Hyperemesis Gravidarum – what is it exactly? Tips for second time mums

To the excitement of the nation, Clarence House just announced that the Duke and Duchess of Cambridge are expecting their second child. And once again, the news had to come out because of Kate suffering with severe morning sickness and currently being treated by doctors at Kensington Palace.  The complicated Latin name of this condition – Hyperemesis Gravidarum – makes it sound very strange but in fact it’s not uncommon. At least 50% of women suffer from some nausea and vomiting, but in only a small proportion (less than 1%) does this become so severe that it leads to an inability to tolerate enough oral fluids to maintain hydration which can lead to dehydration and occasionally weight loss, imbalances in important electrolytes in the body (such as sodium and potassium) and poor nutrition. The dehydration can cause a rise in heart rate as the body tries to compensate, a drop in blood pressure and dizziness. The key symptoms always begin in the first trimester, most commonly at 6-8 weeks of pregnancy and they tend to resolve in the majority by week 14-16.

kate middleton duchess of cambridge pregnant


To shed some lights into this condition we have spoken with various experts from several London clinics.

First of all to understand what Hyperemesis Gravidarum actually is Robyn Coetzee, Specialist Dietitian at London Bridge Hospital tells us how to reduce symptoms, while limiting the negative impact it might have on a woman’s nutritional status during pregnancy.

What is Hyperemesis Gravidarum?

Hyperemesis Gravidarum is a severe form of nausea and vomiting that typically occurs at around 4 – 10 weeks of pregnancy and affects around 0.3 – 1.5% of pregnancies.  It is characterised by weight loss, intractable vomiting, electrolyte disturbances and often requires hospitalization.  Nausea and vomiting is a common symptom of pregnancy but rarely develops into the more severe hyperemesis gravidarum.  Although symptoms may be milder, nausea and vomiting during pregnancy can still be debilitating and have a negative impact on a woman’s nutritional status during pregnancy.

What is thought to be the cause?

There are a number of hypotheses such as to what might cause hyperemesis gravidarum such as hormone changes and genetics but currently there is not enough evidence to clearly establish why some women develop this severe form of nausea and vomiting.

In addition to Robyn Coetzee‘s advice, Dr James Nicopoullos, Consultant Gynaecologist and Subspecialist in Reproductive Medicine & Surgery at Chelsea-based Lister Hospital added: “The reason why some women suffer and others do not is poorly understood. It may be as a consequence of hormonal, mechanical and psychological factors. Early pregnancy hormone (hCG) stimulates the thyroid gland the level of hCG and thyroid hormones seem to correlate with the severity of symptoms in some but not all women. Pregnancy also naturally leads to certain mechanical changes that predispose to the symptoms so are exacerbating factors but unlikely to be the underlying cause (such as changes in pressure in the oesophagus and slower emptying of stomach contents).”

Is there a diet plan to follow to minimise nausea?

  1. Unfortunately there is limited research available to help inform us as to the best diet to treat nausea.  Different people find different strategies helpful, but some of the following may help.
  2. Try to have small, frequent meals and snacks.  Having an empty stomach tends to make feelings of nausea worse.
  3. Keep hydrated.  Sip on small amounts of fluids across the day.
  4. Cold, plain foods are often better tolerated than hot food as these tend to have less of an aroma which can aggravate nausea.
  5. Avoid fatty, spicy foods.
  6. Sip or suck on ginger flavoured drinks and sweets.
  7. Stay out of the kitchen during meal preparation.  If possible, ask someone else to prepare meals or make use of ready prepared meals to reduce exposure to aroma during cooking.
  8. Sometimes drinking and eating at the same time can make nausea worse.  Consume foods and fluids separately.


If you are suffering from hyperemesis, how can you ensure that your body is getting all the nutrients and vitamins it needs?

Getting enough nutrition can be difficult when suffering from hyperemesis.  It is important to try to keep on top of things early before nausea and poor nutritional intake become a vicious cycle.  Trying the above may be helpful, however at times severe nausea and vomiting may make taking anything orally very difficult.  It is important that women with hyperemesis seek medical attention as hospitalisation may be required where anti-sickness medication and intravenous fluids may be prescribed.  A dietitian can also help to optimise nutritional intake through tailored nutritional advice, nutritional supplements or tube feeding in severe cases.

Will frequent vomiting affect the baby and its development?

A women’s body goes through a number of adaptations during pregnancy to ensure optimal growth of the baby.  The milder, more common, form of nausea and vomiting during pregnancy is therefore unlikely to have a significant impact on the baby’s development.  There is however growing evidence that due to the severity and its impact on nutritional status, hyperemesis gravidarum can affect the baby’s development.  Some studies have found hyperemesis to be associated with a lower birth weight, small head circumference and reduced insulin sensitivity in offspring which can have implications for the long term health of the baby.

What tips would you give to women who have to travel into work on the tube to reduce their sickness?

  1. Be sure to wear your ‘baby on board’ badge to help to make the journey more comfortable.
  2. Take a cold bottle of water or diluted fruit juice to sip on during the journey.  This will help to keep you cool and hydrated.
  3. Take something to snack on if you have a long journey.  Long periods without eating can make nausea worse.  Plain biscuits, cereal bars and nuts all travel well and can be helpful to nibble on.
  4. Make sure to wash your hands after travelling and before eating.  A women’s immunity drops slightly during pregnancy making it easier to pick up bugs and become sick from food contamination.


CAREFUL KATE! More tips for second time mums 

Varicose Veins of the Vulva – a pregnancy problem prone to second time mums

Varicose veins in the vulva is prone to women having their second child but is considered an embarrassing topic to discuss. Internationally renowned vascular specialist, Professor Mark Whiteley of the The Whiteley Clinic, believes it is time for pregnant women to be made aware of this hidden pregnancy symptom and to let them know that there are treatment’s available!

The accompanying tiredness and morning sickness as a result of pregnancy is well documented and accepted as a part of being a new mum to-be.

Unfortunately, many women are unaware that the condition even exists and don’t know that it can be treated.

Varicose veins of the vulva and vagina commonly stem from pelvic or ovarian vein reflux and first present themselves during pregnancy. The condition can be very uncomfortable for those affected, with symptoms including; pelvic aching, dragging pain, an increase in stress incontinence and IBS, and discomfort around the bladder/rectum caused by the distended veins pushing against them.

Being pregnant does not specifically cause varicose veins to occur, however, if a woman already has the underlying venous condition then pregnancy can ‘bring it to the surface’ and ultimately worsen it.

Whilst many in the medical sphere believe there to be no suitable treatment for the condition, Professor Whiteley strongly disagrees – having studied the condition for the past fifteen years – and has tested a pioneering procedure known as Coil Embolisation. The procedure, which has previously been used to treat varicose veins of the testicles, uses an X-Ray technique to place a metal coil within the problem vein and block off the blood vessel. The procedure has been proven to treat the veins from the root of the problem, both quickly and effectively and provides long term results.

A stressful commute while pregnant puts mother and baby at risk


While Kate Middleton can expect to be chauffeur driven to her work commitments, those of us who are pregnant alongside the Duchess are unlikely to be so lucky. Commuting on public transport while pregnant can put both mother and baby at risk; experts at London Bridge Hospital told us how to minimise risk and make the experience safer and more bearable.

For most of us, the daily commute is a stressful and uncomfortable experience; spending time on a hot train nestled under somebody else’s armpit is never the best start to the day. For pregnant ladies however, commuting on busy public transport is not only uncomfortable but poses risks for both mother and baby.  A recent study found that stress during pregnancy not only increases our own risk of complications, but can also affect the pregnancies of our daughters and granddaughters. Therefore reducing stress during pregnancy is of paramount importance.

When you are pregnant, even in your first trimester, it is really important that you sit down when possible to reduce the risk posed to you and the baby. “Pregnancy hormones such as those aimed at relaxing you not only cause relaxation of the joints around the pelvis, aimed at preparing the body for childbirth, but also generally around the body”, explains Mr Simon Moyes, Consultant Orthopaedic Surgeon. “This, combined with even a normal amount of weight gain will put additional strain on the joints during pregnancy. On top of this, the change in the body’s centre of gravity alters the posturing and gait, which can also contribute to joint pains”.

While sitting down obviously offloads the affected joints reducing the chance of flare-ups, Emma Brockwell, Senior Physiotherapist with an interest in Women’s Health, highlights which other pregnancy-related issues can be alleviated by sitting down on the tube:

  1. During pregnancy the body’s centre of gravity if altered which can affect your balance and increase your risk of falling. Falls will always put the baby and you at risk, thus sitting will reduce this risk compared with standing
  2. Standing in the same position whilst pregnant can also cause dizziness and fainting because blood pools in the lower extremities, again increasing the risk of falls
  3. People barging and elbows digging in, whilst unlikely to injure the baby can be very uncomfortable to you and make you feel vulnerable. Taking a seat helps avoid this
  4. Water retention and swollen ankles is yet another symptom you are likely to experience so taking some load and sitting can help even the most swollen extremities
  5. Morning sickness is a very common symptom of pregnancy and can affect women throughout their pregnancy if they are suffering from hyperemesis gravidarum. Motion can trigger the sickness but it is easier to cope with it sitting down.

Keep your knees in line with your hips when you are sitting and keep weight spread evenly through both hips. Crossing or widening your legs may feel more comfortable but can place unnecessary strain on pelvic and low back joints. If your journey is longer than 30 minutes, wriggle your toes and pump your ankles up and down frequently to prevent blood pooling at the bottom of your legs.

While commuting, it is important to keep hydrated at all times, especially if you are suffering from morning sickness or, more severely, hyperemesis gravidarum.


Flat coke may be the cure for Kate Middleton’s morning sickness

Alison Edwards – Senior Lecturer in Midwifery at Birmingham City University, suggested that flat coke can  help reduce sickness. She said: “Though there is an increased chance due to having the excessive sickness before she may well have an entirely different experience this time with little or no sickness.  Though there is no ‘cure’ for morning sickness (and certainly not hyperemesis) there are steps that can be taken to try to settle the unpleasant symptoms.”

“Though there are few sources of scientific evidence to support any ‘remedies’, making sure fluid intake is maintained is a priority. Flat coke has been found to help here as can arrowroot or ginger. Some women swear by travel bands.  Small low fat meals can help and avoiding anything spicy.  If the symptoms become excessive then medical advice must be sought as there are medications that can reduce the sickness and nausea; these do need prescribing however.”


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