One of the most frustrating things about having hyperemesis gravidarum (HG)—otherwise known as unrelenting nausea and vomiting during pregnancy, or the Kate Middleton disease—is that doctors don’t know how to help you. They don’t know why it happens. They don’t really know how to make you feel better. Two of the more common treatments for hyperemesis are antihistamines such as Benadryl, which doesn’t fix the nausea but does knock you out, and Zofran, which is a drug meant for cancer patients to help with the nausea and vomiting that is caused by chemotherapy and radiation.
When I was pregnant and couldn’t hold down anything except lemonade and the occasional clementine for several weeks, I opted for the Benadryl. My OB-GYN mentioned Zofran, but that sounded terrifying—it goes through the placenta and to the fetal brain, and it’s for cancer patients. But according to a new study by Dr. Marlena Fejzo, an assistant professor of research in obstetrics and gynecology at UCLA, I may have made the riskier decision.
The study, published in the European Journal of Obstetrics and Gynecology and Reproductive Biology, compares 254 women with HG to 308 women who had normal or no morning sickness. Fejzo found that women with HG have four times the risk of adverse outcomes, like low birth weight and premature babies, than women without HG. But then she compared the women with HG and adverse outcomes to the women with HG who had good outcomes and found that more than 50 percent of the women who had adverse outcomes had taken antihistamines such as Benadryl and Unisom to combat their nausea.
I spoke to Fejzo over the phone, and she said that Zofran is more effective and is not as correlated with adverse pregnancy outcomes as antihistamines are. But she was also careful to note that we still don’t know how Zofran affects babies whose mothers took the drug—that’s one of the topics of her future research.
And unfortunately, Fejzo is one of the few researchers looking into HG. She’s doing it for a personal reason: She had undiagnosed HG with her first pregnancy, and she lost her second pregnancy when she was 15 weeks along—and nearly died herself—because her vomiting was so extreme. She’s not just trying to figure out what medications best treat HG; she’s also trying to figure out which genes predispose you to the disease. Though many obstetricians aren’t up on the latest research about HG, Fejzo has found that having a family history of hyperemesis means you will have a 17-fold greater risk of developing it.
So why is there so little information about a malady that sends around 285,000 women to the hospital every year? Fejzo says that research stalled after the 1950s, when women with severe pregnancy nausea were given thalidomide, which turned out to cause major birth defects. “After that, studies with pregnant women pretty much came to a halt. Drug companies stopped doing research and so did universities.” Even though the thalidomide scandal was more than half a century ago, the research Fejzo does is funded through the Hyperemesis Education Research Foundation, which runs pretty much on donations. She was hoping Kate Middleton’s publicizing of the disease would help the cause, but so far there hasn’t been much movement. “It’s the second leading cause of hospitalization in pregnancy,” Fejzo says, but “it’s just not thought of as a serious problem.”
When I was so sick, besides being terrified that my daughter would be harmed by my inability to keep food down, I was infuriated by people who thought I was exaggerating—who thought “morning sickness” was just a spot of nausea that could be fixed with a ginger ale and some saltines. Fejzo says the first thing that women with HG can do is to visit the HER Foundation support forums, where they can find other people who understand how horrible it is. She also suggests that pregnant women with HG ask their doctors for a vitamin B1 shot. If you’re unable to tolerate food, drink, or vitamins taken orally, a vitamin B1 shot can prevent your baby from having a neurological disorder called Wernicke's encephalopathy.
I was lucky—my daughter seemed to be unaffected by the Benadryl. (At 9 pounds, 2 ounces, and four days overdue, she was hardly suffering from low birth weight or prematurity.) But if we decide to have a second child, my risk of developing HG is sadly quite high—80 percent of the women Fejzo studied have had hyperemesis recur. Though I may have to spend another several months with my head over a toilet, I’m glad there’s someone looking into fixing this. I swear, if men got pregnant, we’d have a solution by now.