After just 12 weeks of pregnancy, Braelyn found herself with a case of extreme morning sickness that lasted all day long. Her first pregnancy’s severe symptoms included persistent nausea. And vomiting made it impossible for her to do any of her most routine daily activities. It had her husband so concerned he considered taking her to the emergency room.
Instead, Braelyn found the energy to search for a concierge OBGYN. Dr. Rad, an obstetrician specializing in perinatology, higher-risk pregnancies, and maternal-fetal medicine, the name immediately grabbed her attention because of his excellent reviews and patient stories.
“Dr. Rad opened his office after-hours so he could see me right after I contacted him,” says Braelyn. He immediately put her on Zofran (ondansetron), one of the various nausea meds (antiemetics) for pregnant patients used to help mitigate morning sickness and nausea in pregnancy.
“He then ran some tests and advised me that I was positive for hyperemesis gravidarum (HG pregnancy),” she said.
What is HG pregnancy (hyperemesis gravidarum)?
A HG pregnancy is one in which women experience a severe form of morning sickness with nausea and vomiting that goes beyond the typical discomfort. HG during pregnancy can lead to dehydration, weight loss, and electrolyte imbalances.
Unlike regular morning sickness, which often subsides after the first trimester, the symptoms of HG can persist throughout the pregnancy and require medical intervention to manage symptoms.
Some common signs and symptoms of hyperemesis gravidarum include:
- Severe nausea and severe vomiting that does not subside.
- Inability to keep food or liquids down, which can lead to malnutrition.
- Significant body weight loss (over 5% of pre-pregnancy weight).
- Low or high blood pressure.
- Signs of dehydration (with symptoms such as dry mouth, extreme thirst, or reduced urination). Often, IV fluids are administered.
- Fatigue and weakness.
- Lightheadedness, dizziness, or fainting.
- Mental health impacts.
What causes hyperemesis gravidarum pregnancy?
The exact cause of hyperemesis gravidarum (HG) is not fully understood. Still, it’s believed risk factors may be related to hormonal changes in pregnancy, particularly elevated levels of human chorionic gonadotropin (hCG) and estrogen.
Some pregnant people are susceptible to a hormone called GDF15, which is produced at low levels throughout the body.
Dr. Rad manages Braelyn’s HG pregnancy
Early management of HG is crucial to prevent complications for both the mother and the baby.
“I had no idea that an HG pregnancy could cause so many serious issues for my baby, such as low birth weight, premature birth, nutrient deficiencies, and even developmental delays,” said Braelyn. “So, I visited Dr. Rad three times a week to stay on top of my symptoms.”
Treatment of hyperemesis gravidarum (HG) during pregnancy primarily involves a combination of things, which can include:
Lifestyle Modifications and Dietary Changes
- Small, frequent meals: Patients are encouraged to eat small, frequent meals to avoid an empty stomach, which can exacerbate nausea.
- Avoiding triggers: Identifying and avoiding foods, smells, or situations that trigger nausea.
- Hydration: Maintaining adequate hydration with oral fluids is crucial. Electrolyte-rich fluids can be more beneficial.
Antiemetic medication
The first line of treatment typically includes antiemetic medications such as:
- Vitamin B6 (Pyridoxine): Often combined with doxylamine (an antihistamine) as a first-line treatment.
- Ondansetron: Used when other treatments are ineffective. However, there may be concerns regarding its use in early pregnancy; thus, it is prescribed after careful consideration.
- Metoclopramide: Another option, though it may have side effects like drowsiness.
- Ginger: Ginger supplements may also be recommended as a natural remedy, although the evidence for its effectiveness is variable.
Supportive care
- Intravenous (IV) fluids: For patients unable to get enough fluids orally, IV hydration is crucial to correct dehydration and electrolyte imbalances.
- Nutritional support: In the most severe cases, patients might require enteral (via a feeding tube), or even in less severe cases, intravenous fluids and nutrition (parenteral) can help maintain caloric intake and prevent weight loss.
Hospitalization
- Hospital admission may be necessary for those who do not respond to outpatient management, are severely dehydrated, or have significant electrolyte imbalances.
- Continuous monitoring of weight, electrolytes, and overall health is important to adjust treatment as necessary.
Psychological support
- Given the physical and emotional toll of HG, psychological support is also important to help manage the condition’s impact on mental health.
- “Dr. Rad personalized my care so much!” says Braelyn. “He made me feel comfortable and safe, and his loving staff was a miracle within a miracle.”
A peaceful end to a hypergravidarum pregnancy
When Braelyn hit the 41-week mark, she decided to have a home birth with the help of a midwife. “Dr. Rad was fine with that, as long as the midwife was well trained, and I would insist that we call Dr. Rad at the first sign of trouble,” says Braelyn.
Unfortunately, Braelyn ran into problems when she didn’t dilate for two days. When the pain became too much for her, she contacted Dr. Rad, who told her to meet him at the hospital ASAP. When Braelyn arrived, Dr. Rad was already there waiting for her.
He immediately administered an epidural rather than wait for the anesthesiologist to get there. Within 20 minutes, Braelyn gave birth to a baby girl, Luka Isabella. The anesthesiologist missed the show and arrived two hours later.
Says Braelyn, “I’d give birth every day with Dr. Rad. If I hadn’t had Dr. Rad, I would have been screwed.”
Why trust Dr. Rad with your high-risk pregnancy?
Expectant mothers with high-risk pregnancies worldwide are finding their way to Dr. Steve Rad’s Beverley Hills offices. Dr. Rad is recognized as one of the premier healthcare providers for high-risk pregnancy and maternal-fetal medicine.
A maternal-fetal medicine specialist (perinatologist) receives a traditional obstetrics and gynecology education but with an additional three years of training to treat medical complications and promote a healthy pregnancy.
Dr. Rad treats pregnant women with a full range of abnormalities, including vasa previa, placenta accreta (adherent placenta), placenta increta, placenta percreta (invasive placenta), velamentous cord insertion, and placenta previa.
Call (844) 473-6100 or schedule your consultation online. We are currently accepting new patients.
Dr. Rad offers in-home prenatal care and a fly-in program for out-of-town and international patients. He travels to patients who need him throughout the U.S. and worldwide and offers virtual consultations.
Call (844) 473-6100 or click here to schedule online
Sources:
GDF15 linked to maternal risk of nausea and vomiting during pregnancy | Nature
https://www.nature.com/articles/s41586-023-06921-9
Extreme morning sickness? Scientists finally pinpoint a possible cause
https://www.nature.com/articles/d41586-023-03982-8
Placenta and appetite genes GDF15 and IGFBP7 are associated with hyperemesis gravidarum Nature Communications
https://www.nature.com/articles/s41467-018-03258-0
Thyroid Storm Caused by Hyperemesis Gravidarum
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9123575
Managing hyperemesis gravidarum: a multimodal challenge
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913953
Expert consensus from the College of French Gynecologists and Obstetricians: Management of nausea and vomiting of pregnancy and hyperemesis gravidarum]
https://pubmed.ncbi.nlm.nih.gov/36150647
