Relief at Last for Severe Morning Sickness

Many pregnant women experience morning sickness. But those with a rare condition called hyperemesis gravidarum (HG) experience nausea and vomiting so severe, they can’t eat or sleep. Some end up terminating their pregnancies.

Now, a University at Buffalo-led study has shown that gabapentin, a seizure drug, can successfully treat HG. The double-blind, randomized trial is the first to demonstrate an effective therapy in treating outpatients with the debilitating disorder.

The study involved 21 women with HG who didn’t respond to standard treatments and who required intravenous hydration. Twelve received gabapentin, while the other nine received the standard-of-care treatment. They each kept track of their symptoms for seven days.  

Those on gabapentin experienced a 52% greater reduction in nausea, vomiting and retching, “which is quite significant,” says lead researcher Thomas Guttuso Jr., professor of neurology at the Jacobs School of Medicine and Biomedical Sciences. Even more striking, he says, was a 96% increase in oral nutrition scores. Women with HG can be so nutritionally deprived that their babies are born prematurely, with low birth weight and with a low score on the Apgar scale, which measures the health of newborns.

Though rare, HG is a devastating condition. “These women can’t sleep,” says Guttuso. “They can’t keep anything down.”

Typically, they become dehydrated and have to be admitted to the hospital, where their condition improves with intravenous fluids. But at least a third, says Guttuso, end up readmitted because the treatments aren’t effective.

Surveys show as many as 15% of women with HG end up terminating their pregnancies, Guttuso adds. One woman in the UB study experienced vomiting so violent it ripped a hole in her esophagus; she had considered terminating her pregnancy, but once she was on gabapentin, she was able to carry the baby to term. She then went on to have another child, again while being treated with gabapentin.

Guttuso’s interest in gabapentin stretches back decades, stemming from an accidental discovery he made as a neurology resident. After he prescribed it to a breast cancer patient for her hot flashes, she told him it also appeared to resolve her chemo-induced nausea and vomiting. That led him to wonder if gabapentin might be able to treat HG.

The next step in his journey will be to enroll more women in a larger study. “If this subsequent larger study also shows positive results,” he says, “this will reassure the medical community that this is a true effect that’s consistent and reliable.”