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Hyperemesis Gravidarum: Severe Nausea

What is it? What Causes it?


Hyperemesis Gravidarum (HG) is a severe version of "morning sickness," which causes relentless vomiting and nausea throughout the entire pregnancy, not just the first trimester.


This severe case of nausea and vomiting can sometimes lead to hospitalization due to malnutrition, weight loss, dehydration and even psychosis. HG can also increase the risk of preterm birth, preeclampsia and blood clots.



Symptoms, Triggers & Cause


Some women have reported their symptoms being triggered by smells, noise, and even bright lights. No one knew the cause of this disease until recently. Dr. Fejzo, who's a geneticist, experienced HG herself and was ignored by her own doctor, leading to a miscarriage at 15 weeks. She was eventually able to conduct a study in 2018 showing that women who experienced HG tended to carry a variant in a gene for hormone GDF15. This hormone is released by many tissues in response to stress. Receptors for this hormone are clustered in a part of the brain responsible for feeling sick and vomiting.


The research found that women experiencing Hyperemesis had much higher GDF15 during pregnancy than women who had no symptoms. They also found that the hormones effect depended on the woman's sensitivity and exposure to the hormone before pregnancy. The research found that women with higher levels of GDF15 prior to pregnancy hardly ever had experiences of nausea and vomiting. Researchers hypothesize that prolonged exposure to GDF15 before pregnancy could protect women to being less sensitive to the sharp surge in the hormone caused by the pregnancy.


Lowering your stress levels can help reduce the chances of triggering symptoms of HG and morning sickness. I highly recommend you have a daily grounding and breathing practice to help you reduce stress and prepare your mind and body for labor. My online Doula guide can help you with this which you can access here.


Eating smaller frequent meals may also help, as well as staying hydrated. I recommend drinking tea or coconut water for better hydration. Let's look at common and not so common remedies for HG and morning sickness symptoms.


Remedies


Medical control of symptoms:


Once you start developing severe symptoms, your Ob/Gyn will most likely suggest to you an IV drip for hydration. They may prescribe vitamin B1 (Thiamine) and if you cannot stomach pills they will suggest an IV. They may also prescribe to you an antiemetic like Zofran (ondansetron) or Reglan. Antiemetics are drugs that alleviate vomiting and nausea. They may also prescribe you a sleeping aid such as Unisom (doxylamine) or diclectin (contains a combination of B6 and doxylamine). Some doctors may also prescribe some magnesium (vitamin b6). These remedies may help with mild cases of morning sickness but hardly ever help with severe cases such as HG.


Homeopathic control of symptoms:


I've shared on my social media my use of homeopathic pellets for my Doula clients. Here is a list of different pellets that have shown some relief for nausea and vomiting during pregnancy:


Asarum- Use this if: you have constant nausea, retching and extreme sensitivity to everything, especially noise. This is for those who feel better lying down and resting or when drinking cool drinks/food. Also for low appetite.


Kreosotum- Use this if: you salivate a lot and become nauseous when swallowing it, you vomit up food that looks undigested.


Lacticum Acidum- Use this if: you have the classic "morning sickness" where nausea is worse immediately after waking up, you salivate a lot and have burning stomach pain, you usually have an appetite and feel better after eating.


Sepia- Use this if: you have intermittent nausea with an empty feeling in stomach, you feel irritable, sad, worn out or indifferent to your family, you feel worse in the morning before you eat & symptoms do not improve by eating and you vomit after, if the nausea gets worse by lying on your side, if odors trigger the symptoms, if food tastes too salty, if you lose your taste for many foods but still crave vinegar and sour things.


Tabacum- Use this if: you feel extreme nausea with a sinking feeling in the pit of your stomach, you look extremely pale, feel very cold and faint, you need to lie very still and keep your eyes closed, if you move at all you may vomit violently or break out in cold sweat.


Colchicum- Use this if: you get horrible nausea that gets worse from seeing or selling food (esp. eggs or fish), if you have a sore and bloated stomach, you have trouble eating anything even though you have cravings, you may feel sick from odors no one else notices.


Ipecacuanha- Use this if: you get intense and constant nausea all day with retching, belching and excessive salivation, you feel worse when lying down and motion, you feel nauseous even after vomiting.


Nux Vomica- Use this if: you are nauseous after eating in the morning and are irritable, impatient, chilly, urge to vomit but nothing comes out, your stomach feels sensitive and crampy, you are constipated.


Pulsatilla- Use this if: your nausea is worse in the afternoon or evening, you're not thirsty but feel better after drinking a cool drink, you have cravings but they make you sick, you crave creamy foods but they make you. vomit or throw up, you feel affectionate, insecure and weepy, you want a lot of attention and comforting.


***These can be found at Whole foods, Amazon or any health food store/ vitamin shop in your area.***


Home Remedies control of symptoms


Some holistic Doctors may suggest getting some acupressure nausea/motion sickness wrist bands, which may work for mild cases of morning sickness. Those can be ordered online or any pharmacy.


Ginger tea and ginger tablets have also been known to help with the symptoms of nausea, 1-3 cups a day. Another herb that has been helpful is peppermint (1-3 cups a day), in tea form and as an essential oil. You can use peppermint essential oil on a cotton ball to smell it whenever the nausea is triggered by odors.


Liquorice tea and orange peel tea have also been used for symptoms of nausea and vomiting.


In traditional Chinese medicine, many herbal formulas are suggested for different symptomatic patterns, much like the homeopathic remedies. In TCM, we look at where the harmony of the body's system is disrupted, where the Qi, or vital energy is being obstructed from flowing normally.


Below are listed the fundamental root causes of nausea during pregnancy and the herbal formulas as per TCM:


Phlegm: If you tend to vomit clear fluid like mucus, you may have stomach and spleen deficiency, making it difficult for your body to transform and transport bodily fluids. The fluids accumulate and form phlegm in the stomach, obstructing the movement of Qi. This may cause pressure in your chest, dizziness or vertigo. The herbal formulas used for this are Ling Gui Zhu Gan Tang (Poria-Cocos Mushroom, Cinnamon, Rhizomes, Liquorice) and Xiao Ban Xia Tang (Crow-Dipper Rhizomes & Ginger).


Stomach Deficiency: You may have symptoms of feeling cold (Qi deficiency) or the opposite of night sweats. Both are due to a disruption of your Qi flow. The three herbal formulas suggested for this are Xiang Sha Liu Jun Zi Tang (Ginseng, Rhizomes, Poria-Cocos Mushrooms, Liquorice, Tangerine Peel, Crow-Dipper Rhizomes, Costus Roots, Amomum Fruit, Ginger), Er Chen Tang (Crow-Dipper Rhizomes, Tangerine Peel, Poria-Cocos Mushrooms, Liquorice, Ginger) or Mai Men Dong Tang (Dwarf Lilyturf root, Ginseng, Rice Sprouts, Jujube Dates, Liquorice, Crow-Dipper Rhizomes).


Liver Qi Stagnation: You may vomit food and drinks right after ingesting. Emotional stressors such as anger, resentment or frustration may cause these liver issues. The recommended herbal formulas are Ban Xia Hou Pu Tang (Crow-Dipper Rhizomes, Magnolia Bark, Poria-Cocos Mushroom, Perilla Leaves, Ginger) and Zuo Jin Wan (Goldthread Rhizomes, Evodia Fruits).


Stomach Fire(Heat): You may vomit frequently and it may last beyond the first trimester. You may often feel thirsty and have a strong craving to cold icy drinks. The herbal formulas suggested are Yu Nu Jian (Gypsum, Rehmannia, Anemarrhena Rhizomes, Dwarf Lilyturf root, Achyranthes root) and Wen Dan Tang (Crow-dipper Rhizomes, Bamboo Shavings, Bitter Oranges, Tangerine Peel, Poria-Cocos Mushrooms, Ginger, Liquorice, Jujube Dates).


***Please make sure that you get your herbal formulas from. a reputable TCM shop in your area.***


Cannabis as an Antiemetic


The consumption of Cannabis for HG symptomatic relief has been studied for its antiemetic properties. Women who used cannabis reported weight gain within 2 weeks and better relief than when they used common antiemetic prescribed drugs.


However, it is important to note that women who frequently consume cannabis might not receive the same relief as women who do not consume cannabis on a regular basis. In those women who are daily long-term users of cannabis, they may develop a condition that leads to repeated and severe vomiting called cannabinoid hyperemesis syndrome. This is due to the overstimulation of the endocannabinoid receptors. A tolerance break may be necessary for those women before conception.


References

 

Me & Qi (2024) Morning sickness according to Chinese medicine, Me & Qi. Available at: https://www.meandqi.com/tcm-education-center/diseases/morning-sickness.


Koren, G., & Cohen, R. (2020). The use of cannabis for Hyperemesis Gravidarum (HG). Journal of Cannabis Research, 2(1). https://doi.org/10.1186/s42238-020-0017-6


Norml. (2022, August 26). Survey: Cannabis reportedly More Effective than Prescription Anti-Emetics for Hyperemesis Gravidarum - NORML. NORML. https://norml.org/news/2022/08/25/survey-cannabis-reportedly-more-effective-than-prescription-anti-emetics-for-hyperemesis-gravidarum/


Morning sickness (Homeopathy) – Health Information Library | PeaceHealth. (n.d.). https://www.peacehealth.org/medical-topics/id/hn-2243000


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