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- Essential Tips for Expectant Mothers
Author: Dr. Prathima Reddy, Director & Lead Consultant, Department of Obstetrics and Gynaecology at SPARSH Hospital for Women and Children, Bengaluru
New Delhi, August 28, 2024;
Motherhood is a period of joy and transformation, filled with excitement as a woman prepares to bring new life into the world. The journey to motherhood is also marked by several challenges and adjustments, one reason is the hormonal changes and the array of symptoms that pregnancy brings. Symptoms like nausea and vomiting are common with varying intensities in 70 to 80% of the mothers, mostly only in the first trimester. This can be managed by avoiding the triggering factors and by being hydrated. However, some women experience symptoms severely termed hyperemesis gravidarum (HG) which can have a drastic impact on their physical and psychosocial well-being.
What is Hyperemesis Gravidarum (HG) and why does it occur?
Unlike morning sickness, hyperemesis gravidarum can differ significantly in severity and impact and is prevalent in over 3.2%of women in India. This condition causes persistent nausea, vomiting, dehydration, weight loss of more than 5%, and difficulty in keeping liquids or solid food down.
Additional symptoms include dizziness, ketonuria i.e. high levels of ketones in urine, fatigue, electrolyte imbalance, urinating more than usual, acid-base imbalances.
Several factors such as young maternal age, being under or over the prescribed weight, using assisted reproductive technology (ART) to conceive, carrying twins or triplets, carrying a female fetus and having a genetic disposition have been identified as considerable contributors to increasing the risk of hyperemesis gravidarum. Psychological factors like stress, anxiety and depressionhave also been known to be associated with a rise in symptoms of HG.
While the exact cause of HG has not been determined, research says that it can be caused due to a rise in levels of hormones like human chorionic gonadotropin (hCG). This is because elevated hCG levels, which usually peak around 12-14 weeks of the pregnancy period, correlate with HG symptoms. Another hormone, growth differentiation factor 15(GDF15) which is secreted primarily by the placenta, has also been strongly linked to HG.
“Timely intervention and support are crucial in managing hyperemesis gravidarum (HG). Without appropriate treatment, severe cases can lead to complications such as vitamin deficiencies, dehydration, and malnutrition. A deficiency in vitamin B1 can cause Wernicke encephalopathy, a potentially fatal condition that can result in permanent disability if untreated. There have also been reports of injuries from forceful and frequent vomiting, including esophageal rupture and pneumothorax. Electrolyte imbalances, like hypokalemia, pose additional risks of significant morbidity and mortality. Moreover, women with HG may experience higher rates of depression and anxiety during pregnancy, and HG is associated with an increased risk of preterm birth and low birth weight in infants,” highlights Dr. Prathima Reddy, Director & Lead Consultant, Department of Obstetrics and Gynaecology at SPARSH Hospital for Women and Children, Bengaluru.
Best ways to manage the symptoms?
While there is nothing that can be done to prevent the occurrence of hyperemesis gravidarum, there are some ways the symptoms can be managed to avoid excess discomfort.
- Making dietary adjustments and eating small but frequent meals throughout the day to reduce the production of stomach acid and minimize nausea triggers.
- Opt for bland foods over spicy or oily dishes to prevent excess bile production.
- Staying well-hydrated by drinking at least 2 liters of water daily, and taking small sips to avoid aggravating nausea, and adding electrolytes to the water can also help maintain hydration and electrolyte balance.
- Increasing the consumption of vitamin B6 can help reduce the risk of hyperemesis gravidarum and may decrease the chances of vomiting in pregnancy.
- Managing stress and anxiety is necessary for mothers as stress can trigger nausea and can also lead to over or under-eating, increasing acid production.
- It is recommended for expectant mothers to engage in activities like yoga, meditation, or walking.
- Keeping comfort as a top priority and wearing loose clothing to avoid abdominal pressure can help with managing the symptoms.
Navigating through hyperemesis gravidarum (HG) during the complex period of pregnancy requires a lot of care and a proactive approach that addresses the physical challenges and emotional strains it imposes on expectant mothers, to ensure that there are no complications for the mother and the baby. By understanding the risks this condition poses and incorporating lifestyle changes, it would be easier for mothers to deal with the severe symptoms that arise because of HG and seeking the help of a medical professional is highly recommended to avoid the escalation of symptoms to extreme levels.
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