Second Royal Baby on the Way

“Their Royal Highnesses The Duke and Duchess of Cambridge are very pleased to announce that The Duchess of Cambridge is expecting their second child. The Queen and members of both families are delighted with the news.”

So came the official announcement from Buckingham Palace this morning. It went on to say:

“As with her first pregnancy, The Duchess is suffering from Hyperemesis Gravidarum. Her Royal Highness will no longer accompany The Duke of Cambridge on their planned engagement in Oxford today.

“The Duchess is being treated by doctors at Kensington Palace.”

As you recall, news of her Kate’s first pregnancy “leaked” when she had to be hospitalized for dehydration due to the severe morning sickness she experienced. Looks like this time, they hope to handle her condition at home.

The baby, whether it is a boy or girl, will become the fourth in line to the British Throne (behind Grandpa Charles, Dad Will and Brother George). Uncle Harry has been moved down into the fifth slot.

What is Hyperemesis Gravidarum and how is it different from Morning Sickness?

Morning sickness, which is nausea and vomiting during pregnancy, is very common. It is estimated that 70-80% of women suffer from some degree of morning sickness. Most complain of nausea, and a third will also have vomiting. Despite its name, morning sickness can occur at any time of the time.  It  usually begins during the first month of pregnancy and continues through the 14th to 16th week (3rd or 4th month).

Hyperemesis gravidarum (HG) is a more severe form of morning sickness.   HG is extreme, persistent nausea and vomiting during pregnancy that may lead to dehydration.

It is postulated that both morning sickness and hyperemesis gravidarum are caused by a variety of factors. These include the rise in the hormone human chorionic gonaditropin (HCG), slow emptying of the stomach after eating and genetic factors. Its exact cause is remains unknown. It is more common during pregnancies with multiples (twins, triplets, etc) and in a condition called hydatidiform mole.

The symptoms of HG include:

  • Severe nausea and vomiting
  • Weight loss of 5% or more of pre-pregnancy weight
  • Dehydration
  • Decrease in urination
  • Aversion to food
  • Headaches
  • Fainting

How likely it is to get HG in second pregnancies?

Although studies vary, most find that women who have had HG have a good chance of experiencing HG in future pregnancies. Over 50% will have it with each pregnancy and those with more than one experience of HG have a higher risk of experiencing HG in future pregnancies. It also seems to occur in similar patterns and severity, though it is not always consistent.

How is it treated?

Small, frequent meals and eating dry foods such as crackers may help relieve uncomplicated nausea. Drink plenty of fluids, especially at times of the day when the nausea is less of a problem. Seltzer, ginger ale, or other sparkling waters are good choices.

Severe cases of HG require hospitalization. The pregnant mother will receive IV (intravenous) fluids and may have a small feeding tube placed in the stomach to restore nutrients.

Most cases of HG resolve by 20-21 weeks of pregnancy.

For more information, go to the Resounding Health Casebook on the topic.

Our congratulations and best wishes to the royal couple!

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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