COMMON TREATMENTS FOR HYPEREMESIS GRAVIDARUM

Nausea and vomiting, the most common conditions of pregnancy, affect up to
80 percent of all pregnant women.

Commonly called "morning sickness," nausea and vomiting can occur
throughout the day. Rarely does this cause problems for mother or baby, and
most often it resolves itself around the 12th week of pregnancy, when
levels of the pregnancy hormone Human Chorionic Gonadotropin (hCG) plateau.

Ninety percent of nausea and vomiting is relieved by the 22nd week of
pregnancy.

For a small percentage of pregnant women, however, there is no relief.

For these women, the severe nausea and vomiting, in such cases called
hyperemesis gravidarum, never abate, and sometimes require hospitalization
with intravenous (IV) fluids and medications. In many cases, a home health
nurse can administer IV fluids, so that the pregnant woman can stay at home.

Hyperemesis gravidarum can be related to hyperthyroidism, gall-bladder
disease, pregnancy-induced hypertension, appendicitis, or irritable bowel
syndrome. Smaller, more frequent meals that are low in fat and sugar and
contain plenty of vegetables and fruits can help. Caffeine should be avoided.

Acupressure has proven successful in relieving the nausea of pregnancy.

The NeiGuan Pressure Point (P6) is located about two inches below the wrist
crease dividing the wrist from the hand, on the underside of the wrist,
between the two tendons.

Apply direct pressure either with fingers or with a wristband.

Ginger root has been used for centuries for nausea; it can be taken raw or
in the form of tea, tinctures, capsules, or candy.

It is often suggested that the intake of foods containing B vitamins be
increased. These include whole grains, leafy greens, dried beans, almonds,
peanuts, broccoli, and cabbage.

Antiemetic drugs are prescribed for some women who suffer from pernicious
nausea and vomiting.

Medications are taken rectally, orally, or through an IV line, and may
include pyridoxine (vitamin B6). These drugs include Promethazine
(phenergan), Compazine, Haloperidol, and even Thorazine (chlorpromazine).
Newer antinausea drugs, such as Zofran (ondansetron), were designed for
cancer patients and are expensive.

Nor are they always covered by insurance, as they are not labeled as
approved for use by pregnant women.

In one study, two thirds of the women surveyed believed that drug use was
more likely to increase their baby's risk for birth defects.1 These fears
are fueled by memories of such drugs as thalidomide, which was prescribed
to pregnant women for nausea in the 1950s. Thalidomide was withdrawn from
the market in 1961, when it was discovered that the drug was a human
teratogen; i.e., a substance that would cause developmental malformations
in the fetus.

Approximately 5,000 to 7,000 malformed infants were born to women who
ingested thalidomide during pregnancy.

Bendectin, a combination of vitamin B6 (pyridoxine) and the antihistamine
Doxylamine, was commonly prescribed for nausea in pregnancy.

Because of repeated accusations that Bendectin caused fetal malformations,
its manufacturer, Merrell Dow Pharmaceuticals, voluntarily removed the drug
from the market in 1983. According to its supporters, Bendectin was never
proven to be teratogenic. It is still marketed in Canada, under the name
Diclectin.

Hyperemesis is a serious condition-the dehydration that results from
repeated nausea and vomiting can put both baby and mother at risk. However,
the drugs commonly prescribed for severe nausea and vomiting have never
been tested on pregnant women.

In some cases, the results of animal trials are available, but there simply
have been no tests on pregnant women. Although no animal or human
teratogenicity has been reported regarding Zofran (ondansetron), arguably
the most effective drug for nausea and vomiting, Zofran's package insert
cautions: "There are, however, no adequate or well-controlled studies in
pregnant women.

Because animal reproductive studies are not always predictive of human
response, this drug should be used during pregnancy only if clearly needed."

For some women, nothing seems to work. One mother reported vomiting 10 to
30 times a day, sometimes every 15 minutes.

Steroids are used to control the vomiting.

In addition, the antiemetic drug Zofran is prescribed, as well as the
antipsychotic Zyprexa. These drugs can be taken as tablets dissolved under
the tongue, or by IV. In one study of 267 pregnancies, preliminary survey
data reported that medical marijuana was 34 to 40 percent effective in
relieving the symptoms of hyperemesis gravidarum-at least as effective as
Antivert (meclizine), corticosteroids, and Diclectin.

NOTE 1. Paolo Mazzotta, MSc, et al., "The Perception of Teratogenic Risk by
Women with Nausea and Vomiting of Pregnancy," Reproductive Toxicology 13,
no. 4 (Jul-Aug 1999): 313--319.