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More than morning sickness


Columbus Dispatch (OH)

05-01-13

April 28--Hillary Bates expected to be sick during her second pregnancy.

With her first -- Graham, who is 5 -- she vomited a lot, and for many months. She was sick so often that she decorated a bucket and carried it around work with her as she gave tours at the National Aquarium in Baltimore.

"But I was totally functional. I was happy. I could keep some food down."

Bates, who now lives in Grandview Heights with her husband, Josh; Graham; and 2-year-old Jillian, had a horrendous time with her second pregnancy.

She couldn't eat. She couldn't keep down a tablespoon of water. At one point, her weight dipped 20 pounds below her pre-pregnancy weight.Bates, now 33, learned she had hyperemesis gravidarum, an illness that can persist throughout pregnancy and is far more severe than run-of-the-mill morning sickness.It can cause malnutrition and dehydration and lead to depression. The condition can put women in the hospital and sometimes leads to their decision to terminate a pregnancy. When Bates' illness became so severe that she could do no more than rest and could eat nothing for days, she and her husband considered that option. They made -- and canceled -- the appointment. It's not something she likes to talk about.

"I felt so helpless and so depressed," she said.

Bates got through it, but not without anti-nausea medicine typically used for people undergoing chemotherapy, intravenous fluids and lots of support from family and friends. A third child is not something the couple would ever consider, they said recently.

"The nausea is just constant. You feel horribly nauseated and for months and months," Bates said. "I feel like it changes your whole personality."

She said she cried a lot and felt that she couldn't connect with other people. The hyperemesis triggered abnormal heart rhythms and damaged her teeth, both from persistent vomiting and malnutrition.

Bates and others who have suffered with hyperemesis advocate for more research and awareness. Too often, they say, people brush off the suffering of an expectant mom.With news last year that Kate Middleton was hospitalized with hyperemesis, many hoped for a wider understanding of the disorder.Dr. Andrew Bokor, the chairman of obstetrics and gynecology at Grant Medical Center, said there's typically no explanation why some women develop the problem.

It is more common with women who are pregnant with multiple babies and have higher levels of the hormone human chorionic gonadotropin, or HCG, he said. Levels of HCG peak at the end of the first trimester.

"That's why some people seem to get better in the second trimester, but not everyone does," Bokor said. "It can persist through the whole pregnancy."

Women are sometimes hospitalized for dehydration and malnutrition but usually go home in a day or so, he said.

Obstetricians say that babies typically don't suffer as a result of hyperemesis unless the mother has severe malnutrition.

But Kimber MacGibbon, a nurse who suffered from hyperemesis and co-founded the nonprofit Hyperemesis Education and Research Foundation, pointed to research that has suggested a link between HCG and psychological and behavioral disorders in children. More research is needed to investigate causes, treatments and the harm done to mother and baby, she said.

There are about 300,000 hospital discharges a year for hyperemesis, she said, but that doesn't account for the disease's toll, given that most women don't go to a hospital.

MacGibbon's Virginia-based organization is working on a genetic study to look for markers that predispose women to hyperemesis. Bates has submitted her DNA.Dr. Uma Ananth of Comprehensive Women's Care on Olentangy River Road said ruling out other medical conditions is important when a woman has severe nausea and vomiting during pregnancy and is losing weight. Vitamin deficiencies, exorbitant stress and thyroid disorder should be considered, she said.

In most cases of hyperemesis, anti-nausea medicine and fluids are enough treatment, Ananth said. Sometimes, women need IV nutrition as well.

She said people who know women experiencing these symptoms should offer them support and not dismiss their concerns.

"Caregivers of pregnant women need to understand that she doesn't want to be sick. Nobody wants to be sick," Ananth said. "If a woman is losing weight in the first trimester, encourage her to get help."

For more information, visit www.HelpHer.org

mcrane@dispatch.com

@MistiCrane

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(c)2013 The Columbus Dispatch (Columbus, Ohio)

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Copyright Columbus Dispatch (OH) 2013

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