Yesterday Clarence House announced the happy news that Will and Kate are expecting again. Every detail of her first pregnancy was scrutinized, analysed and debated by the media, and I’m sure she will have braced herself for more of the same this time round. If that wasn’t bad enough, it is no great secret that she suffered with hyperemesis gravidarum when she carried baby George, and it would seem she is having the same torrid time with this pregnancy.
Just to refresh your memory, in case you had forgotten, hyperemesis gravidarum is the extreme end of morning sickness. I am eternally grateful that I avoided anything other than mild queasiness during my pregnancies, and compared to even ‘standard’ morning sickness, hyperemesis is quite another matter.
A degree of nausea and vomiting affects the vast majority of pregnant ladies. However only around 1% are categorised as having hyperemesis. It causes intractable vomiting which can result in weight loss and dehydration. In extreme cases there is a need to be admitted to hospital for intravenous fluids and careful monitoring of electrolyte levels.
I must say that the initial advice offered to women with any degree of pregnancy induced nausea is fairly unsophisticated. We usually suggest fairly common sense things, such as eating little & often, avoiding smells or foods that particularly trigger nausea and trying anything ginger based. There is also some limited evidence that acupressure e.g.Sea Bands may be of help. However in my experience if people have got as far as coming to the doctor specifically to discuss the problem, it’s usually gone beyond treatment with a ginger hobnob.
As a general rule doctors try to avoid prescribing any medication in pregnancy, but in the case of severe repeated vomiting, medication is sometimes helpful. The two commonly used drugs are promethiazine, an antihistamine, and cyclizine, an anti sickness medication. These are both available as tablets and recommended by NICE, although it is worth noting that all anti sickness medications are officially unlicensed in pregnancy.
If these measures fail there are other medications available, although any sign of dehydration would usually warrant referral to hospital for specialist care.
In the majority of cases hyperemesis gravidarum subsides at around 12 weeks, but (before you all start shouting!) some ladies are unlucky and it can drag on much further into the pregnancy. Fortunately despite all the misery it causes, unless there are substantial problems with maternal weight gain, it is not known to have any adverse effects on the developing baby.
Congrats again to Will & Kate and I hope she starts to feel better very soon!
If you, or someone you know is struggling with Hyperemesis Gravidarum you may find Pregnancy Sickness Support useful.