Hyperemesis Gravidarum: A Devastating Pregnancy Condition

Introduction to Hyperemesis Gravidarum

A woman who almost terminated her second pregnancy due to a serious illness says sterilization is now her best option as she faces difficulties accessing treatment. Chloe, 26, said she could not bear another pregnancy because of Hyperemesis gravidarum (HG), which causes persistent severe nausea and vomiting that may last until birth.

Effects of Hyperemesis Gravidarum

Chloe, from Newport, was admitted to hospital with dehydration early in her first pregnancy when she had never heard of HG. "I literally spent my entire first trimester in bed on ice cubes because I couldn’t eat or drink," she said. "I struggled to shower, my partner sometimes had to bathe me; I was physically unable to care for myself." Chloe received reduced duties at work until the birth of her son in 2023 and the illness stopped.

Access to Treatment

Due to her difficult pregnancy, Chloe did not want a second child, but became pregnant unplanned. "I remember when I found out, I literally turned to my partner and said, ‘What are we doing?’" she said. Chloe, a sleep coach for toddlers and babies, said her mental health had deteriorated and she was unable to take her antidepressants due to the serious illness. A pack of 20 Xonvea tablets costs £28.50, making it significantly more expensive than other alternatives. It is not routinely available in Wales but may be prescribed if other treatments have failed.

Xonvea: A Lifesaving Medication

The medicine is recommended by the Royal College of Obstetricians and Gynecologists alongside alternatives such as Cyclizine, Prochlorperazine, and ondansetron, which are regularly prescribed by doctors. Chloe said it helped change her journey and she felt well enough to cancel her abortion. “In the beginning, it just meant I could take my antidepressants, which then helped to calm my mood.

Prevalence of Hyperemesis Gravidarum

According to NHS Wales, around one to three in 100 pregnant women will develop HG, although this may go unreported. Symptoms include severe nausea, vomiting, dehydration, and weight loss, so sufferers often require hospital treatment. Dr. Georgina Forbes, a specialist in sexual and reproductive health, said she knew firsthand how devastating HG can be for patients.

Calls for Better Access to Xonvea

Forbes, chairman of the Wales committee of the College of Sexual and Reproductive Healthcare, called on the Welsh government to reconsider the decision on Xonvea and dismissed concerns about the costs. "If you take into account the costs incurred every time a woman is admitted to hospital, these run into hundreds, if not thousands of pounds, depending on how long they stay, how many bags of IV fluid they need and how many other medications. So that’s just the cost of healthcare," she said. Plaid Cymru MS Lindsay Whittle has called for better access to Xonvea, saying it’s less than the price of a meal at an average restaurant.

Response from the Welsh Government

In response, the Welsh Government said: “GPs across all health boards in Wales regularly prescribe Xonvea.” It added it relied on independent advice from the All-Wales Medicines Strategy (AWMSG) group to make medicines routinely available on the NHS. “Without formal guidance from Nice, AWMSG’s assessment remains the most recent formal assessment of xonvea in Wales. Due to insufficient cost-effectiveness data, routine use was not recommended,” a spokesperson said. The AWMSG said it has “been working proactively with the manufacturer for over 18 months and is actively reviewing the options available to them”.