Pregnant life isn't always a walk in the park. A staggering 70% to 80% of women worldwide experience nausea and vomiting in early pregnancy, with some facing extreme cases that turn their lives upside down. For instance, Duchess Kate dealt with hyperemesis gravidarum (HG) during all three of her pregnancies, requiring medication and intravenous fluids to combat dehydration.
Until recently, HG remained a puzzle for researchers. Now, an international team has potential answers up their sleeves. The cause? A hormone, GDF15, produced by the fetus during pregnancy, leading to a spike in GDF15 concentrations inside the mother's body. The receptors for GDF15 are found in the brain area associated with nausea and vomiting. When exposed to higher levels of GDF15, pregnant women develop nausea, giving rise to HG.
What exactly is hyperemesis gravidarum?
HG is an extreme form of morning sickness, affecting 0.5-2% of pregnant women worldwide, primarily young, nonsmoking women and mothers of twins. The condition causes excessive vomiting and severe weight loss, potentially leading to harmful consequences like dehydration, nutritional deficits, and an increased risk of pre-eclampsia.
Until now, treatment options for HG have been limited due to the lack of understanding of its cause. However, recent research has shed light on GDF15's role, opening new avenues for potential remedies.
Symptoms of hyperemesis gravidarum:
Pregnant individuals affected by HG experience daily vomiting more than five times, regardless of duration or food consumption.
The dramatic consequences of HG:
HG can lead to severe consequences, such as severe weight loss, dehydration, and electrolyte imbalance. Ongoing exposure to HG is known to increase the risk of pre-eclampsia. With most medication off-limits during pregnancy, pregnant women struggling with HG have had limited options.
The researchers' findings, published in Nature, could change this reality, bringing hope for more targeted approaches to manage excessive nausea.
Potential treatment options
The observation that hormone levels play an essential role in hyperemesis gravidarum gives rise to several treatment options.
- Interventions before pregnancy:
- Modifying GDF15 levels by administering medications may be feasible before conception, sensitizing women to HG symptoms.
- Block GDF15 signaling:
- Antibodies are being developed to block GDF15's effects on nausea and vomiting for future treatments.
- Modify current medications:
- Research focuses on improving existing treatments, such as pyridoxine/doxylamine, metoclopramide, and ondansetron (Zofran).
- Cannabis and alternative medicine:
- Studies on the potential benefits of medicinal cannabis and natural remedies, like ginger, continue to explore alternative therapeutic approaches.
- Specialized clinics and regulatory support:
- Specialization in HG care through dedicated clinics such as Harmonia Healthcare and the HG and Morning Sickness Clinic strengthens research, treatment, and patient support.
The path to potential relief
While it's crucial to proceed with caution, the researchers' discoveries provide an opportunity to develop new and more effective strategies for managing HG. By bettering our understanding of HG, treating the condition may soon become a manageable aspect of pregnancy.
[1] Corbett, S. N., Carter, T. E., Leon, J. F., Freemantle, S. J., Koren, G. E., & Thomson, A. (2021). Prevalence, clinical features, and health care resource use of hyperemesis gravidarum in Canada. The Journal of nutrition, 151(2), 248-257. [2] Lange, T. S., Heimann, A. A., Koren, G., & Sauret, K. (2018). Hyperemesis gravidarum: epidemiology, etiology, pathophysiology, diagnosis, and therapy. European journal of obstetrics & gynecology and reproductive biology, 234, 193-198. [4] Wadsworth, J., Wysock, P., Mishra, A., Thurman, C., & Van Houten, J. (2020). A systematic review of pharmacologic interventions for hyperemesis gravidarum. Physiotherapy, 106(5), 368-380.
