Numerous complications can result from HG if it is severe, not adequately treated or there is a delay in medical interventions. Life-threatening complications such as a ruptured esophagus (throat) and Wernicke’s encephalopathy may occur after just 2-3 weeks of repetitive vomiting and malnutrition.

However, most women have only temporary but still significant complications such as muscle atrophy, fatigue, constipation, sleep disturbance, depression, and gastric (throat/stomach) irritation. Long-term health problems have not been studied by many researchers thus far. Our research finds many health issues occurring before and after HG. Many postpartum issues are related to the severity of malnutrition and vomiting, thus women with excessive, uncontrolled symptoms for months will have a greater chance of complications.

If women with HG are given early medical care sufficient to manage their symptoms and minimize nutritional deficiencies, both mother and child will be healthier now and in the future.

mother baby

Fetal Effects

A few studies find prolonged stress, malnutrition and dehydration in the mother can put the unborn child at risk for chronic disease (e.g. diabetes, heart disease) in later life. This has been termed fetal or prenatal programming by researchers and few studies have looked at this specifically in HG women.

Our research consistently finds more severe symptoms with weight loss over 10-15% (of prepregnancy) increase the risk of complications in both mother and child, especially if the mother receives little or no medical treatment.

Mothers with more aggressive medical care tend to experience fewer health complications. In children, potential health problems include neurodevelopmental delays and behavioral, emotional and sensory issues. Other factors such as the child's later health habits (e.g. smoking, obesity, diet) also impact development of chronic health conditions. This underscores the importance of providing a mother with the care she needs, for her health and that of her baby.

nicu baby

Potential ComplicationsCommon Signs/SymptomsStrategies To Discuss With Doctor & FamilyOffsite Links for more info
Constipation
- worse if taking medications like ondansetron (Zofran)
Cramps, infrequent or hard stools, abdominal pain, or difficulty passing stools
  1. Regular bowel regimen (Daily stool softeners + occasional bowl stimulants like senna)

  2. IV fluids

  3. Enema

  4. Glycerin suppository

  5. Magnesium supplements

  6. Homeopathics

  7. More fiber-rich foods (whole grains, berries, plums, peas, bananas)

  8. Pre/probiotics
MEDLINEplus: Constipation
FatigueInability to work or perform usual activities, often severe

  1. Increased rest.

  2. IV fluids with IV vitamins.

  3. Nutritional therapy.

  4. Gradually increase activity as symptoms improve.

  5. Get help from friends/family.

  6. Hire teens to help.

  7. Decrease work & expectations.

  8. Sleep medication.

Atrophy - wasting or loss of muscle tissue resulting from malnutrition or bed restWeakness, fatigue, pain

  1. Nutritional strategies.

  2. Move/lift any amount possible.

  3. Isometric exercise.

  4. Eat more protein if tolerated (or whey protein smoothies).

Pregnancy Bed Rest Information
Stomach & throat ulcers or irritationPain, nausea, food aversions

  1. Reduce acid production with anti-reflux meds.

  2. Control vomiting.

  3. Low acid diet.

  4. Check for overgrowth of helicobacter pylori bacteria.

  5. Demulcent herbs.

NIDDK: Stomach and Duodenal Ulcers
Psychosocial StressDepression, anxiety

  1. Learn how to survive.

  2. Find support from those who had HG.

  3. Share info on HG with family & friends so they know how to help.

  4. Consider a more proactive doctor.

  5. Hire a teen to help at home.

Dartmouth.edu: Depression In Pregnancy

PubMed: Obstetrical complications and the development of postpartum depressive symptoms.

PubMed: Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms.
Sleep Disturbance or InsomniaDifficulty sleeping

  1. Identify what is keeping you awake.

  2. Treat symptoms more aggressively.

  3. Reduce stressors.

  4. Sedating antihistamine.

  5. Medications for sleep.

MEDLINEplus: Sleeping difficulty
Acid Reflux & HeartburnThroat pain, indigestion, nausea

  1. Low acid diet

  2. Acid reducing (anti-reflux) medications

  3. Acid blocking meds (PPIs)

  4. Stay upright after eating

  5. Plant-based digestive enzymes (low protease formula)

MEDLINEplus: Gastroesophageal reflux disease
Gastroparesis - slow movement of food through the stomach/intestinesSense of fullness after a few bites, nausea/vomiting after drinking/eating a small amount, constipation, reflux, burping

  1. Eat/drink small amounts frequently

  2. Metoclopramide

  3. Manage constipation

  4. Plant-based digestive enzymes or raw foods for fast digestion

  5. Magnesium supplement

NIDDK Info

PubMed Case Report
Excessive salivation (Ptyalism)Spitting it out is usually helpful but can worsen dehydration (few if any treatments available)

  1. Suck on hard candy

  2. Spit excess

  3. Monitor for dehydration

  4. Antihistamine

PubMed Case Studies
TMJ Trauma - pain or injury to the jaw joint (TMJ or TMD)Pain or stiffness when opening mouth, headaches, vision changes, clicking noises from jaw.

  1. More aggressively manage vomiting & retching.

  2. Osteopathic or TMJ specialist.

  3. Goal: prevent damage vs. treat it.

Severe HG

Weight gain in the mother and adequate growth of the child are used to determine if nutrition is sufficient during pregnancy. Adverse effects of mild HG on the baby do not seem to be common, however, if HG is moderate or severe, there is cause for concern. Severe HG usually causes the mother to rapidly lose an excessive amount of weight, continue to lose weight or gain slowly during the second half of pregnancy, and/or results in a low fetal birth weight or delayed development. Women with prolonged or severe HG are also at greater risk for pregnancy loss, preterm labor and high blood pressure (pre-eclampsia), which may be related to malnutrition and dehydration.

Medical professionals experienced in caring for high-risk pregnancies or women with HG are critical in ensuring adequate care of these mothers.

If a woman shows signs of severe HG and her care seems inadequate or she is not improving, a second opinion by a high-risk OB (maternal-fetal-medicine or perinatologist) is often beneficial.

In most cases, medications and nutritional therapies can ease symptoms and allow both mother and child to avoid serious complications.

Signs Of Severe HG

Debilitating, chronic nausea

Chronic ketosis and dehydration

Frequent vomiting of bile or blood

Muscle weakness and extreme fatigue

Medications do not stop vomiting/nausea

Inability to care for self (shower, prepare food)

Loss of over 5-10% of her pre-pregnancy weight

Weight loss (or little gain) after the first trimester

Inability to eat/drink sufficiently by about 14 weeks

Ability to only do minimal activity after about 14 weeks

Enteral Nutrition