Hyperemesis: Kate Middleton's rare pregnancy condition

by Ruth Nichol / 29 September, 2017

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Catherine, Duchess of Cambridge. Photo/Getty Images

The Duchess of Cambridge, enduring her third bout of morning sickness, is raising awareness of a debilitating condition.

Having had hyperemesis gravidarum during both her pregnancies, Joy Wadham says her heart goes out to Catherine, Duchess of Cambridge, who has been resting at Kensington Palace because of debilitating nausea and vomiting caused by her third pregnancy.

But the Wellington midwife also thinks a palace is a good place to be if you have hyperemesis: no childcare or work worries and a personal nurse to hook you up to the essential intravenous fluids used for rehydration.

“I wish I could have been taken care of at a palace,” says Wadham, laughing. “Although when you’re that sick, you don’t really care.”

Fellow sufferer – or “survivor”, as Wadham prefers to call herself – Wendy Harper agrees. “Hyperemesis is just as horrible for a princess,” she says.

Harper also had hyperemesis. After being blindsided by the condition during her first pregnancy, she was reluctant to go through the experience again. At 12 weeks, she was forced to give up work – she made it in only a few times before that – and during the rest of her pregnancy, she rarely left the house.

But eventually, the desire to have a second child overrode her fears. By the time she was seven weeks’ pregnant, in late 2015, she had such severe nausea that she could barely eat or drink, although she tried to avoid vomiting, because once she started, it was hard to stop.

Knowing what she was in for, she hired a nanny to look after her son and settled in for the long haul: extended spells in bed, punctuated by regular trips to her GP – or occasionally to hospital – to be rehydrated with intravenous fluids. She took an anti-nausea drug, ondansetron, which is used to prevent nausea during chemotherapy.

“I couldn’t really leave the house. I had to go out for medical appointments, but it was an ordeal. I had to stop the car a lot and get off the motorway, because I couldn’t keep driving.”

In the second half of her pregnancy, things settled down a bit and she no longer needed intravenous fluids. And as with her first pregnancy, she had a brief respite in the two weeks before the birth. “By then, it was more like normal morning sickness.”

Wadham, who was pregnant with her second child at about the same time, also needed regular rehydration. She took ondansetron and several other anti-nausea drugs, including metoclopramide and cyclizine.

“The reason you can take them all at once is because they work on different pathways in the brain to prevent nausea.”

She also drank Enerlyte solution to keep her electrolyte levels up, although she could tolerate only very small quantities at a time.

At about 14 weeks, Wadham stopped needing intravenous fluids, although she continued taking anti-nausea drugs until the birth. She also developed antenatal depression – a common complication of hyperemesis.

“This condition has quite a psychological impact on women as well as a physical one,” says Auckland obstetrician Gillian Gibson. “That side of it has to be recognised, because it can be 24/7.”

Gibson says about 3% of pregnant women develop hyperemesis. It’s thought to be caused by an unusual sensitivity to rising levels of pregnancy hormones in the first trimester, in particular human chorionic gonadotropin (HCG). No one knows why some women are more sensitive to HCG than others, although higher levels – as happens in a twin pregnancy – increase the likelihood of having hyperemesis.

Most hyperemesis sufferers notice a lessening of symptoms by the second trimester, when HCG levels start to plateau. A small number with persistent symptoms need nasogastric feeding and if left untreated, the condition can be fatal because of the metabolic effects of dehydration.

But as ghastly as it is, hyperemesis does go away. Even the most severely affected women get relief once they give birth.

“The good thing about it is that it’s not cancer, and it’s got an end point,” says Gibson. “I think that’s the only thing that gets women through sometimes.”

This article was first published in the September 30, 2017 issue of the New Zealand Listener.

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