Feeling sick over baby

SINGAPORE - Housewife Syahdah Mohamed Hashim, 26, and consultant obstetrician and gynaecologist Dharshini Gopalakrishnakone, 35, were both mentally prepared for "morning sickness", or nausea and vomiting, when they got pregnant.

But they did not reckon on developing an acute form of the condition called hyperemesis gravidarum (HG). Both could not even keep down a glass of water and had to be hospitalised for dehydration.

HG has become well-known because Kate Middleton, the Duchess of Cambridge, had to be hospitalised for the condition.

Unlike normal morning sickness, HG can lead to potentially fatal complications if left untreated, said doctors here.

In normal morning sickness, which affects 50 to 90 per cent of pregnant women, the nausea may occur without vomiting.

With HG, which affects about 0.3 to 2 per cent of pregnant women and is thought to be related to higher levels of the pregnancy hormone, human chorionic gonadotropin, the nausea is always accompanied by severe vomiting.

Both normal morning sickness and HG start early in pregnancy and often subside after the first trimester (which ends around 12 weeks), but HG symptoms may continue until the third trimester in about 20 per cent of the affected women.

Prolonged and severe vomiting, if left untreated, may put women at risk of dehydration, malnutrition and weight loss, said Dr Lim May Li, head and consultant of the peripartum unit of maternal fetal medicine at KK Women's and Children's hospital.

The severe retching may cause the mucosa (lining) of the oesophagus (food pipe) to tear and bleed, a condition called Mallory Weiss tear.

In rare cases, there is also a risk of thiamine (vitamin B1) deficiency, which may lead to Wernicke's encephalopathy. A potentially fatal condition, it can lead to changes in mental status and neurological abnormalities.

While most cases of HG respond well to dietary changes (such as taking smaller and more frequent meals) and anti-nausea medication, less than 5percent of women may become so severely dehydrated that they need to be hospitalised so that fluid, nutrients or medication can be given intravenously, said Dr Chee Jing Jye, the medical director of Obstetrics & Gynaecology Centre of the Singapore Medical Group.

Although the condition can be physically and emotionally draining, the good news is that early treatment leads to rapid recovery, said Dr Citra Mattar, an associate consultant at National University Hospital Women's Centre.

She said: "Women should not accept severe vomiting as a normal part of pregnancy and think it is unnecessary to seek help for it."

Take action plans

About 15 to 20 per cent of women with HG - one study showed up to 80per cent - are likely to have it again in future pregnancies, said DrMattar.

It may be more common in women who have multiple or molar pregnancies (which are abnormally formed growths), younger women in their first pregnancies, those who are prone to motion- or migraine-induced nausea, and those with heightened senses of taste and smell, DrMattar added.

Genes or a family history may also play a role, and numerous studies indicate a higher incidence of female foetuses among affected women, she said.

She added that there is limited data on the long-term effects of HG. There seems to be a risk of pre-term birth in women with poor weight gain.

Ms Syahdah and DrGopalakrishnakone (right) said they had normal weight gain during their pregnancies and were none the worse for the experience.

Ms Syahdah, who is now in her 23rd week of pregnancy, developed HG in September, when she was in her 10th week of pregnancy. She was admitted to hospital for three days after she had five hours of severe vomiting.

After she was discharged, she took the advice of her doctor and ate smaller meals five to six times a day. She also made sure she drank about two litres of water throughout the day. Her symptoms gradually improved and finally disappeared by 16 weeks.

Dr Gopalakrishnakone was diagnosed with HG in 2007, when she was six weeks pregnant with her daughter. She had a week of vomiting and nausea before she was admitted to hospital for severe dehydration.

She was discharged after two days and coped with her symptoms by taking small frequent meals. By her 18th week of pregnancy, the symptoms went away.

She became pregnant a second time round last year, with twin girls. The HG returned but this time, she was prepared. She stocked up on dry crackers and ginger beer and took frequent, small sips of fluid every hour.

She said: "I ate high-calorie, nutritious food for as long as I could to build up my stores before the nausea hit. When the HG started, I focused on staying positive, remembering that I just had to get through this period as healthily as I could.

"The next thing I knew, I was fivemonths' pregnant and the condition made its quiet exit. It was an amazing feeling."

One good thing that came out of her experience, she said, is that she is now better able to advise her pregnant patients with the same debilitating condition.

She even develops action plans for them. She said: "I take into consideration the women's cravings and the food smells that trigger their symptoms, and come up with a plan to ensure good hydration and food with enough calories and nutrients to avoid hunger pangs."

As there is data linking the presence of nausea and vomiting with a reduced risk of miscarriage, DrGopalakrishnakone said: "I try to change the women's perception of their condition by telling them that their symptoms indicate an abundance of protective hormones for the baby.

"Their symptoms will eventually pass and at the end of the day, a beautiful baby beckons."

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