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Go Ask Mom

How bad is your morning sickness? Garden variety vs. Kate Middleton's severe form

Posted September 12
Updated September 13

Over in England, Kate Middleton is expecting her third child with husband Prince William. And, for the third time, the Duchess of Cambridge also is experiencing an extreme form of morning sickness called hyperemesis gravidarum.

In fact, Kensington Palace announced the pregnancy last week at the same time that it shared that she wasn't feeling well enough to attend an official engagement that day.

Kate experienced this same acute form of morning sickness with her first two pregnancies. Prince George is now 4. Princess Charlotte is 2. It even sent her to the hospital in 2012 where she was reportedly treated for dehydration.

As many as 90 percent of women will experience some kind of nausea and even vomiting during pregnancy - usually starting at the fifth or sixth week and peaking around week nine, said Dr. Ann Collins, an ​OB-GYN at UNC REX Healthcare.

By about the 20th week, most women feel better. But up to about 20 percent still may have symptoms of nausea into the third trimester. For a few, it can last the entire pregnancy.

And, as any women who has been pregnant knows, it doesn't just happen during the morning.

"It can happen any time during the day," said Collins, who treats patients at Centre OB/GYN on the campus of UNC Rex in Raleigh.

But, some women, like Kate, experience a kind of morning sickness on steroids. Hyperemesis gravidarum effects about 3 percent of pregnant women, Collins said. Like morning sickness experienced by most pregnant women, this acute form of the illness can improve by the second trimester though, for some, it continues throughout the pregnancy.

Morning sickness can be an extremely uncomfortable part of pregnancy for expecting moms. (I experienced it myself with both of my pregnancies).​ And women experience it differently.

"Nausea for some people is completely intolerable. They just can't tolerate it at all," Collins said. "Other people are like, 'Yeah, it's awful, but I just keep going.' They tolerate it better."

So, how can expecting moms know if they have this acute form of morning sickness? Collins said there are signs that a woman may have more than the typical garden variety morning sickness.

Nothing stays down: Any food or drink comes back up.

Physical signs of dehydration: Dry mouth, dizziness, low blood pressure and infrequent urination are common signs that your body doesn't have enough fluids.

Extreme weight loss: You experience weight loss of more than 5 percent of your pre-pregnancy body weight.

Normal routine isn't possible: You're so sick that you can't care for your other children, run errands, go to work or otherwise go about your life.

Previous experience with acute morning sickness: If you've had hyperemesis in a previous pregnancy, it's 15 percent to 20 percent more likely that you'll get it again during a new pregnancy.

"It is extremely common to have nausea and some vomiting in pregnancy," Collins said. "It's really becoming hyperemesis when it's interfering with your daily activities or you're dizzy, you're lightheaded, can't get out of bed, not peeing. And then that's a problem. You need to see your doctor."

IV fluids can help women with severe dehydration. In worst case scenarios where a woman has lost a lot of body weight, doctors will recommend a feeding tube, Collins said.

Medications also can help, Collins said. The latest option is Diclegis, the only FDA-approved morning sickness medication on the market.

"It's very safe in pregnancy and it's been shown to help with moderate to severe hyperemesis," Collins said. "That's been a nice drug that has low side effects and can work for patients."

Like with the typical morning sickness that most women experience, diet and lifestyle changes also can help improve the symptoms of this severe form of morning sickness.

Collins recommends women ...

Look out for triggers: It could be a particular food, activity or smell. "If going by the deli department at the grocery store makes you gag, send your husband," she said.

Don't let yourself get hungry: Eat small, frequent meals.

Bland foods are your friend: Stay way from really spicy or greasy food if you aren't feeling well.

Try peppermint or ginger products: Peppermint tea, mint gum or ginger ale can help settle stomachs.

Don a new bracelet: Or, specifically, a Sea-Band, which uses accupressure to ease nausea.

Exactly why pregnant women experience morning sickness - in any form - is the million dollar question.

"Nobody really knows," Collins said. "There are a lot of theories out there about hormone levels and abnormal gastric motility. But we still don't know what it is."

The good news is that there is a definite end - when that baby is born.

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