Duchess Kate’s Severe Morning Sickness Explained in 12 Points

Royal watchers everywhere rejoiced when Kate Middleton, the Duchess of Cambridge, announced earlier this month she was expecting her third child. However, the happy news was undercut by reports of another round of morning sickness for the Duchess.

And not just any morning sickness. We’re talking about the rare, severe kind called Hyperemesis Gravidarum (HG), which affects roughly 1 to 3 percent of pregnant women. (Kate suffered from HG during her first two pregnancies, too.)

There’s no way to sugarcoat this condition: “it’s horrible,” according to Dr. Kristi Weaver, an OB-GYN at HCA Healthcare’s Overland Park Regional Medical Center in Kansas.

“There are people who are literally confined to their homes,” says the physician who, at press time, was treating two or three patients with hyperemesis. “They are at the hospital for multiple days at a time getting intravenous (IV) fluids and some are even sent home with a PICC (peripherally inserted central catheter) line, so they can continue to get the fluids and nutrients they need.”

We asked Dr. Weaver for more to better understand what the Duchess might be going through. Here are her top 12 responses.

1. We know that nausea and vomiting are common symptoms of pregnancy. Hyperemesis Gravidarum is a very severe form of that.
2. The symptoms include severe nausea and vomiting that are associated with weight loss and dehydration.
3. Hyperemesis Gravidarum often requires hospitalization.
4. The condition typically starts in the first trimester, during the sixth or seventh week.
5. Sadly, some patients have severe nausea and vomiting throughout their entire pregnancy. More likely, the symptoms are severe in the first trimester and often resolve, or, at least improve, by early-to-mid second trimester. It really depends on the patient.
6. The difference between normal morning sickness and HG is that morning sickness is not severe enough to require in-patient admission and IV fluid hydration.
   • Most women that are having an episode or two of vomiting a day, although it is very disruptive, are typically not at risk for dehydration.
   • With HG, women often cannot take in any measureable fluids or nutrition. They are vomiting multiple times a day, and therefore, can become dehydrated.
   • Sometimes we see severe electrolyte abnormalities because they are not able to hold down those nutrients, which often have to be replaced by IV during a hospital stay.
7. Hyperemesis often does not respond to routine oral anti-nausea medications because “they literally cannot keep them down”. It can be treated with medications such as Diclegis, Reglan and Zofran, which can be administered through an IV. “We may not resolve symptoms completely, but we can improve patient symptoms dramatically,” says Dr. Weaver.
8. Identifiable risk factors include a history of the condition, multiple gestation (twins or triplets) and infertility treatments prior to pregnancy.
9. Home remedies like eating ginger, peppermint and saltine crackers that may work for someone with morning sickness, are not effective for hyperemesis.
10. If not treated, this disorder can literally lead to death from dehydration. According to Dr. Weaver, that is typically not a risk as long as you’re seeking care by a medical professional.
11. In an extreme case of hyperemesis, if mom experiences weight loss throughout the pregnancy due to severe vomiting, there can be fetal growth restriction because she is not taking in enough calories to help support the baby. “Even if they had a significant weight loss early on in pregnancy, they can catch up later in pregnancy when they’re feeling better,” Dr. Weaver says.
12. Weaver says: “If you’re experiencing any type of nausea or vomiting during pregnancy, please discuss it with your provider. If you are having severe nausea and vomiting – to the point where you cannot hold anything down – you absolutely need to contact your doctor soon,” she recommends. “Many women suffer in silence before they will mention this to someone. Please reach out so that we can get you the help you need.”

Dr. Kristi Weaver is an OB/GYN at Overland Park Regional Medical Center, part of a network of hospitals in HCA Healthcare Midwest Health.