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If HG continued past mid-pregnancy, did you experience complications during delivery related to your poor health such as a strained ligaments/joints, pelvic floor damage, prolonged or weak pushing, fainting, low blood pressure, low pain tolerance, forceps/assisted delivery, broken bones, nerve damage, low amniotic fluid, fetal problems due to difficult delivery, etc.?

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Offsite Resources
  • Multi-Vitamin Infusion
    Critical parenteral vitamins with vitamin K.
  • Ginger People
    Award-winning ginger products that may help ease a queasy stomach.
  • Juice Plus
    An all-natural, whole foods supplement in a gummie bear, protein shake or capsule form.
  • NutriHarmony
    Ultra-fine protein powder that is rich in whole nutrients v. concentrated vitamin extracts (the vitamin smell often increases nausea).
  • Nutritional Programs for Pregnancy
    Read more on the nutritional requirements during pregnancy by Elson M. Haas M.D.
  • Dietary Suggestions
    Dietary guidelines for women with HG. (PDF)

Nutritional Therapy

Nutrition is one of the most challenging and important issues for women with HG. Pregnant women require a variety of nutrients both for their own healing and for the normal development of their unborn child. The baby's requirements for minerals, vitamins, and other nutrients come first and are taken from the mother's bones, organs, tissues, and other storage areas. This can leave the mother depleted very quickly, which can take months, or even years, to correct.

These nutrients are also needed to form the placenta, to increase the size of the uterus and breast tissue, and to create amniotic fluid. A mother's blood volume increases by 25–50%, and more fluids, iron, B12, folic acid, zinc and copper, calcium, magnesium, and proteins are needed to support this new blood. Storage levels of most nutrients must be obtained from the diet as well. A nutritional consult may be helpful both during and after pregnancy to ensure she sufficiently rebuilds her nutrient stores, especially before becoming pregnant again.

Food Aversions and Cravings

It is very typical for mothers with HG to have very strong cravings and aversions that prohibit a well-balanced diet for much of their pregnancies, and these preferences may change frequently until delivery. It may be the smell, texture, appearance or taste that leads to nausea and vomiting.

The cause is likely a complex interaction of endocrine (hormone) changes related to pregnancy, nutrient deficiencies, mechanical changes in the body, gastrointestinal dysfunction (e.g. reflux), and changes in neurochemicals. The intensity of cravings and aversions can be very high and trigger repeated bouts of severe nausea and/or vomiting.

Thinking about foods, smelling them, or even just seeing food on the television is enough to trigger vomiting for many. She may crave very specific combinations of food characteristics, such as salty and crunchy, or sweet and soft. Entering a grocery store, opening the refrigerator, or even contemplating food preparation are usually intolerable for at least the first trimester. This has significant impact both on her and her family, and is not something she can control.

These issues have to be acknowledged, supported and accepted by her family and care providers. It's impossible to fully understand the unusual dietary preferences of HG unless you have experienced it for yourself. Trying to force other foods that do not appeal will typically result in vomiting and greater anxiety for the mother.

Nutritional Deficiencies and Hyperemesis

Women with HG may vomit or have severe nausea for months that will leave her exhausted and very depleted. It is imperative that women losing weight rapidly and not responding to medications be given nutritional support. Research has shown significant nutrient depletion in these women. Vitamins, especially B-vitamins, are depleted very quickly and if not replaced can worsen her symptoms or put her at risk for life-threatening neurological disorders like Wernicke's Encephalopathy.

At a minimum, mothers requiring hydration should also receive vitamins and electrolytes. Those who continue to lose over 5% of their body weight in the early months should be considered for IV nutrition to protect the mother and child's well-being. Studies show that an inadequately nourished fetus may grow and develop more slowly, have chronic disease in later life, and is more likely to be preterm.

These mother's are also at greater risk for complications such as pre-eclampsia and postpartum depression. Ironically, nutrition is likely the most prolific topic related to pregnancy, yet when a woman has HG, she is often told malnutrition will not harm her unborn child or herself. Surgical patients are given nutritional therapy typically within one week if they are still unable to eat. However, it is ironic that mothers with HG may go weeks or months nearly starving and not receive nutritional support. The research does not support the idea that prolonged starvation is acceptable during pregnancy. These women should be given interventions and better care to promote a healthier outcome for both the mother and child.

More Info Nutritional Therapies:

Offsite Research:

Nausea, vomiting and nutrition in pregnancy
Glenda Lindseth, Marlene Buchner, Patti Vari, April Gustafson
Nausea and Vomiting of Pregnancy: State of the Art 2000 Conference

The stomach's response to unappetizing food: cephalic-vagal effects on gastric myoelectric activity.
Stern RM, Jokerst MD, Levine ME, Koch KL.
Department of Psychology, The Pennsylvania State University, Pennsylvania, USA. (e-mail: RS3@PSU.EDU)
Neurogastroenterology and Motility 2001 Apr;13(2):151-4

In conclusion, we have demonstrated that the cephalic-vagal reflex, as measured by power in the 3 cpm frequency region of the EGG, is sensitive to the subjective palatability of the food.
 

The stomach's response to unappetizing food: cephalic-vagal effects on gastric myoelectric activity.
Stern RM, Jokerst MD, Levine ME, Koch KL.
Department of Psychology, The Pennsylvania State University, Pennsylvania, USA. (e-mail: RS3@PSU.EDU)
Neurogastroenterology and Motility 2001 Apr;13(2):151-4

Mean dietary intake of most nutrients fell below 50% of the recommended dietary allowances and differed significantly (p < 0.01) from that of controls. More than 60% of the patients had suboptimal biochemical status of thiamine, riboflavin, vitamin B6, vitamin A, and retinol-binding protein. Vitamin C, calcium, albumin, hematocrit, and hemoglobin values were significantly higher in those patients where the duration of vomiting had been longer, suggesting the presence of dehydration. Treatment was associated with cessation of vomiting and improvement in blood nutrient status. Pregnancy outcome was favorable in all patients. The hyperemetic pregnant patient is at nutritional risk; prompt initiation of corrective therapy is recommended.
 

The nutritional status and treatment of patients with hyperemesis gravidarum.
van Stuijvenberg ME, Schabort I, Labadarios D, Nel JT.
American Journal of Obstetrics & Gynecology 1995 May;172(5):1585-91

Mean dietary intake of most nutrients fell below 50% of the recommended dietary allowances and differed significantly (p < 0.01) from that of controls. More than 60% of the patients had suboptimal biochemical status of thiamine, riboflavin, vitamin B6, vitamin A, and retinol-binding protein. Vitamin C, calcium, albumin, hematocrit, and hemoglobin values were significantly higher in those patients where the duration of vomiting had been longer, suggesting the presence of dehydration. Treatment was associated with cessation of vomiting and improvement in blood nutrient status. Pregnancy outcome was favorable in all patients. The hyperemetic pregnant patient is at nutritional risk; prompt initiation of corrective therapy is recommended.
 

Hyperemesis gravidarum. A comparison of single and multiple admissions.
Godsey RK, Newman RB.
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston 29425.
Reproductive Medicine 1991 Apr;36(4):287-90

Recurrent hyperemesis gravidarum is a frustrating and poorly studied complication of early pregnancy. Despite published reports that hyperemesis gravidarum has no impact on ultimate perinatal outcome, this study indicated that women admitted repeatedly have a more severe nutritional disturbance, associated with significantly reduced maternal weight gain and neonatal birth weight. These risks argue for more aggressive antenatal treatment and increased fetal surveillance in pregnancies complicated by recurrent hyperemesis gravidarum.
 

Updated on: Apr. 18, 2013

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