85% of pregnant women experience nausea and/or vomiting at some point during their pregnancy. If most often, these symptoms are part of the minor inconveniences of pregnancy, some women are confronted with a severe form of nausea and vomiting, hyperemesis gravidarum. Explanations.
Nausea, vomiting and pregnancy, a classic trio?
Nausea and vomiting are a classic sign of the first trimester of pregnancy. Some women also realize that they are pregnant at the time of their appearance. Most often, these symptoms remain transient and benign, and disappear in the second trimester of pregnancy. Some women find them at the very end of pregnancy, in the month before giving birth, when the baby presses hard on the stomach.
Nausea and vomiting of pregnancy are often trivialized, presented by relatives and health professionals as a benign, even normal symptom of pregnancy. However, in some cases, this nausea and vomiting, poorly controlled, progress to a severe form, hyperemesis gravidarum. This severe form of pregnancy-related nausea and vomiting can have significant health consequences for both mother and child. It must therefore be detected and taken care of in order to prevent its complications.
What is hyperemesis gravidarum?
According to the National College of French Gynecologists and Obstetricians (CNGOF), hyperemesis gravidarum affects about one in three pregnant women, of whom 0.3 to 3.6% require hospitalization to treat this nausea and vomiting and their consequences. This severe nausea and vomiting can be recognized by several particular characteristics:
- Severe uncontrollable vomiting;
- Weight loss of more than 5% compared to pre-pregnancy weight;
- The presence of ketone bodies in the urine (ketonuria);
- Blood ionogram disturbances (sodium, potassium and blood chlorides);
- Dehydration.
Some pregnant women have an increased risk of developing hyperemesis gravidarum, especially in cases of infection with Helicobacter pylori, a history of migraine, a personal or family history of hyperemesis gravidarum or intolerance to birth control pills. On the other hand, an age greater than 35 years, smoking or pregnancy with a male embryo would protect pregnant women from hyperemesis gravidarum. In any case, this severe form of nausea and vomiting of pregnancy must be detected as soon as possible, in order to be treated appropriately.
What treatments for nausea and vomiting of pregnancy?
Recently the CNGOF (National College of French Gynecologists and Obstetricians) made recommendations for the management of nausea and vomiting during pregnancy. Experts recommend first eliminating prenatal vitamins and iron supplementation in the first trimester of pregnancy, while maintaining folic acid supplementation, which is essential to prevent serious congenital malformations (spina bifida). Dietary modifications and adaptations showed no effect on the occurrence of nausea and vomiting.
Some approaches have shown no benefit, such as vitamin B6, ginger, acupressure, acupuncture and electrostimulation. Aromatherapy is to be avoided, because of the risks associated with taking essential oils during pregnancy. Depending on the situation, drugs may be prescribed, first-line doxylamine, whether or not associated with pyridoxine or dimenhydrinate. When hyperemesis gravidarum requires hospitalization, intravenous metoclopramide is the first-line drug, accompanied if necessary by parenteral rehydration and vitamin B1 supplementation. Psychological support is essential for these women, whose course of pregnancy is deeply disturbed by severe nausea and vomiting.
Estelle B., Doctor of Pharmacy
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