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For most people, a bout of vomiting is something akin to torture. So it’s easy to sympathize with pregnant-again Kate Middleton who, it’s just been revealed, is suffering from a debilitating condition called hyperemesis gravidarum (HG), which causes persistent nausea and vomiting to the point of weight loss and dehydration, apparently making standard morning sickness look like a walk in the park.
It’s the duchess’s second bout with the condition. She also suffered through it during her first pregnancy, with Prince George, who is now a year old. And now, not quite 12 weeks into her second pregnancy, she’s being treated for HG once again — which is not all that surprising, since women who have HG in one pregnancy tend to have it again, though often less severely than the first time around. “The Duchess of Cambridge’s second pregnancy with HG is a reminder: Women who experience this condition face an 80% chance of repeat diagnosis in future pregnancies,” noted a statement from the HER Foundation, a grassroots network of HG survivors and an information clearinghouse on the condition. “And while the severity and duration of symptoms vary among women, HG remains a debilitating and even life-threatening medical condition that can have serious consequences for the health of both mom and baby.”
Since the condition is genetic, 20 percent of women who are affected have a sister who also had HG, and 30 percent have a mother who had HG, Marlena Fejzo, of Harvard University, a leading researcher on HG, told Yahoo Health.
“It’s terrible,” said Fejzo, who is an advisory board member with the HER Foundation. Maternal complications of severe HG, she said, can include detached retinas, fractured ribs, blown eardrums and esophageal tears, she said, all a result of frequent vomiting, as well as malnutrition. Fejzo has found through her research that 18 percent of women who suffered through an HG pregnancy wind up with post-traumatic stress disorder, while 37 percent decide to not have any more children because they don’t want to endure HG again. In addition, 15 percent of HG sufferers wind up making the painful decision to abort, often referred to as a “therapeutic termination,” she said. There have also been a few reports of maternal deaths, as a result of stomach tears and bleeding. “So it’s very severe,” she noted.
“It is a devastating condition,” Dr. Irina Burd, director of research for the division of maternal fetal medicine at Johns Hopkins University in Maryland, told Yahoo Health. It’s also quite rare, affecting only about one to two percent of pregnant women. “We try to manage with a patient’s treatment at home, but it often winds up with a hospitalization,” Burd said. “Every patient and every situation requires a personalization of care.” The constant nausea and vomiting can lead to dangerous vitamin deficiencies, weight loss, and dehydration for the affected mom-to-be, which is why hospitalization is so often required, though Middleton has not yet reached that point this time around.
It’s not known what causes HG, although it’s widely understood to be related to rising levels of the pregnancy hormone, hCG (human chorionic gonadotropin), and how, in certain individuals, that may trigger the part of the brain affecting nausea and vomiting. “We are on the cusp [of understanding the root cause],” Fejzo said. “But as far as a genetic study and finding the cure, we’re just getting there.” Other factors triggering HG seem to include rising estrogen levels, gastrointestinal changes, and high-fat diets.
While effects on the fetus seem to be rare, some research has indicated that babies whose mothers suffered an HG pregnancy are more likely to be premature or have a low birth weight, or to be vitamin-K deficient, Fejzo noted.
Treatments vary greatly, Burd said, and often begin with dietary changes and the consumption of small, protein-filled snacks rather than large meals. If weight loss continues, and the patient is hospitalized, treatments can include pyridoxine, a high-dose vitamin B6, and doxylamine, an antihistamine, the combination of which can ease nausea, Burd explained. Reglan and Zofran have also been effective, Vincenzo Berghella, president of the Society for Maternal-Fetal Medicine, told Yahoo Health. “Even ginger, or those acupressure wristbands, like people use for seasickness, can help,” he said, adding that symptoms of HG most often spike between the 10th and 12th week of pregnancy, often subsiding between week 14 and 16. But for those for whom it lingers, life can be difficult.
“I wouldn’t wish hyperemesis gravidarum even on evil people,” wrote Parents blogger Kristen Kemp in a revealing first-person essay during news Middleton’s first difficult pregnancy. “Hyperemesis gravidarum (HG) tried to kill me during both of my pregnancies. I took gobs of medication, checked in for several stays at the hospital and, as a last resort, considered abortion at the suggestion of my ob-gyn.” She managed to move past that idea, although it was a very tough road — one that often had her questioning her sanity. But, she soon realized, “I had a freak illness, but I was not a freak. Just ask Kate Middleton.”