. Reassurance and emotional support is important at this time, and psychological counseling can be initiated once symptoms have abated.
Patients with intractable, prolonged vomiting may be treated with nasogastric enteral feedings, peripheral parenteral nutrition, or total parenteral nutrition. Rarely is interruption of pregnancy necessary.
Oral medications have long been the main stay of out-patient treatment. Until forced off the market Bendectin [pyridoxine-vitamin B-6 (10 mg) and doxylamine succinate (10 mg)], a category B medication, was efficacious and safe for both mother and fetus (This was removed from the market in 1984 and listed as a known or suspected teratogenic chemical). This formula can be reproduced over-the-counter using Unisom Nighttime Sleep Aid (25 mg) (not Maximum Strength Unisom Sleepgels, which contains diphenhydraminehydrochloride) one half tablet and Vitamin B-6 (25 mg) one half tablet, each in the morning and afternoon, and one tablet each at bedtime, as needed. Useful category C medications are prochlorperazine, promethazine, trimethobenzamide, and droperidol. Although because of their category designation, informed consent should be obtained on all patients treated with the above medications. (Anytime your health care provider asks for an informed consent before giving you a medication, this should be a red-flag for consumers about the product.)
Note: Italics added by MoonDragon.org research staff.
- Briggs G, Freeman R, Yaffe S: Drugs in Pregnancy and Lactation, 2nd edition. Baltimore, Williams and Wilkins, 1986
- Creasy R, Resnik R: Maternal-Fetal Medicine: Principles and Practice, 2ndedition. Philadelphia, W.B. Saunders, 1989
- Gabbe S, Neibyl J, Simpson J; Obstetrics: Normal and Problem Pregnancies, 2ndedition, Churchill Livingstone, 1991
- Cunningham F, MacDonald P, Gant N: Williams Obstetrics, 18th edition. Appleton and Lange, 1989
- Greenspoon J, Rosen D, Ault M: Use Of The Peripherally Inserted Central Catheter For Parenteral Nutrition During Pregnancy. Obstetrics and Gynecology 1993;81:831-4
- Hsu J, Clark-Glena R, Nelson D, Kim C: Nasogastric Enteral Feeding In The Management Of Hyperemesis Gravidarum. Obstetrics and Gynecology 1996;88:343-346
MoonDragon's Pregnancy Information: Hyperemesis Gravidarum - Conventional Medical
MORNING SICKNESS SUPPLEMENTS & PRODUCTS
Peppermint Stomach Soother Tea, Yogi Tea, Caffeine Free, Certified Organic, 16 Tea Bags - Organic Peppermint Tea from Yogi Tea is the perfect way to lift your spirits and quiet your stomach; with a fresh flavor and aroma you will want to enjoy everyday.
Vitamin C 1000 with Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps - Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.
Nausea / Morning & Motion Sickness Tincture, 100% Organic, 2 fl. oz. - The Nausea / Morning & Motion Sickness Tincture is for upset stomach, nausea, and morning sickness; helps to soothe and calm the stomach.
Vitamin B-6 (Pyridoxine), 100 mg, 100 Caps - Vitamin B-6 (Pyridoxine) is converted in the body to the main coenzyme responsible for amino acid and protein metabolism.
Vitamin C 500 with Rosehips, Nature's Way, 100% Natural, 500 mg, 250 VCaps - Nature's Way Vitamin C with Rosehips provides antioxidant protection useful in treating infections, bruising, colds & flu, sinusitis, sore throats, blood clots, atherosclerosis, high blood pressure, physical and mental stress, immune function, cholesterol levels, liver toxicity and assists in collagen formation.
Stomach Upset Formula Tincture, 100% Organic, 2 fl. oz. - Stomach Upset Formula is used as an all natural herbal remedy for an upset stomach and acidosis, digestive problems, halitosis, morning sickness, and motion sickness.
L-Methionine, 500 mg + B-6, 10 mg, 100 Caps - L-Methionine is an essential sulfur amino acid. The body cannot produce L-Methionine, which must be obtained from food or supplement sources.
Ginger Tea, 20 Tea Bags - Caffeine Free Ginger Tea is used in Chinese medicine to remove toxins, warm the stomach, maintain good health, especially in changing weather conditions, and to prevent seasickness.
Ginger Root Tincture, 100% Organic, 2 fl. oz. - Ginger Root helps to promote gastric secretions, thus aiding with food absorption and excellent for indigestion, flatulence, nausea (including travel sickness), and colic.
Kelp Seaweed (Norwegian) Tincture, 100% Organic, 2 fl. oz. - Due to overwhelming research results, Kelp has become an effective treatment for hyperthyroidism.
Ginger Peach Longevity Tea, Republic of Tea, Regular, 50 Tea Bags - Ginger Peach Longevity Tea is one of the best selling teas with the sweet lushness of a fancy peach with spicy ginger. Voted "Outstanding Beverage" by the National Association of the Specialty Food Trade.
Motion Mate Formula w/ Ginger (Natural Motion Sickness Remedy), Nature's Way, 100 Caps - Motion Mate, a natural motion sickness remedy, formula is based on clinical studies that show ginger root is more effective against motion sickness than dimenhydrenate, but exhibits none of the negative side effects.
Female Estrogen with Progestrone Tincture, 100% Organic, 2 fl. oz. - Female Estrogen With Progestrone formula is used mainly to promote hormonal balance. It does not contain hormones, however.
Alfalfa Leaves, Nature's Way, 405 mg, 100 Caps - Nature's Way Alfalfa Leaves are organically grown by Trout Lake Farm, Washington, and Certified Organically Processed in accordance with Oregon Tilth standards and the California Organic Foods Act of 1990.
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps - Nature's Way Prenatal Vitamin with Folic Acid is a women's complete vitamin formulated to support the health of the mother and child.
Morning Sickness Supplements, Information & Products
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