Hyperemesis Gravidarum: What Princess Kate Middleton is Going Through


Since I have been pregnant four times, including a twin pregnancy, boy pregnancy and girl pregnancies, I could have sworn I knew it all (cough, cough). But then when the news came out that Princess Kate Middleton — a.k.a. William’s wife — was hospitalized for hyperemesis gravidarum, I had no idea what in the world that was. Naturally, Breezy Mama had to get to the bottom of it and turned to Giuseppe Ramunno, M.D., obstetrician and gynecologist on the medical staff at Mountain Vista Medical Center and Tempe St. Luke’s Hospital, to get his answers on the symptoms and treatment for hyperemesis gravidarum, who it can happen to, if it truly means that Kate is expecting twins and more.

What exactly is hyperemesis gravidarum?

Hyperemesis gravidarum (HG) is a severe case of morning sickness characterized by heavy nausea and vomiting, ultimately resulting in unbalanced electrolytes and weight loss.

How does it differ from normal “morning” sickness?

With morning sickness, you’re still able to function through the motions as you would any other day. Nausea is sometimes accompanied by vomiting, but the nausea will eventually subside and you’re still able to eat and drink regularly. HG however causes moms-to-be to suffer from severe vomiting as a result of constant nausea. They can’t keep food down and become extremely dehydrated. Signs and symptoms also include headaches, dry and waxy skin, confusion, fainting, fatigue and a rapid heart rate. While typical morning sickness diminishes after the first trimester, HG symptoms are persistent through mid-pregnancy and moms can continue to feel nauseous until late pregnancy.

When should a woman seek medical help if she suspects she is suffering from more than just standard “morning” sickness?

You know your body better than anyone else, the key it to listen. If you’re having difficulty performing daily activities or notice a weight loss 5 percent or greater than pre-pregnancy weight, further care is recommended.

Is hyperemesis gravidarum more consistent with twin pregnancies?

Yes, expecting mothers are more likely to suffer from HG while carrying multiples.

What is the treatment for hyperemesis gravidarum?

Early detection is important towards restoring the health of mother and baby. Mild cases can be treated with dietary changes and rest, while severe cases often require hospitalization. An array of steps is taken but every patient’s case is different. Medication, bed rest, IV fluids and nutritional therapy are some of the treatments available but they often come with consequence. Many mothers become anxious about the health of their child and depressed from being confined and unable to perform simple everyday activities.

Does hyperemesis gravidarum only occur in the first trimester or can women suffer throughout their pregnancy?

Unfortunately, 10-20 percent of suffers endure HG through their whole pregnancy. In most cases it begins at 4-7 weeks, eases up at 14-16 weeks and ends by week 20.

Once the baby is born, does it go away?


What causes hyperemesis gravidarum?

The exact cause of HG is unknown but it’s believed to be caused by a rise in hormone levels in addition to other varying factors. It’s common in multiple pregnancies and in women with migraines. Women with a family history of or who had the condition in a previous pregnancy are much more likely to have it.

If a woman suffers from it in her first pregnancy, is she likely to have it again during her next pregnancy(ies)?

Yes, HG stays consistent in future pregnancies.

Does Kate Middleton’s tiny frame by chance a reason she would have it?

The answer is no, but is Kate Middleton’s thin frame going to affect her pregnancy? A woman who is malnourished or a competitive athlete who has stopped ovulating can have trouble getting pregnant. Likewise, malnourished pregnant women can have an increased risk of delivering early. In Middleton’s case, she is neither malnourished nor a competitive athlete. For the most part, people who are thin do very well during pregnancy.

Thin women have similar pregnancy outcomes as women of normal weight, and they have better outcomes than very overweight women, who are at higher risk of diabetes, pregnancy-induced high blood pressure and C-sections.

It remains to be seen whether Middleton will gain the 25 to 35 pounds recommended for a healthy pregnancy. What’s certain is that women who are pregnant — and those who are not — will be paying close attention to every inch of her expanding belly.

Ramunno photoAbout Dr. Ramunno
Dr. Ramunno has been caring for women since 2004. Dr. Ramunno was raised in Youngstown, Ohio, and has lived in Detroit, Michigan, and Tulsa, Oklahoma. He attended Case Western Reserve University where he received a bachelor’s degree in biology and Italian and continued on to medical school at Ross University School of Medicine. Dr. Ramunno completed his training in Obstetrics and Gynecology at The University of Oklahoma School of Medicine. During his residency, he participated in research on gestational diabetes and was selected to present this research at the American Congress of Obstetrics and Gynecology/Council of Resident Education in Obstetrics and Gynecology Annual Conference. Dr. Ramunno is a member of the American Congress of Obstetricians and Gynecologists, the Phoenix Obstetrical and Gynecologic Society, and the American Medical Association.

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  1. …and I thought heartburn with twins was the worst thing possible to go though. Poor girl!

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