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By Tomoeh Murakami Tse
Washington Post Staff Writer
Tuesday, November 4, 2008

I found out I was pregnant on an early December morning last year and, for two days, went about my routine in a euphoric trance: a grin on my face, elbows out slightly to guard my belly from the crush of commuters and holiday shoppers.

I daydreamed about turning the guest room into a nursery, of taking prenatal exercise classes and bonding with other moms-to-be. We would trade tips on baby gear and shop for maternity clothes, for my body had begun the 40-week process of nurturing a new life.

But I wouldn't get to do any of those things.

By the sixth week of my pregnancy, I was vomiting so much I was spitting up blood. Dehydrated and dizzy, I landed in the emergency room at week nine. In my 20th week, I started receiving nutrition intravenously.

What I had was hyperemesis gravidarum, a severe form of pregnancy sickness characterized by persistent nausea and vomiting as well as significant weight loss, often more than 5 percent. It occurs in about three to 20 of every 1,000 pregnancies, hospitalizing more than 30,000 women a year in the United States, according to studies and government statistics.

Women with the condition can suffer from dehydration, malnutrition, electrolyte imbalance and, in severe instances, neurological disorders, spleen tearing, kidney failure and lung collapse. Before intravenous fluid treatment became available, it was not uncommon for women to die from hyperemesis. It can affect the unborn baby, too: Some researchers have linked the condition with restricted fetus growth, preterm delivery and low birth weight.

No one knows exactly what causes nausea and vomiting in pregnancy, but elevated hormone levels are widely thought to be at fault. Multiple studies have found that women with hyperemesis have higher levels of human chorionic gonadotropin, a hormone unique to pregnancy, and thyroxin, a thyroid hormone, than women with less-severe nausea and vomiting, said Roberto Romero, chief of the perinatology research branch at the National Institute of Child Health and Human Development. At higher risk are women who are carrying twins, had the condition in a prior pregnancy, have gastric disorders or are prone to motion sickness; so are women whose mothers and sisters experienced hyperemesis, suggesting that genetic predisposition plays a role, Romero added.

"It's extremely debilitating," said Marlena Fejzo, a geneticist and researcher at the University of Southern California who has studied hyperemesis. "It's most devastating for women who end up aborting. Many women decide to change their plans for having another child. A lot of them adopt or don't have more children."

* * *

My ordeal began three days after learning I was pregnant, when I woke up in the early morning with a queasy feeling in my stomach. As I lay in the darkness, the sensation grew stronger until I could no longer ignore it. I felt sweaty and drowsy. My mouth went dry and in the next instant filled with saliva. As the contents of my stomach rose, I crawled over my husband, Archie, and headed for the bathroom. I retched loudly several times, then vomited.

Unpleasant, I thought, but no big deal. Plenty of friends had told me about their trials with morning sickness. It was just something most women had to put up with during the first few months of pregnancy, a small price to pay for the ultimate joy that lay ahead.

Evolutionary biologists have proposed that nausea and vomiting in pregnancy are nature's way of protecting the fetus from food-borne toxins in the critical first trimester, when major organs are formed and the fetus is still small enough to live off the mother's stored fats. This seemed to fit with research showing that women who experience morning sickness have lower rates of miscarriage, and I took comfort in that.


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