Race, Ethnicity, Gender and Other Social Characteristics as Factors in Health and Health Care Disparities by Jennie Jacobs Kronenfeld

Author:Jennie Jacobs Kronenfeld [Kronenfeld, Jennie Jacobs]
Language: eng
Format: epub
Tags: Nonfiction, Health & Well Being, Health, Social & Cultural Studies, Social Science, History
ISBN: 9781839828003
Publisher: Emerald Publishing Limited
Published: 2020-09-28T04:00:00+00:00

Hyperemesis Gravidarum Unresolved

The massively understudied health condition puts approximately 60,000 women (0.5%) in the United States in hospitals or 167,000 HG women visit the ER each year (Dengler, 2018; Fejzo, 2016). HG is the second leading cause, after preterm labor, of hospitalization during pregnancy in the United States (London et al., 2017), and clinical intervention is necessary. However, because severe NVP is characteristic of HG, HG is often medically misdiagnosed as “severe ‘morning sickness’”. HG cannot be treated/controlled by small frequent meals and saltine crackers – a myth – and HG is not a psychological issue – another myth – and, therefore, cannot be treated with talk therapy and psychotropic medications. Providers simply often do not realize how ill HG people are. Meaning, HG is often not diagnosed, not properly recorded, and/or not treated by hospitalization (Fejzo et al., 2011).

Since the 1990s, common biomedical treatments of HG include IV fluids; medications like Zofran, Phenergan, and Reglan; and/or Total Parenteral Nutrition (TPN) (with a PICC line) (see also McCall, 2006, pp. 171–188). However, the experiences of HG women show the typical treatments are less than adequate and archaic, and maternal complications – from nutritional deficiencies (thiamine deficiency may lead to theneurological impairment WE), esophageal injury (repetitive wrenching may cause esophageal laceration associated with hematemesis, known as Mallory–Weiss syndrome), psychosocial effects (15% of HG people have had at least one termination due to their symptoms and PTSD) to invasive resuscitation (central line catheters have been associated with complications such as infections, thrombosis, hematomas, pneumothoracies, and cardiac arrhythmias) – and poor fetal outcomes (e.g., preterm birth less than 37 weeks and low birth weight) pursue (London et al., 2017). My point is, HG is far more common than we think, and the misdiagnosis is distant from the lived experiences of hyperemetic pregnant women, leaving many of us with inadequate medical attention, genetic component ignored (see Fejzo, 2016; Fejzo et al., 2013), and etiology unexamined (Fejzo et al., 2017).

Reasonably, we must ask, what causes HG? I begin by pointing to intriguing historical HG moments (see London et al., 2017). Charles Darwin's (born in 1809) mother suffered from hyperemesis of pregnancy. Archival medical literature cites Antoine Dubois, a consultant surgeon and head obstetrician to Empress Marie Louise (Napoleon Bonaparte's second wife), medically identified HG in 1852. Charlotte Brontë died from dehydration and malnourishment due to vomiting during pregnancy in 1855 (Harman, 2017). And, the American physician C.S. Bacon credited the term “hyperemesis gravidarum” in 1897. Yet, today, we have no single accepted definition of HG and we lack specific diagnostic criteria; the differential diagnosis of patients with HG is wide and includes infections, metabolic, gastrointestinal, neurologic, and iatrogenic causes (London et al., 2017). Meaning, our understanding of HG, what causes it and how to treat it, continues to be murky and unresolved! (Hence, I find the PUQE – Pregnancy Unique Quantification of Emesis and Nausea – classification system to categorize HG on a scoring index is both insensitive and unhelpful.) HG remains woefully and dangerously underrecognized.

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