Research uncovers link between hormone and severe morning sickness during pregnancy

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• Geoff Bennett:

  The extent to which women experience morning sickness can vary, and those with extreme nausea and vomiting during pregnancy often face stigma when trying to receive care.

  While the condition is understudied, new research is giving hope for better treatment.

  Amna recently spoke with several women affected by the condition and one researcher working to understand the cause.

• Amna Nawaz:

  Anywhere from 50 to 90 percent of all pregnant women struggle with morning sickness, but, for a smaller group, about 2 percent, it can be debilitating or dangerous. The extreme nausea can lead to malnutrition or hospitalization, a condition known as hyperemesis gravidarum, or H.G. for short.

  But new research has identified a single hormone behind the condition, leading to hope that there could be a new treatment. More on that in a moment, but, first, let's hear from some women who've lived through this firsthand, two of whom are pregnant right now.

• Sarah Bregel, Maryland:

  My name is Sarah Bregel. I'm a freelance writer and I live in Baltimore, Maryland.

  When I was first pregnant with my daughter, Piper, I was like a young mom. I was 24 years old. I had no idea what was going on. The best way that I can describe it is essentially like you feel like you have been poisoned.

• Ariel Monticure-Kline, Texas:

  My name is Ariel Monticure-Kline. I'm from Fort Worth, Texas, and I'm a stay-at-home mom.

  For me, on my first pregnancy and second, which I'm currently in, I threw up 24/7, regardless if I had food or fluid in my body. I was so violently ill that blood vessels broke in my face, my eyes.

• Celina Pina, California:

  My name is Celine. I'm a department manager at an art university. And I'm from Bakersfield, California.

  I will say, yes, this is my first pregnancy, first time ever getting pregnant, so that I really came into this not knowing anything about what to expect. I ended up having to go to the emergency room because I just — I was, — yes, I scared myself in the sense that I couldn't get out of — I felt like I couldn't get out of bed. I had zero energy.

  I couldn't keep water, food down.

• Aubree Watson, Michigan:

  My name is Aubree Watson. I live in Michigan and I have two children.

  I was on TPN bags, which is total nutrition. It has everything you need, so you don't have to actually eat. I was on that for 12 hours a day.

• Sarah Bregel:

  No one ever said, there is this thing that you may have. No one ever brought it up my first pregnancy until I was about halfway through, and I stepped on the scale, and the nurse looked at the number, and she looked at my chart and she said, no, this — that can't be right.

  And I said, no, it is. I'm still not really keeping anything down, and I had lost like 22 pounds.

• Ariel Monticure-Kline:

  It wasn't until I adamantly advocated for myself and ended up switching practices, because I didn't feel like I was being taken seriously, that I was recommended a home service. The service here was called Option Care here in Texas. Highly recommend.

  But they not only administered I.V. They would come to my house and teach me about a medical pump which administered Zofran 24-7. Zofran is actually a medication given to chemotherapy patients.

• Aubree Watson:

  I was literally throwing up 20 to 30 times a day. I would throw up so much that it would, like, ruin the inside of my throat. I would throw up blood.

  And the only person I could really compare my struggles to was with my dad, who's had cancer.

• Sarah Bregel:

  I had some moments of enjoying being pregnant, but, for the most part, it's — pregnancy is miserable for people going through this. There's not a lot of enjoyment. It's about just making it through.

• Ariel Monticure-Kline:

  I knew I wanted to provide my daughter a sibling, but I can't say that I was filled with anything but fear when I found out I was pregnant.

  And I'm still very much detached from my pregnancy or the idea that another baby's coming into this world.

• Celina Pina:

  I really wish my doctor had told me to take medicine sooner. I wish he would have understood the severity of the situation.

  I feel like I — coming into this, I knew nothing about the medication or how important it was to not get to a really low point.

• Aubree Watson:

  I don't think I will have any more children because of it. I think it really affected all of us, not just me, but even my partner. I don't think we could go through that again.

• Amna Nawaz:

  Dr. Marlena Fejzo at the Keck School of Medicine at the University of Southern California. She's worked on this breakthrough research and joins us now.

  Dr. Fejzo, welcome.

  And just put this into context for us. How big a breakthrough is this, identifying this one hormone?

  Dr. Marlena Fejzo, Keck School of Medicine of USC: Well, it is a really huge breakthrough, because it tells us that there is actually something biological that is causing this.

  And a lot of people are mistreated who have this condition and told that it's all in their head or made to feel that it's their fault. And it is also a huge breakthrough, because it gives us new ways to potentially prevent it and to treat it.

• Amna Nawaz:

  And what does that mean? What could those new ways look like? Is that a pill that one day may be possible for women to take?

• Dr. Marlena Fejzo:

  Yes, so, for the prevention strategy, what is going on is that people who have this condition of severe nausea and vomiting, they have a predisposition for having lower levels of this hormone prior to pregnancy.

  So, to prevent it, we would give them something to increase their levels to desensitize them to the high levels of this hormone that people have during pregnancy. So, that's one strategy. And then the second strategy is to lower the levels of this hormone by blocking it or blocking its action during pregnancy.

• Amna Nawaz:

  And would that kind of treatment just be for those who suffer from this severe form of H.G., or could it also be applicable for the many, many women who suffer from morning sickness during pregnancy?

• Dr. Marlena Fejzo:

  I mean, first, I think we have to try it on those most severe cases, because those are the people who are going to benefit the most and have the least risk.

  People with hyperemesis already have a high risk of adverse outcomes because of it, adverse maternal and child outcomes. So, for them, it's worth it to test out these methods. And then we would move into other people that have less severe symptoms once we know that everything is safe and we know how to do it correctly. But it's going to take some time.

  So, yes, I think so eventually, to answer your question, but, first, we need to get things right. And with those, we will start with the most sickest patients.

• Amna Nawaz:

  Dr. Fejzo, I know this is obviously professional work for you, but you do have a personal connection to this specific work.

  I wonder if you wouldn't mind sharing your own experience with your second pregnancy.

• Dr. Marlena Fejzo:

  Yes.

  So, similar to all those stories, I was extremely ill in my second pregnancy. I could not eat, drink or move without violently vomiting. It was really like a form of torture. I just had to lie completely still week after week. And I lost so much weight. My doctor tried seven different drugs at one point at once on me, and nothing really worked to get me to be able to eat.

  So, finally, I was put on a feeding tube, but it was too late, and I lost the baby in the second trimester.

• Amna Nawaz:

  I'm so sorry for what you lived through.

  But how does all of that inform your work now?

• Dr. Marlena Fejzo:

  Yes.

  So, during that time, even though I was completely bedridden and had to have my parents take turns changing my bedpan during the day, my doctor had told me that he thought that I just wanted attention from my parents and that's why they were there at my house.

  So I knew that wasn't the case, but I was too weak to argue with him. I couldn't even talk. At one point, I had to use a buzzer because I was so weak. And so, afterwards, after I lost the baby and I recovered, I looked into what was known about it,and I saw there was so little known.

  And so I knew that there was something biological. I heard someone say it felt like being poisoned. Yes, I could feel something was poisoning me. And so I wanted to find out what that was. And I decided to dedicate my life to figuring that out.

  And now we are finally here. So it's very rewarding.

• Amna Nawaz:

  You mentioned there wasn't a lot of work done on this. This has long been understudied when it comes to this issue or others around women's health.

  Why is that? Why does it take so long to get to these answers?

• Dr. Marlena Fejzo:

  I mean, I think there are a few reasons. One reason is because of the thalidomide disaster in the 1950s, where people took thalidomide for this and babies were born with limb deformities.

  And so that really put a halt on pharmaceutical companies investing in research on this, as well as doctors in using medicines to treat it, and also fear in patients of taking medicine in pregnancy. So that stopped a lot of the research.

  But, in addition to that, of course, it is a women's health issue and a health issue during pregnancy, and so I feel like there is a lot of lack of research into conditions that affect only women. And so, hopefully, that is changing now.

• Amna Nawaz:

  Dr. Marlena Fejzo from the Keck School of Medicine at the University of Southern California, thank you so much for joining us today. We appreciate it.

• Dr. Marlena Fejzo:

  Thank you for having me.

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