Hyperemesis Gravidarum in Pregnant Women and Effect on Dental Health

July 15, 2021

Pregnancy frequently causes vomiting and nausea for many women. Although it’s usually called ‘morning sickness’ since it often occurs in the morning, it can happen at any time of the day.
However, vomiting and nausea can be much more intense than regular morning sickness for some pregnant women. This condition, called hyperemesis gravidarum, can lead to severe consequences, one of which is loss of teeth.

We’ll discuss dental complications relating to Hyperemesis gravidarum and top treatments for patients.

What Is Hyperemesis Gravidarum?

Hyperemesis gravidarum is a severe form of persistent nausea and vomiting that affects about 3% of pregnant women. Unlike morning sickness, it doesn’t fade after the first trimester. It develops between the 4th and 6th week of gestation, worsens around weeks 9 to 13, and may last till the 18th week.

This uncontrollable vomiting can occur over four times a day, with many women feeling intensely sick and unable to go about their daily activities.

Symptoms

Symptoms of hyperemesis gravidarum are similar to those of morning sickness, but more severe. Some of these symptoms include:

● Weight loss of 5% or more
● Dizziness and lightheadedness
● Excessive salivation (Ptyalism)
● Signs of dehydration such as dark urine and dry skin
● Intense nausea and vomiting
● Increased heart rate
● Fatigue
● Vitamin and mineral deficiencies

Causes

Doctors do not know the exact cause of hyperemesis gravidarum. It was once believed that hyperthyroidism, hCG, vitamin B deficiencies, reflux, and psychological problems were significant causes of this condition. However, many of these theories do not support current research.

Some evidence suggests that the cause may be genetic and related to a rise in hormone levels. GDF15, a hormone that affects appetite and placenta development, has a receptor gene, GDFRAL, which resides in the part of the brain controlling vomiting. Patients with Hyperemesis gravidarum have been found to have high GDF15 levels, suggesting a genetic link.

Additionally, genetic changes in IGFBP7 and the progesterone receptor PGR may elevate the risk of hyperemesis gravidarum. While these genetic factors contribute to abnormal hormonal levels, other contributing factors may further increase GDF15 levels. Some of which are nutrient deprivation, infection, hyperthyroidism, and potassium depletion.

Risk Factors

Women who had hyperemesis gravidarum in a previous pregnancy have a higher chance of getting it again during their subsequent pregnancies Other risk factors include:

● Family history of hyperemesis gravidarum
● Multiple pregnancies
● High body weight (obesity)
● Taking medications containing estrogen
● No previous completed pregnancies (nulliparity)
● Motion sickness
● A first-time pregnancy
● Hydatidiform mole (a rare mass that forms in the uterus at the beginning of pregnancy)
● Allergies and a restrictive diet

According to a recent study, using multivitamins early on in pregnancy can be a preventive factor. Similarly, women who smoke are likely to suffer hyperemesis gravidarum.

Diagnosis

There are no specific diagnostic criteria for hyperemesis gravidarum, making it sometimes challenging to diagnose. The reason is that nausea and vomiting during pregnancy (NVP) are on a spectrum from mild to severe. Hyperemesis gravidarum is on the extreme of the NVP spectrum and may go undetected in less extreme cases.

Thus, doctors apply different criteria in diagnosing. Some distinguish hyperemesis gravidarum from regular morning sickness and other conditions that may cause NVP by testing for the following:

● Increased urine ketones
● Increased blood urea nitrogen
● Abnormal thyroid or parathyroid levels
● Serum electrolytes and renal function
● High liver enzymes or bilirubin levels
● Increased hematocrit

Ultrasonography will also be conducted to rule out multiple pregnancies and hydatidiform mole.

Complications Resulting from Hyperemesis Gravidarum

If not well managed, hyperemesis gravidarum can cause severe complications, including:

● Damage to the teeth due to excess vomiting
● Severe malnourishment
● Damage to the esophagus from reflux and vomiting
● Electrolytes imbalance
● Dehydration
● Delayed gastric emptying (gastroparesis)
● Blood clots due to severe dehydration
● Depression and anxiety
● Wernicke’s encephalopathy (an acute neurological condition resulting in confusion, loss of muscle coordination, vision changes, and loss of mental activity.)

Hyperemesis gravidarum can also be detrimental to the developing fetus. It can lead to preterm labor, low birth weight, damage to the placenta, and congenital disabilities.

Treatment

The treatment for hyperemesis gravidarum depends on an individual’s symptoms and the severity of the condition. Women experiencing severe symptoms will need hospitalization and administration of intravenous fluids and nutrients to make up for lost vitamins and minerals.
In more severe cases, such as where patients have electrolyte imbalances, nothing is given by mouth till vomiting stops. The patient may have to undergo nasogastric feeding for an extended period. If nausea and vomiting persist after initial fluid and nutrient replacement, the physician may prescribe antiemetics and other medications such as:

● Doxylamine or Pyridoxine
● Promethazine
● Metoclopramide
● Prochlorperazine
● Ondansetron
● Diphenhydramine
● Antacids
● Antihistamines
● Corticosteroids

Other options can help to alleviate the symptoms of Hyperemesis gravidarum. They include:

● Dietary changes
● Supplements like Thiamine, vitamin B6, vitamin C
● Ginger
● Rest
● Antinausea medications
● Anti-nausea wristbands
● Alternative medicine such as acupuncture and hypnosis
● Eating dry food such as crackers

Using Bayesian Inference, StuffThatWorks.health data scientists analyzed several hyperemesis gravidarum treatment options from different contributors. Drugs such as Ondansetron and Promethazine topped the survey for the most tried treatment options. However, Vitamin B6 and ginger supplements were also among the top 10 most tried methods.

How Hyperemesis Gravidarum Affects Dental Health

Hyperemesis gravidarum can cause severe dental and oral complications either during or after pregnancy. Vomits contain stomach acids with low pH similar to battery acid and can erode the teeth’ enamel. With many hyperemesis gravidarum sufferers vomiting more frequently than some bulimic patients, they could face serious oral consequences.

Patients suffering from hyperemesis gravidarum find it challenging to perform routine oral care. Many are unable to floss, use a toothbrush or other oral device without inducing nausea or vomiting. A combination of a constant acidic environment and a lack of oral hygiene can lead to enamel erosion.

Hyperemesis gravidarum also causes dehydration which may result in dryness of the mouth (xerostomia). Patients may also experience excessive amounts of saliva production (ptyalism), which can induce further vomiting. Other dental problems that can arise are halitosis and bruxism.
Several women sharing their experiences on an online forum complained about dental issues arising from hyperemesis gravidarum. However, many studies on the relationship between vomiting and dental health are among patients with disorders such as bulimia.

Thus, further research specific to hyperemesis gravidarum patients may be necessary to fully understand its impact on dental health.

Loss of Teeth Resulting From Hyperemesis Gravidarum

Jamie A. Pena from the University of New Mexico conducted research to determine common oral and dental complications from hyperemesis gravidarum and their prevalence. The study surveyed 251 women who had endured hyperemesis gravidarum and were no longer pregnant.

Over 81.9% of the women were reported to have experienced ptyalism during their hyperemesis gravidarum pregnancy. 155 participants developed oral pain, and 138 developed dental caries, which is a known cause of tooth decay and tooth loss.

25.2% of the participants reported that they lost a tooth during or after their pregnancies. The number of women who experienced tooth loss is lower than those who had other dental problems from the data. However, many dental and oral issues recorded, such as gum disease and dental caries, are leading causes of tooth loss.

Treatments

Pregnant mothers can have dental treatments anytime during their pregnancy. However, they need to inform the dentist that they are pregnant. Some safe treatments include pain relievers and antibiotics for treating infections. If a dental filling is required or a tooth needs pulling, local anesthesia is hyperemesis gravidarum can do to help their dental health. For instance, it’s recommended for patients to rinse with water rather than brush after vomiting. This action will prevent more bristles resulting from mechanically moving the acid around the teeth during brushing.

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