August 22, 2012
Is vomiting normal during pregnancy?
Illustration by Ton Dañas
So, you have Hyperemesis Gravidarum? Hyper... what? With the avalanche of Latin words used in the impreachment trials, we don't need to hear another one—except when the doctor tells you that this is your diagnosis. Let's break it down: Hyper-excessive; Emesis-vomiting; Gravida-pregnant. Simply put, it is excessive vomiting during pregnancy.
Vomiting is a common observation in most pregnancies and no dangerous effects are seen subsequently in their babies. It is usually called "morning sickness" and is accepted as part of pregnancy, so the mothers just grin and bear it. But, it should not lead to the mother's weight loss, weakness and dehydration. If it does, this is obviously abnormal, and is then labelled as Hyperemesis Gravidarum. The exact cause is unknown. Many factors are implicated as causative agents, such as the following:
Genetics. As in almost many diseases and health issues, genetics is thought to be a major factor. So if your mother or sisters had HG during their pregnancy, chances are you will too.
Hormones. With the increased hormones during pregnancy, the body reacts adversely. It is thought that the hormone beta HCG is the culprit hormone because it is highest during the first few months of pregnancy and decrease thereafter. This seems to mirror the observation that vomiting starts at about the 2nd month when the pregnancy test becomes positive because this test is a reaction to the amount of beta HCG present. After the 4th month, beta HCG starts to decrease so does vomiting. This also correlates well with those with abnormally elevated beta HCG, like twin or multiple pregnancies and molar pregnancy (H-mole).
Psychological. The American College of Obstetrics & Gynecology has warned against attributing vomiting to psychological factors as this may mislead us to the true cause of vomiting, much more for HG.
Factors that increase nausea and vomiting in pregnancy are:
• Previous history of vomiting even in non-pregnant state
• History of motion sickness, migraine, psychiatric illness
• Vit B deficiency
• History of gastrointestinal illnesses
• Psychiatric illness
• Underweight
• Certain medicines, particularly multivitamins containing iron
• Certain food and odors
Factors that decrease a woman's tendency to develop HG are:
• Cigarette smoking
• Age over 30
When does vomiting become Hyperemesis Gravidarum (HG)?
HG is diagnosed when vomiting is excessive and leads to weight loss, dehydration, gastric reflux, difficulty in doing daily activities and general lack of energy of the woman. This is the reason why they are best hospitalized to correct whatever deficiencies they may have and prevent possible danger to the mother and child. HG used to be a major factor in maternal deaths but now that intravenous fluid can be easily given to correct nutritional and metabolic deficiencies,
HG may lead to complications largely due to the metabolic changes in the body. For the mother, it may lead to organ failure. For the baby may not develop properly due to poor maternal
Nausea and vomiting in pregnancy is usually treated with anti-emetics ( (anti-vomiting) as an outpatient. On the other hand, HG is considered a medical emergency and so the patient must be admitted for correction of her deficiencies.
Nausea and vomiting can be self-medicated. Conservative measures are the eating ice chips and sweet candy. There are many anti-emetics sold over the counter, meaning you don 't need a doctor 's prescription. However, when the vomiting becomes so severe that almost everything you take in is thrown up, it is time to go to the hospital. Waiting too long may lead to dangerous effects on both the mother and her baby.
If you have questions for Dr. Malu, you can email her at feedback@herword.com.
Dr. Ma. Luisa V. Torralba-Mangubat is a Fellow of the Philippine Obstetrical & Gynecological Society, Philippine College of Surgeons and International College of Surgeons. In addition to this, she is also a Fellow in Aesthetic & Medicine Surgery of the Philippine Academy of Medical Specialists and a member of the Philippine Academy of Non-Surgical Aesthetics. For personal consultations, her clinic hours are as follows:
Asian Hospital and Medical Center, Room 722
Monday, Wednesday, and Friday, 8 a.m. to 10 a.m.
Tel. (632) 771-9340
Medical Center Manila, Room 337
Monday, Wednesday, and Thursday, 1 p.m. to 6 p.m.
Saturday, 9 a.m. to 1 p.m.
Tel. (632) 528-1173
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