Hyperemesis gravidarum causes nausea and vomiting so severe, it could be a challenge for the Dutchess to keep up her usual schedule of official events and royal duties, according to an ob-gyn who treats other women with the debilitating condition.

Amanda MacMillan
September 05, 2017

Kate Middleton and Prince William are expecting baby number three, Kensington Palace announced Sunday in a statement. And as with babies one and two, the mom-to-be is again suffering from hyperemesis gravidarum, a severe form of morning sickness that causes debilitating nausea and vomiting.

Middleton’s previous two pregnancies were announced in her first trimester—earlier than couples traditionally share their happy news with family, friends, and (in this case) adoring subjects—because her symptoms forced her to cancel public events.

That also appears to be the case with her third pregnancy. In fact, this latest news came in the form of a nearly identical statement as the one released when the couple announced their second pregnancy and revealed that the Duchess would no longer be attending a planned engagement.

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As someone who lives much of her life in the public eye, Middleton’s absence from the British event circuit is noticeable, and news of her illness can be concerning for those who follow the royal family—or who worry about experiencing the same symptoms themselves during their own pregnancies.

So what might the next few months look like for the Duchess of Cambridge, or any other pregnant women suffering from hyperemesis gravidarum? To find out, Health spoke with Richard Davis, MD, interim division director of maternal-fetal medicine at the University of Alabama at Birmingham. Dr. Davis is not involved in Middleton’s care, but he has treated other women with the same diagnosis.

Dr. Davis says hyperemesis gravidarum is different from regular morning sickness in that it is extremely hard for women to keep down any foods or liquids without vomiting. “Women can get dehydrated, they can lose significant amounts of weight, and they can obviously feel very weak,” he says. “It can become a dangerous cycle because the esophagus gets irritated from vomiting, which can cause reflex and contribute to the nausea, which then causes more vomiting.”

That’s why it’s so important for women with hyperemesis gravidarum to seek medical attention, Dr. Davis adds. Some women only need a few days of intravenous fluids to hydrate them and help the worst of their symptoms pass, while others need medications to calm their stomach and suppress nausea. In severe cases that have gone undiagnosed or untreated, women may also have vitamin deficiencies or other complications that need to be addressed.

The Duchess’s hyperemesis was bad enough during her first pregnancy with Prince George that she was hospitalized for four days in the “very early stages” of her pregnancy. For her second pregnancy, she was reportedly cared for at home, but she missed several high-profile appearances during her first trimester, including a trip to Malta and the Invictus Games for wounded servicemen and women.

Middleton also spent part of her first trimester at her parents’ home when she was carrying second-born Princess Charlotte. At that time, a family friend told People that Middleton was “not well at all, the poor thing.” Still, the fact that the Duchess was able to stay with her parents, who live about 50 miles from her main doctors, likely meant that her symptoms were being kept under control.

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Middleton stayed out of the public spotlight during her pregnancy with Prince George until about the 13-week mark, and followed a similar pattern while pregnant with Princess Charlotte. In the later months of both pregnancies, she kept up a regular schedule of high-profile events and made plenty of headlines about her chic maternity (or, more accurately, non-maternity) style.

That makes sense, says Dr. Davis, since many women with hyperemesis gravidarum start to feel better around the 12- to 14-week mark. “They may still have some nausea or vomiting,” he says, “but most can keep it under control with strategies like small, frequent meals or natural remedies like ginger.”

That’s not true for everyone, however; some women experience serious symptoms throughout their entire pregnancies. There’s not a lot of research to predict whether Middleton’s third case of hyperemesis gravidarum will mimic her first two, but Dr. Davis says that’s likely to be the case.

And while there’s no way to prevent hyperemesis gravidarum from occurring and nothing a woman can do differently a second or third time around, it can help if she and her doctors know what to expect, says Dr. Davis, and are prepared with preventive medicine and preemptive scheduling strategies.

“It can be challenging for women to keep up with work or their daily lives,” he says. “You have nausea, you may still be vomiting, and you just feel really lousy, so going out in public and keeping appointments can be hard, especially when food is involved.” (Just like with regular morning sickness, he explains, the smells and sights of certain foods can be potent triggers.)

At the same time, he says, women with hyperemesis gravidarum need to listen to their bodies and eat whenever—and whatever—they feel the urge to eat. “Even if it’s something very surprising, like if a woman says she wants a cheeseburger and French fries,” he says. “Chances are if she’s craving it, she’s going to be able to keep it down.”

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Hyperemesis gravidarum can be physically and emotionally devastating, and in severe (and very rare) cases, it can cause long-term health issues for both mom and baby. But if a woman receives proper care and is able to manage her symptoms, she can recover fully and go on to have a perfectly healthy newborn.

Just look at Middleton’s two previous deliveries: Insiders told People that the Princess Charlotte’s birth went “extremely well,” and Middleton wowed her fans by appearing in public, looking radiant of course, shortly after giving birth to both George in 2013 and Charlotte in 2015.

So we may not see or hear much from Middleton for a while—until at least her second trimester, if her previous pregnancies are any indication. yet it's comforting to know that she’s come back from this before looking as healthy and happy as ever.