12/18/2012 04:31 pm ET Updated Feb 17, 2013

A Duchess, Morning Sickness, and Royal Implications... Twins? A Baby Girl?

Many admirers of the Kate Middleton were both happy to hear that she is pregnant and concerned about her health. Having treated many women with hyperemesis gravidarum (HG), I imagine she is appreciative if not in a good mood to receive the well wishes of her many admirers.

The symptoms and experience of severe HG are well described by Lisa Belkin on The Huffington Post. While HG occurs in a small minority of patients, the effects can be severe and long-lasting. Severe HG has been associated with prematurity and infants born small for their gestational age. These findings may have long-term consequences for an heir to the throne, including increased risk of heart disease. Other epidemiologic data has repeatedly pointed to higher rates of both twins and female infants, although the data are not strong enough to order either twin strollers or start painting the nursery pink.

Nausea and vomiting in early pregnancy is associated with a decreased risk of miscarriage, likely due to higher hormone levels, and most pregnant women experience some degree of nausea and vomiting. My personal preferred first-line treatment includes ginger (250mg, three to four times per day) and vitamin B6 (25mg three times per day). Both are safe supplements that have demonstrated effectiveness in randomized, placebo-controlled clinical trials. Taking a half pill of Unisom (doxylamine) results in some sedation but also helps with limited side effects. Unfortunately, Bedectin, an effective, delayed-release combination of Vitamin B6 and doxylamine fell victim to our litigious culture and was voluntarily pulled from the market due to litigation and unproven claims it caused birth defects. As a result, hospital admissions for nausea and vomiting in pregnancy increased by 37-50 percent in the ensuing three years.

If symptoms require greater intervention, as in the case of the duchess, one can add medications with increasing amounts of side effects and costs. Hospitalization is typically a last resort for those with a 10-pound weight loss and electrolyte abnormalities. When the patient has as high a profile as the duchess, one must always wonder whether the hospital admission criteria were lessened, in favor of a more royal treatment.

Regardless, I wish her improved symptoms and an easier, safe pregnancy for her and her family. I also hope that someday all expecting women will experience the skilled care and concern that a duchess deserves.

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