Kate Middleton, the Duchess of Cambridge, was recently hospitalized with a severe type of morning sickness. It's called hyperemesis gravidarum. This form affects only 1 or 2 of every 100 pregnant women. Many pregnant women become nauseous and may vomit during the first trimester. But women with hyperemesis gravidarum have severe nausea and frequent vomiting. They become dehydrated. Their blood levels of sodium and potassium are off balance. This can endanger the woman's health. It also can lead to pregnancy problems, such as a low birthweight baby or a baby born prematurely. For the pregnant woman, treatment often includes hospitalization. There, she is given intravenous fluids and medication to reduce nausea.

By Reena Pande, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

The word is out! William and Kate are expecting a baby! But the early stage of pregnancy has not been so easy for the royal couple. Reports are that the Duchess of Cambridge has been hospitalized with a severe and uncommon form of morning sickness called hyperemesis gravidarum.

The first trimester of pregnancy can be hard. Morning sickness can cause nausea and vomiting in as many as 70% of pregnant women. For some women, this is just mild discomfort, but for others it can interfere with daily life.

Despite the name, the symptoms of morning sickness can happen any time of day. Run-of-the-mill morning sickness is quite common and is not dangerous. It can be triggered by certain foods, smells, or sensations of heat and cold.

Hyperemesis gravidarum is far less common. It affects only about 1% to 2% of pregnant women. In this case, women have severe nausea and vomiting to the point of dehydration and abnormal electrolyte levels (such as sodium and potassium). This can actually be a danger to the mom's health and to the long-term health of the pregnancy if not treated. Symptoms of dehydration can include:

• Dizziness when standing
• Dark colored urine
• Urinating less than usual
• No increase in weight as expected during pregnancy or even weight loss

Symptoms may start as earlier as 5-6 weeks of pregnancy, and in most women, the symptoms will resolve by 20 weeks. In a small percent of women, the symptoms can continue during the entire pregnancy. The cause of this severe form of morning sickness is not well understood but may be due to hormone changes.

Treatment of the severe nausea and vomiting of hyperemesis gravidarum often requires hospitalization. This may include placement of an intravenous (IV) tube to administer fluids and anti-nausea medications. These treatments are generally safe for the baby.

What changes can I make now?

Most women will experience some degree of morning sickness. Here are some general tips about how to avoid or limit these symptoms:

• Try eating bland foods such as crackers or rice; avoid spicy or acidic foods.


• Eat frequent, small meals, and eat as soon as you feel hungry or even before.


• Try ginger-flavored tea. Ginger has been suggested to have some anti-nausea effects.


• Take vitamins. All women should be taking a prenatal vitamin, and some studies suggest the addition of vitamin B6 (pyridoxine) can help relieve moderate or severe nausea. Take these vitamins at night with a snack, and not in the morning.


• Figure out what your triggers are (foods, smells, locations?) and try to avoid them.

If you are experiencing severe nausea and vomiting and have any of the signs of dehydration noted above, talk to your doctor right away. You may need to be evaluated and hospitalized.

What can I expect looking to the future?

Morning sickness is a very common problem. Thankfullyit is not usually dangerous. But for some women, it can limit quality of life during pregnancy. In even rarer cases, it can require hospitalization, as is the case for the Duchess of Cambridge. With the right treatment and supportive care, even women with hyperemesis gravidarum can expect to have healthy pregnancies.