Morning, noon and night sickness

 

One in 50 pregnant women are affected by hyperemesis, a pregnancy sickness so severe that it leaves them weak, dehydrated and malnourished, writes SHARON DEMPSEY.

“I think we are all conditioned into thinking pregnancy is not an illness so that it is hard to admit you are really suffering and I certainly thought people wouldn’t take me seriously. Luckily I have been treated very well.

A NEW study carried out at Cork University Maternity Hospital has shown that a higher number of female babies are being born to mothers who have experienced the extreme pregnancy sickness condition, hyperemesis.

Most pregnant women experience morning sickness, nausea and sometimes vomiting but, for a few, pregnancy sickness is so severe that it leaves them weak, dehydrated, malnourished and desperate for the pregnancy to end.

Some 70-80 per cent of pregnant women will experience what is generally referred to as morning sickness, leading to 35 per cent of pregnant women being absent from work on at least one occasion.

However, for some, the vomiting and nausea is so persistent that it leads to electrolyte imbalances, evidence of ketones in the urine and a typical weight loss of 5 per cent of the pre-pregnancy weight. This is hyperemesis, a condition which affects one in 50 pregnant women.

Although the results of the study will not be published for a couple of months, Dr Louise Kenny, senior lecturer at the department of obstetrics and gynaecology, University College Cork, says, “Significantly we found that the baby is more likely to be female if the mother has been admitted to hospital for treatment.”

Preliminary analysis of local data suggests 62 per cent of babies are female with the normal sex ratio of female to male newborns being 48.6-51.4 per cent.

As recent as 1993 there were three maternal deaths related to hyperemesis recorded in the UK. There have been no maternal deaths caused by hyperemesis in over a decade due to how the condition is recognised and managed better now.

According to Kenny, “If the hyperemesis is severe and goes untreated, it can result in mortality.”

The effect of the sickness on the baby is not as worrying. As Kenny puts it, babies are “basically refined parasites”. However, she points out that infants born of pregnancies complicated by hyperemesis are more likely to be born premature, with lower birth weight in accordance to the maternal weight gain. The rate of pre-term birth was three times higher in women with hyperemesis.

A pilot study, overseen by Prof John Higgins, head of the department of obstetrics and gynaecology, UCC, indicates that women are better served by being treated as outpatients in a dedicated facility.

“This is a dreadful disorder in its severe form. We have been piloting managing the patients as day care patients and the initial observations are that many patients will go home after rehydration if they know they have ready and regular access to hospital review,” Higgins says.

“We are about to start a randomised study comparing treating patients as inpatients versus day care treatment. There is very little evidence out there about this topic. The mainstay of treatment remains adequate rehydration.

“Our study should formally assess the safety, clinical effectiveness and cost-effectiveness of the day care approach,” he adds.

In the majority of cases of hyperemesis, fluid and electrolyte replacement with vitamin supplementation is sufficient to elevate symptoms and prevent serious complications.

When this treatment is not sufficient, anti-emetic drugs are used. There is a reluctance to prescribe anti-emetics following the thalidomide cases of the 1950s and 1960s when pregnant women were prescribed the drug for morning sickness with devastating outcomes for their children.

However, there is extensive evidence to support the safety and effectiveness of certain drugs for nausea and vomiting in pregnancy.

Best-selling novelist Claire Allan experienced sickness which was so severe that she couldn’t even drink water without vomiting.

“I was told at 17 weeks I probably had hyperemesis and officially diagnosed at 25 weeks – this was when my sickness levels were so bad I had to be hospitalised to be rehydrated,” she says.

Allan was prescribed metoclopramide and Cyclizine (also known as Valoid).

“I took Valoid, 50mgs three a day from 25 weeks through to the day she was born. The sickness left as soon as she was delivered – it was amazing!” she adds.

While metoclopramide and cyclizine are active ingredients in licensed medicines in Ireland, the use of these drugs should be avoided in pregnancy, unless the treatment decision is made on the basis of a risk-benefit evaluation for the individual patient based on the approved product information, specialist knowledge and monitoring, according to an Irish Medicines Board spokeswoman.

Under the Medical Products Licensing and Sale Regulations 1998, any registered medical doctor has the legal right to prescribe any medical product (licensed or unlicensed) to patients under their care if they believe the medicine will be of benefit to their patient.

Although Allan felt that the Cyclizine controlled the sickness, it didn’t go away completely.

Allan, who gave birth to a baby girl on March 4th, had been told by three different medical professionals that she was carrying a girl and felt that this pregnancy was completely different from her first when she gave birth to a boy.

“During my first pregnancy I had morning sickness – which started at six weeks and lasted until approximately 13 weeks and then I was fine. I only threw up once in that pregnancy.

“With this pregnancy I started to feel sick even before I took a pregnancy test – and there was no reprieve although generally I was only nauseous until around 14 weeks and then started throwing up regularly,” she says.

“Unusually I only started being physically sick every day at around 24 weeks. Then, under the control of medication, I was sick three or four times a week – which was blissful compared to being sick every day,” she says.

Allan has found combining work as a novelist and a journalist with looking after her son, Joseph, aged five, to be draining.

“I have spent a lot of time in the loos at work bent over the toilet bowl which doesn’t give the best impression. I have also had to take about three weeks off work through illness – simply when I could not eat or drink anything, or was waiting for medication to kick in to help ease the symptoms.

“The worst work-related incident came when I was 17 weeks and in Dublin promoting Feels Like Maybe and had to leave a dinner with my publishers [Poolbeg] and representatives of the book trade as I was so violently ill. I had to cancel signings and press for the next day as I could barely move,” she adds.

Allan felt supported throughout her sickness by her health professionals. “Once it became clear that this wasn’t ‘just’ morning sickness they have been fantastic.

“During a stay in hospital I was also treated wonderfully and very sympathetically.

“ I think we are all conditioned into thinking pregnancy is not an illness so that it is hard to admit you are really suffering and I certainly thought people wouldn’t take me seriously. Luckily I have been treated very well.”