The Truth About Kate Middleton: What Exactly is Hyperemesis?

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By Tara Rasmus, Refinery29

So, as the entire world has heard, a pregnant Kate Middleton was recently hospitalized for a rare form of morning sickness called hyperemesis gravidarum. The illness is actually really scary, with the key symptoms including nonstop nausea and vomiting, leading to serious dehydration and dangerous weight loss (notably, it has been reported that author Charlotte Bronte died of the disease). Even more shocking, however, is the lack of comment from health professionals being reported amidst all of the the alarming personal accounts of how serious and debilitating the condition is.

While hyperemesis gravidarum is rare (it affects only 1-2% of pregnancies, morning sickness affects close to 90% of cases) and treatable, thanks to modern availability of rehydration and renutrition via IV, but there isn't a cure per se. Some women that have suffered the condition have come forward saying that they found some relief via acupuncture. Others were offered Zofran (a medication sometimes given to patients receiving treatment for cancer; the effects of which have not been tested on fetuses) - one doctor even went so far as to offer a woman an abortion if she "couldn't take it anymore." Wait a second: What exactly is this condition, and why is it so difficult to treat?

To get the lowdown (because, first of all, we believe that it's important for us women to be adaquately informed of our health-care options, and second, yes, we are concerned about the tiny future royal), we reached out to three New York City-based health-care professionals to get their take: Amy Magneson, M.D., F.A.C.O.G., assistant clinical professor at Columbia University; Ellen Chuse, a certified childbirth educator with a practice in Brooklyn, New York; and Barbara Sellers, C.N.M., a midwife practicing in New York City. From symptoms and possible causes to the latest treatments and tips, these women gave us the real truth, which is beneficial for both women with hyperemesis, as well as those suffering from general morning sickness - take note, Duchess Kate!

Causes and Symptoms
While it is unknown why exactly nausea and vomiting occurs in pregnancy (this phenomenon is referred to by health professionals as NVP), it is thought to be connected to the increase of the pregnancy hormone Human Chorionic Gonadotropin, or HCG. "We believe that HCG is the emetogenic culprit in hyperemesis gravidarum," says Dr. Magneson. "The placenta makes it, and a woman who is very susceptible to the emetogenic effect of HCG can end up with hyperemesis."

According to Dr. Magneson, susceptability to hyperemesis gravidarum can be predicted a few ways: First, if the mother has experienced HG in previous pregnancies, she will likely experience it in subsequent pregnancies. Secondly, the presence of a large placental mass is associated with HG, as is the case with twin pregnancies (which, according to Dr. Magneson, is why there is so much speculation that Dutchess Kate is carrying twins). Third, a family history of HG, or the presence of other medical conditions, such as hyperthyroidism, can contribute to the presence of hyperemesis. Finally, according to Ms. Chuse, there is believed to be a psychological component to the disease. "You have to take into account what might be going on for the woman emotionally," says Chuse. "There are so many changes going on in the body, so many hormonal changes, and that can affect your psychological well-being as well as your physical health." Dr. Magneson concurs: "[HG] is seen more commonly in women with high-stress levels or in women with a history of anxiety or depression."

As previously stated, symptoms of HG include constant, relentless nausea and vomiting, along with extreme sensitivity to smell. As with normal morning sickness, these severe symptoms of HG may begin to subside after the 12- or 13-week mark (which, we're hoping, is the case for Kate), but in other cases, the symptoms can last for the duration of the pregnancy, although this is thankfully rare.

As Dr. Magneson describes, the symptoms of HG are pretty unpleasant, to put it mildly. "Hyperemesis is a magnified version of morning sickness, in which [pregnant women's] bodies have trouble distinguishing hunger for nausea. Eating doesn't make the nausea go away...they try to eat small meals, but most of the time, they cannot even keep water down. This causes dehydration and more hunger, creating a vicious cycle. Women with HG can start to lose weight - they are essentially starving." This is scary for a number of reasons, but especially dangerous for women like Kate that are already very slim at the time of conception.

While there unfortunately isn't a one-size-fits-all, proven, fetus-safe cure for HG, there are treatments that can make a difference for many women with the condition. The first priority, of course, is to make sure that the woman is adequately hydrated and replenished with electrolytes. To treat nausea and prevent vomiting, all three health professionals agree that it is best to try natural solutions first, and only turn to medications in the severest cases, for the benefit of the fetus. According to Ms. Chuse, the first treatments a woman might try are peppermint tea and ginger ale, acupuncture, and bed rest. During her time as a midwife, Ms. Sellers has found that many women benefit from frequent small portions of simple carbohydrates and white turkey meat, which she says can sometimes be tolerated better than other proteins.

According to Dr. Magneson, taking prenatal vitamins can actually help prevent HG. "Studies have shown that women who take prenatal vitamins before they are even pregnant (and have higher levels of nutrients in their system) report less NVP than those who did not do this. So, that is my plug for preconception counseling...be sure to talk to your doctors before you think about getting pregnant to get yourself healthy."

Once you're pregnant, however, you may want to consider dropping the prenatal formulas for straight folic acid, says Ms. Sellers: "Folic acid is essential to prevent neural tube defects, but the colors and fillers in the prenatals can make some women sicker." One treatment that all women agree on is the use of special bands that put acupressure on a certain point on the inside of the wrist - a common treatment for those who suffer from motion sickness.

If these natural remedies don't work, women may have to turn to more serious measures. Medications such as Zofran are sometimes prescribed in these instances, but Ms. Chuse insists that it's important to note that this medication has not been tested to ensure safety for unborn babies. "When prescribing medication for pregnant women, health professionals always have to weigh the risks against the benefits. If the mother is in serious danger, she may need to be treated with prescription medications. But we have to remember that Thalidomine was once given to pregnant women to treat nausea, and it was later found to cause serious birth defects."

The Takeaway
So...pregnancy sounds pretty terrifying at this point, right? Despite all of the serious risks associated with HG (not to mention the plethora of women coming forward to tell their scary stories), all three health professionals were quick to assure us that HG is rare, treatable, and has very few risks if the patient is treated early. With support from a compassionate and educated doctor, as well as a supportive partner (hey, Wills!), women suffering from HG (and their unborn babies) are sure to make it through. So, we're happy to report, the lovely Kate should be in the clear (commence countdown to Royal Baby in 3, 2, 1...).


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