As doulas, we provide our clients with up-to-date information. Being able to support clients with morning sickness, and especially those with hyperemesis gravidarum is important. The cause of hyperemesis gravidarum has been found. And surprisingly, it might mean the cause of morning sickness isn’t hCG.
Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy. It is not the same as morning sickness. However, it is often described as severe morning sickness to help people understand what it is.
For decades, many scientists and birth professionals believed hCG was likely the cause of morning sickness and conditions like hyperemesis gravidarum. However, new research shows another culprit: GDF15.
The Cause of Hyperemesis Gravidarum
For centuries, HG has stumped scientists, midwives, doctors, and more. In the past, and sadly occasionally now, providers have told women HG was in their heads. Previous theories even suggested a person would experience extreme sickness if they did not desire their pregnancy.
Added to the extreme illness, people faced gaslighting, emotional manipulation, and were even institutionalized for mental health. Providers falsely assumed the illness was just in their heads.
Dr. Marlena Fejzo lost a baby due to the pregnancy complication, hyperemesis gravidarum, in 1999 and has been researching the cause ever since. “While I have worked, people have continued to contact the HER Foundation with heartbreaking stories like my own, begging for answers. I think we finally have the solution.”
Dr. Marlena Fejzo and her team previously identified three independent genetic variants in GDF15. All of these variants strongly increase the risk of developing HG. GDF15 is known to cause nausea, vomiting, and appetite changes.
While they knew these variants were associated with a risk of HG, they were not sure exactly why. Without understanding the why, it is hard to use the information to develop potential therapies and management for HG.
The new study, first-authored by HER Foundation’s Dr. Fejzo and co-authored by HER’s Executive Director Kimber MacGibbon, was led by Dr. Stephen O’Rahilly at the University of Cambridge and includes an international team of researchers.
The research revealed that people carrying predisposing GDF15 genes results in low levels of the hormone when they are not pregnant. The hormone GDF15 is produced at very high levels by the placenta during early pregnancy.
People who have lower levels before pregnancy seem to become hypersensitive to the rapid rise of the hormone during early pregnancy.
How Does Knowing The Cause of Hyperemesis Gravidarum Help People?
Perhaps a major breakthrough with this research is being able to reassure people HG is not in their heads. They are not dramatic, they are not exaggerating their symptoms, and they are not simply experiencing morning sickness.
This research reassures millions of people, currently pregnancy and pregnant in the past, that they have a genuine pregnancy complication. So much of women’s health is brushed aside. Many are told they are just “hysterical “or this is all in their head. This study is proof we need more women in science and healthcare.
From a clinical standpoint, this helps in a few ways. One, we may be able to identify who is at risk for HG. With that information, we can begin treatment early in pregnancy and potentially reduce the side effects of HG. Ensuring early hydration and nutrition support improves outcomes.
Secondly, this gives scientists a starting point for developing effective therapies for HG prevention. Hypermesis.org shared:
“This research shows that mice pretreated with a low dose of GDF15 can become desensitized to the hormone. It also reveals that patients with beta-thalassemia (a blood disease associated with elevated levels of circulating GDF15 in the non-pregnant state) are unlikely to have nausea and vomiting in their pregnancies. The work suggests that, in the future, HG may be prevented by raising GDF15 levels prior to pregnancy using a priming strategy.”
What Does This Research Mean For Morning Sickness?
It is important to remember that Hyperemesis Gravidarum is not the same as morning sickness. It reaches a level where the person is unable to remain hydrated or properly nourished during pregnancy. Medication, IV therapy, and even ongoing hospitalization is necessary to prevent organ failure and severe complications.
However, this research into the GDF15 levels suggests that this hormone, and not hCG as previously thought, is what triggers pregnancy nausea and vomiting. Even those without HG, it is common to hear they are being dramatic about morning sickness. However, fully understanding it is due to physiological changes, is important.
People are not faking the difficulties they experience in pregnancy. No two people are alike, either. Varying levels of GDF15 related to genetic predisposition can impact whether one has no pregnancy sickness, common morning sickness, or hyperemesis gravidarum. It provides a societal starting point to end comparison and suggest anyone is being dramatic about their symptoms.
What Does This Mean For Doulas?
As doulas, we are meant to provide education and support to our clients. For those experiencing severe morning sickness and especially those with HG, we can be a source of reassurance. We can also be a source of education.
As future therapies come about, we can ensure clients are aware of all potential treatment options.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...