1. Hyperemesis Gravidarum
The majority of pregnant women
experience some form of mild nausea and/or vomiting early in pregnancy.
In fact, almost 50 percent of women experience some form of morning
sickness. However, a very small percentage of women experience extremely
severe and persistent nausea and/or vomiting. This is condition known
as hyperemesis gravidarum (HG). This condition can make it difficult for
a mother to consume the number of calories she needs, get enough
fluids, and simply perform daily activities. If this condition is left
untreated, it can lead to malnutrition, vitamin and mineral
deficiencies, electrolyte imbalances, weight loss, dehydration, and even
possible liver or kidney damage. These symptoms can all be damaging to
the development of the fetus as well as to the health of the mother.
When HG is treated properly, any adverse outcome to the baby—such as low
birth weight, developmental problems, or prematurity—can be avoided.
Diagnosing
For some women, HG develops fairly
rapidly within just a few weeks. For others, it may develop gradually
over a period of a few months. Hyperemesis gravidarum is typically
diagnosed through a thorough health exam, blood test, urine test,
detailed health history, and the identification of symptoms
characteristic to the condition including severe and persistent nausea
and vomiting as well as dehydration and weight loss. HG is only
considered as the final diagnosis when all other possible causes of
severe and persistent nausea and vomiting have been ruled out. The
condition typically begins in the period from week four to six and peaks
between weeks nine and thirteen. Some women see significant
improvements between weeks fourteen and twenty, while others may need
significant care throughout the pregnancy.
Causes
The exact cause of hyperemesis
gravidarum is not known. Though theories abound, none has yet been
proven to be conclusive. Most likely, the condition is the result of
more than just one factor. The factors may vary from woman to woman,
depending on genetic makeup, body chemistry, and overall health. HG does
seem to be more common in first-time pregnancies, women who are
carrying more than one baby, younger women, obese women, and women who
have had hyperemesis gravidarum in past pregnancies. Most theories focus
on hormonal changes, such as an increase in estrogen and pregnancy
hormone, physical changes, psychological causes, hyperthyroidism,
gastric reflux problems, and nutrient deficiencies such as vitamin B6 and zinc.
Signs and Symptoms
There are many different symptoms
of HG besides the obvious severe and persistent nausea and vomiting.
Additional symptoms may include rapid heartbeat, anemia, dehydration,
vitamin and mineral deficiencies, weight loss of 5 percent or more from
pre-pregnancy weight, ketosis, excessive salivation, extreme fatigue,
headache, strong food aversions and/or cravings, heightened sense of
smell, gallbladder problems, and low blood pressure. There can also be
complications from extensive vomiting, such as gastric ulcers and
esophageal bleeding, that can worsen ongoing nausea. For many women,
this condition has a financial impact as well as an emotional and social
one. It can begin to greatly affect the quality of life. Sufferers may
not be able to work, complete daily household chores, or even care for
young children. The earlier proper medical treatment is given, the
better chance for a decrease in severity of symptoms and for a quicker
recovery with no complications.
When is morning sickness something more serious?
If you vomit more than three or
four times a day, are hardly able to keep any food down, lose weight,
feel very tired and dizzy, and urinate less than usual, you may have
something more serious than run-of-the-mill morning
sickness—specifically, you may be suffering from hyperemesis gravidarum
(HG). Additional symptoms include increased heart rate, headaches, and
pale, dry-looking skin. It is important to diagnose and treat HG as soon
as possible, so contact your doctor if you feel any of these symptoms
or feel that your morning sickness is more serious.
Treatment
If you are
diagnosed with hyperemesis gravidarum, you may need hospitalization to
restore fluids, replace electrolytes, and to administer medications if
needed. Some treatment plans may also include vitamin and mineral
supplementation. Depending on the doctor, you may not be given food by
mouth until the vomiting stops and dehydration has been rectified.
Instead, your food will be supplied through a feeding tube, and you will
begin on food slowly. Proper nutritional intake is one of the biggest
challenges and most important issues for women who suffer from HG. If
you are not getting sufficient nutrients to meet your baby’s
requirements, your baby will take it from your stores. This can deplete
your nutritional reserves very quickly, and it might take months or even
years for you to correct these deficiencies. Vitamins, especially the B
vitamins, can be depleted very quickly, and if they are not replaced
can worsen the symptoms. With hospitalization, you can get the proper
care that is needed.
2. Iron Deficiency Anemia
Anemia is defined as a deficiency
of red blood cells or red blood cells having a decreased ability to
carry oxygen or iron. There are different forms of anemia, such as iron,
B12, and folate deficiency. During pregnancy, the most common is iron deficiency anemia.
It is important to be tested for
anemia during your first prenatal visit so that measures can be taken
for treatment if you are found to be anemic. Even if you test negative
for anemia at your first visit, the condition can develop as you
progress through your pregnancy. This is especially true in the last
three months when the baby is using a lot of your red blood cells for
growth and development. Most doctors will test you at different stages
throughout your pregnancy, including at your first visit, at
twenty-eight weeks, once admitted to labor and delivery, and after
delivery.
Diagnosing
A diagnostic blood test that
indicates hemoglobin and hematocrit levels can help to diagnose anemia.
If these levels indicate a problem, additional blood tests and other
evaluation measures may be used to properly diagnose you. Possible
complications that can occur if anemia is not treated include premature
labor, slowing of fetal growth, complications of dangerous anemia from
normal blood loss during delivery, and an increased susceptibility of
infection to the mother after delivery. Just because you are iron
deficient does not necessarily mean you are anemic. For anemia to
actually be diagnosed, you need to have a severe depletion of iron
stores in your blood, with low levels of hemoglobin as well.
Most women are provided with iron
through prenatal supplements before and during pregnancy to help prevent
iron deficiency. Eating iron-rich foods such as lean meats, fortified
breakfast cereals, spinach, pumpkin seeds, beans, and dried fruits can
also be very helpful.
Causes
Women at higher risk of anemia are
those who are unable to eat a balanced diet due to morning sickness or
hyperemesis gravidarum, who pregnant with multiple babies, and who have
overall poor eating habits, including inadequate iron intake. Your iron
needs increase by 50 percent in pregnancy due to an increase in blood
volume. Especially if your iron stores were not optimal before becoming
pregnant, your iron can easily get used up to meet the demands of
pregnancy, and that can lead to the risk of anemia. Good nutrition and
proper supplementation before becoming pregnant and during pregnancy is
vital to help build up your stores of iron and prevent the risk of iron
deficiency anemia.
Signs and Symptoms
Unless blood cell counts are very
low, the signs and symptoms of anemia can be very subtle. Symptoms vary
from person to person and depend on the severity of the condition. Some
symptoms include fatigue and weakness, headache, dizziness, rapid
heartbeat, pale skin, and labored breathing or breathlessness.
Symptoms of anemia can closely
resemble those of other health conditions and/or medical problems. Never
diagnose or treat yourself. Always consult your doctor for a proper
diagnosis.
Treatment
Treatment for iron deficiency
anemia is based on many factors, including the pregnancy, overall
health, medical history, the type and severity of the anemia, tolerance
for specific medications, procedures, and/or therapies, and the doctor’s
protocol. In general, most treatment for iron deficiency anemia
includes some form of iron supplement. Some of these are time-release
capsules, while others are taken several times throughout the day. The
amount of iron provided daily is more than the usual recommended daily
allowance. In general, most therapeutic levels prescribed for treatment
are between 60 and 120 mg daily. Once the mother’s hemoglobin levels
return to normal for her stage of pregnancy, the normal recommended
daily allowance is usually resumed.
Iron absorption can be increased
with vitamin C–rich foods and/or supplements. It is also helpful to take
iron supplements between meals or at bedtime as well as on an empty
stomach to help absorption. On the flip side, antacids can decrease the
absorption of iron.
For many
women, iron supplements can cause nausea and constipation. If these
problems occur, ask your doctor about taking them with meals. Be sure
you are drinking plenty of fluids, and increase your fiber to help
relieve problems with constipation. If the supplements cause problems
for you, do not stop taking them until you have spoken with your doctor.
