When Sickness Strikes

Sick of being sick? Emma Michelsen, mum-of-two and founder and CEO of morning sickness supplement brand Daisy, shares her experience with HG and the latest research into why it occurs.

From royalty to Hollywood celebrities, morning sickness and hyperemesis gravidarum have received a star-studded spotlight. Celebrities like Kate Middleton and Kelly Clarkson have not only shared their pregnancy journeys, but also shed light on the often-underestimated condition. Their candidness has raised awareness and shown that even the glitz of celebrity life isn’t a shield from the challenges of pregnancy. But despite the media attention, we still see vast disparities in funding and research dedicated to women’s reproductive health.

My Story

It hit me quietly at five weeks pregnant, stopping my caffeine addiction in its tracks. I took this as gentle encouragement to fuel my body with the nutrients it needed to grow a healthy baby. By six weeks, I was onto my second hospital admission for intravenous fluids, and by eight weeks, I was admitted with suspected appendicitis-turned-torn muscles due to excessive vomiting. By the time I gave birth to my son, I had clocked 20 hospital admissions, given up my employment and had moved back in with my parents to receive round-the-clock care.

Unfortunately, I’m not alone in what I went through. Up to 90% of pregnant women experience some degree of nausea or vomiting, often referred to as “morning sickness”.

For some, it is relatively mild, coming and going during the first trimester without much fuss. But for the 10% of those who suffer from hyperemesis gravidarum, it can be life- changing and traumatic, and is the most common cause of hospitalisation in pregnancy. Morning sickness in general causes 8.6 million hours in lost work and costs the global healthcare system USD$5 billion per year.

While morning sickness may not hinder foetal development, it imposes a significant impact on a person’s quality of life. In the case of hyperemesis gravidarum, substantial evidence shows adverse outcomes when a baby in utero is not getting all it needs from its mother. Research highlights that the first 1000 days of a baby’s life is critical to its overall development, but it isn’t commonly known that this number includes the gestation period. Despite my wholesome intentions, my healthy happy son was made from anti-nausea medication, frozen Coke and white bread!

The pregnancy stigma

The burden of nausea and vomiting in pregnancy highlights the need for prompt and effective treatment but despite this, surveys have shown that many women are denied medications for these conditions. Misleading beliefs dating back to the early 1900s have led to damaging practices, like dismissing symptoms as purely psychological, leaving women feeling isolated and unsupported.

Is it hormone related?

A new study published in peer-reviewed science journal Nature* reports that women with abnormally high levels of the hormone GDF15, and who are sensitive to it, are at higher risk of hyperemesis gravidarum.

GDF15 is produced by the placenta, but also other tissues when a woman is not pregnant. This hormone is known to cause nausea, vomiting, and appetite and taste changes. The research suggests that hyperemesis gravidarum may be prevented by strategically raising GDF15 levels prior to pregnancy. It also provides the first suggestive evidence that an interaction between certain maternal and foetal genes plays a role in recurrence risk, but larger studies are needed.

New guidelines

Earlier this year, The Royal College of Obstetricians and Gynaecologists (RCOG) published a long-awaited update to their guidelines for the treatment of nausea and vomiting in pregnancy and hyperemesis gravidarum. The comprehensive approach promises to improve care for hyperemesis gravidarum sufferers, and while this is based in the United Kingdom, we can hope to see this update have global reach and implementation.

The guidelines provide crucial clarity on treating hyperemesis gravidarum. While the treatment approach remains unchanged, there is now a more definitive message about the safety and effectiveness of first and second-line anti-nausea medications.

Historically, there has been some hesitance by healthcare professionals to prescribe medication during pregnancy, but the guidelines confidently affirm the safety and effectiveness of those drugs backed by extensive evidence and research. They specifically clarify concerns around Ondansetron and Metoclopramide, which are both used for this purpose. And for severe hyperemesis gravidarum symptoms, the guidelines recommend considering a combination of medications, leveraging their varied mechanisms for more effective relief.

In the past, many hospitals have used the presence of ketones in urine to determine the need for hospital admission or the administration of IV fluids and antiemetics. In some cases, ketone levels have even influenced decisions on discharging patients. But according to the new RCOG guidelines, “Ketonuria is not an indicator of dehydration and should not be used to assess severity”.

Instead, the guidelines advocate for more comprehensive assessment tools, like the PUQE score (Pregnancy-Unique Quantification of Emesis) and HELP (Hyperemesis Level Prediction), which consider a range of symptoms including emotional wellbeing. They also encourage doctors to use their clinical judgement to assess dehydration, moving away from a sole reliance on ketones.

The new guidelines acknowledge the long-term effects of hyperemesis gravidarum and its profound impact on women’s quality of life. For the first time, a strong emphasis is placed on assessing both physical and mental health during pregnancy, and healthcare professionals are encouraged to refer women for psychological support when needed.

Another crucial aspect now documented is the high risk of hyperemesis gravidarum recurrence in subsequent pregnancies. This acknowledgment is vital for better preparation and support for women planning future pregnancies.

All of this ground-breaking research addresses significant issues in hyperemesis gravidarum care, and can contribute to a comprehensive new approach. This will ensure women receive the most effective and safe treatment, so they can hope to thrive and not just survive.

It will always be worth it

By the end of my pregnancy, I was a shadow of my former self. I had grieved the glowing pregnancy I so desperately wished for and had lost confidence in my body’s own ability to do as nature intended, becoming anxiously reliant on others. Despite my pregnancy struggles, I will always be thankful to have two happy, and healthy babies delivered at full-term. My dream is to raise awareness and funding to support the research in this space – for women to live in a world where complications cannot rob us of the joy of carrying life.

Daisy Blackcurrant and Ginger Morning Relief, $24.50

Emma MichelsEn spent two years developing Morning Relief, a water- dissolvable formulation to support women suffering from morning sickness and hyperemesis gravidarum with science- backed ingredients for more info, visit drinkdaisy.co.nz

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