Hyperemesis Gravidarum (HG) is a debilitating illness affecting 1 in 10 women during pregnancy. This could have a profound impact on the physical health and psycho-social wellbeing of the woman. This article gives an overview of this health condition and advocates for a holistic approach to the care of HG.
How common are nausea and vomiting in pregnancy?
Nausea and/ or vomiting during pregnancy (NVP) is very common affecting about 7 out of 10 women during pregnancy.
NVP can happen any time of the day and not only in the morning. Therefore, the term, ‘morning sickness’, is a misnomer.
The symptoms typically start between the 4th and 7th week of pregnancy, peaks in around the 9th week and resolve by the 20th week in 90% of women. (Ref 1)
For the majority of the women, the symptoms are mild and self-limiting.
What is Hyperemesis Gravidarum (HG)?
When a pregnant woman suffers from severe symptoms of nausea and vomiting, then this is called hyperemesis gravidarum (HG). This occurs in 1 in 100 women during pregnancy.
This could require frequent, multiple and/ or prolonged hospital admission.
A diagnosis of HG is made when all other causes of nausea and vomiting have been ruled out. However, there is no single accepted clinical definition of HG (Ref 2).
A clinical diagnosis of HG is made when there are severe nausea and vomiting (in absence of any other cause of nausea and vomiting) along with:
- Weight loss: greater than 5% of the pre-pregnancy weight
- Electrolyte imbalance in the blood
Women with HG could also have the other symptoms such as excessive salivation (‘Ptyalism’), a heightened sense of smell and incontinence of urine. Moreover, dehydration can cause a headache and constipation.
How can you measure the severity of NVP?
The Royal College of Obstetricians and Gynaecologists (UK) recommends the use of a validated scoring system, such as Pregnancy-Unique Quantification of Emesis (PUQE) score.
The International Classification of Disease (ICD – 10) (World Health Organization 2004) classifies HG as:
- Mild: HG starting before the end of 22 weeks without metabolic disturbances.
- Severe: HG starting before the end of 22 weeks with metabolic disturbances (Carbohydrate depletion, dehydration, and electrolyte imbalance).