Hyperemesis gravidarum isn't merely morning sickness - it's much more serious than that

Amy Schumer has made it public knowledge that her first pregnancy has not been easy.

The comedian had to cancel shows a string of shows across the U.S. recently because of a condition called hyperemesis gravidarum (HG), which landed her in hospital.

And at a performance this week where she did manage to perform, she vomited multiple times and stood on stage in front of fans in her slippers.

She opened up about the experience in an Instagram post:

To those unfamiliar with it, the health issue is often assumed to be “merely” extreme morning sickness. But as Schumer can attest, there’s much more to HG than that.

“Baby’s fine but everyone who says the second trimester is better is not telling the full story,” the ‘I Feel Pretty’ star wrote on Instagram next to a photo of her in a hospital bed.

“I’ve been even more ill this trimester. I have hyperemesis and it blows. Very lucky to be pregnant but this is some bullsh*t!”

The International Statistical Classification of Disease and Related Health Problems defines HG as “persistent and excessive vomiting” starting before the end of the 22nd week of gestation.

However, it can have several other effects, including changes in taste or smell, confusion, dehydration, extreme fatigue, fainting or dizziness, anemia, headaches, low blood pressure, rapid heart rate, dry tongue, gall-bladder dysfunction, weight loss, vitamin and electrolyte deficiency, and more, according to the Oregon-based Hyperemesis Education & Research (HER) Foundation.

It’s also the leading cause of hospitalisation in the first half of pregnancy.

Symptoms typically start to appear around the fourth to sixth week of pregnancy and peak between nine and 13 weeks.

They often improve around 14 to 20 weeks, but some women need treatment and care during their entire pregnancy, HER Foundation says.

While nausea and vomiting occur in anywhere from 50 to 80 per cent of all pregnancies, HG happens in approximately 0.3 to 2 per cent of pregnancies, according to the Society of Obstetricians and Gynaecologists of Canada.

“Nausea and vomiting can affect the majority of women who are pregnant, however some experience this to the extreme, to the point of the inability to keep any solid or liquid food down,” says Dr. Nicole Todd, an OB/GYN at B.C. Women’s Hospital and Health Centre in Vancouver.

“It’s always our hope that it’s just in the first trimester, but some women can experience ongoing symptoms throughout their pregnancy.

“Some women can get to the point where they’re vomiting so badly that it can affect their salt or potassium balance as well as their sugars,” she adds. “That’s when it can become a safety concern. At that point, sometimes they do have to be admitted to hospital, and they may need IV [intravenous] fluid replacement and to receive medications and multivitamins.”

Commonly prescribed medications include doxylamine, an antihistamine that’s combined with vitamin B6 in a drug that goes by the brand name Diclectin. Ondansetron, a drug that’s used to treat chemotherapy patients experiencing nausea and vomiting, is sometimes given in more extreme HG cases.

“The main thing for women to know is how safe the medications are,” Todd says. “A lot of times people are hesitant to take medications in pregnancy, but for a short term these can help a woman have enough nutritional intake so she can be helping herself in addition to helping her baby.”

It’s important for women to eat what they can when they can, Todd says. It may help to separate liquids and solids and to consume small meals throughout the day.

While the physical symptoms can be challenging to deal with on their own, another factor related to HG, one that’s often overlooked, is that it can have mental and emotional effects. Some women may experience depression or anxiety as a result.

“Worries and mood changes can go along with this,” Todd says. “Some women may feel overly anxious that they’re not getting enough nutrition or they can feel guilty for not being able to provide that for their baby.

“As soon as someone is concerned about depression, or if they’re not able to go to work or participate in their regular activities, they should approach their primary health-care provider,” she adds. “When it’s affecting their daily life, they should see their health-care provider.”

Other approaches that may alleviate nausea and vomiting include discontinuing iron-containing prenatal vitamins during the first trimester and substituting them with folic acid or adult or children’s vitamins low in iron, according to the SOGC.

Acupressure, ginger, and mindfulness-based cognitive therapy may also help.

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