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12.04.12

Hyperemesis Gravidarum: What’s Ailing Kate Middleton

News that the Duchess of Cambridge is expecting came with a twist: she’s suffering from a nasty variant of morning sickness. Dr. Kent Sepkowitz on the prognosis.

It looks like Kate Middleton is going to ruin all the fun for the 4 or 5 billion Jewish grandmothers out there who were looking forward to reading about and watching the progression of every moment of her just-announced pregnancy. Rather than giving us picture upon picture of fashion, maternity-style, she’s been sidelined: the pregnancy is making her ill. According to reports, she has hyperemesis gravidarum, the evil older sister of morning sickness.

So what, other than a five-dollar Latin term, is hyperemesis gravidarum? It’s not just a goosed-up name for morning sickness—something which at least half of woman develop but generally see fade out by the second trimester. Morning sickness is a routine (though not fun) rite of passage for newly pregnant women. Nausea and vomiting, though everyone winces sympathetically to hear of it, don’t really evince the looks and attitude we exhibit when hearing about heart attacks or intestinal bypasses or drilling holes into the skull. We sympathize, a little, and remember that night with too much Mexican food and too much tequila and sort of shrug it off. Ah, youth.

Morning sickness, though, resembles hyperemesis the way a twisted ankle resembles a compound fracture with two bones sticking out through the skin. This hyperemesis is a real medical condition affecting 1 or 2 percent of women early in pregnancy. In the olden days, before IV fluid was routine, women died of hyperemesis due to the severe dehydration it caused (including Charlotte Brontë, according to apocryphal legend). More commonly, afflicted women felt so bad day after day, week after week that death seemed preferable.

Hyperemesis requires more medical vigilance than any blushing bride, especially the world’s most famous semi-newlywed, would ever want: aggressive intravenous fluid management with women being stuck at home or in the hospital or clinic all day, attached to an IV, getting liters of fluid through a long-term, surgically implanted venous catheter to prevent dehydration, and taking high-end anti-nausea medications that seem—seem—safe during pregnancy. The eternal cloud of thalidomide, though, once the world’s greatest morning sickness pill and now the raison d’être for federal regulation of drugs, looms large in the imagination of many pregnant women.

There is of course a cottage industry of products for those with hyperemesis—devices that hope to pick up the morning-sickness market as well. Elastic bracelets—with brads to place just so in an acupressure spot on the inner wrist purported to reduce nausea—are popular. Various grandma elixirs also are used, as are Mommy Pops and even a “neuromodulation device” that delivers a low-level, electrode-supplied buzz to the same place on the underside of the wrist. Inevitably, poor Kate is getting binders full of advice and motherly reminiscence. It’s enough to try a person’s spirit—and, indeed, rates of emotional upset are higher in women with hyperemesis gravidarum. It is, simply, a very long slog.

The good news is this: hyperemesis, like so many of the other secret miseries accompanying pregnancy, does pass. Eventually. The already thin Kate may become that much thinner. But children born from mothers with this condition turn out great, actually. Plus, there’s this: Kate may have tipped her hand about the sex of her and William’s firstborn: hyperemesis occurs significantly more often when the fetus is a girl. Call it the first shot across the bow from that long and confusing spectacle, the mother-daughter relationship.