GDF15 linked to maternal risk of nausea and vomiting during pregnancy 2023 Fejzo et al (hyperemesis gravidarum - morning sickness in pregnancy)

“I was starving,” she said, “and the doctor just kept trying higher doses of drugs and different drugs, and nothing helped.”
Finally, her doctor agreed to deliver liquid nutrients through a catheter running into a large vein near her heart, but Dr. Fejzo believes this step came too late. Fifteen weeks into her pregnancy, the fetus’s heart stopped beating.
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Maybe this reluctance to intervene on feeding issues is a broader problem than the UK and ME/CFS.

Yet despite the gravity of hyperemesis, as it’s colloquially called, doctors are often slow to treat it. Sometimes, they dismiss it as a temporary discomfort, or even a psychological disorder, said Dr. Jone Trovik, a gynecologist and a professor of clinical science at the University of Bergen in Norway.

“My doctor pretty much thought it was all in my head,” Dr. Fejzo said. He told her that women make themselves sick during pregnancy to gain the sympathy of their husbands, and later, that her illness was a ploy for attention from her parents, who were helping with her medical care.
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And we already know the psychosomatic ideas run wild and free across the broad expanse of medical problems. Some of the content in this article is staggering though.
 
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Researchers speculate that GDF15 may have evolved to help pregnant women detect and avoid unsafe foods that might harm fetal development early in gestation. But in hyperemesis, this normally protective mechanism seems to run in overdrive, at least in part because of too much GDF15, said Stephen O’Rahilly, director of the metabolic diseases unit at the University of Cambridge, who now collaborates with Dr. Fejzo on GDF15 research.

In a study published in 2022, Dr. Fejzo and her colleagues confirmed the link between hyperemesis and GDF15 in the patients she had enrolled over a decade of Fridays.
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But she isn’t done. She’s watching closely as several pharmaceutical companies have begun testing GDF15-based drugs that aim to reduce nausea and improve appetite in cancer patients, with promising early results.
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The answer seems to be a gene that results in higher levels of GDF15.

And, wow
Circulating levels of GDF15 in patients with myalgic encephalomyelitis/chronic fatigue syndrome, 2019
Severe ME/CFS is associated with increased levels of GDF15, a circulating biomarker of cellular stress
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Forum thread here:
Circulating levels of GDF15 in patients with myalgic encephalomyelitis/chronic fatigue syndrome, 2019, Melvin, Lacerda, Nacul et al
I haven't read beyond the abstract yet.
 
As a result, women have often been blamed and punished for their own illnesses. In the 1930s, hospitalized hyperemesis patients were “denied the solace of the vomit-bowl” and forced to lie in their own vomit.
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Gosh, aren't women in the 21st century so lucky that kind of attitude no longer exists, and that being female is no longer seen as predisposing to hysterical conversion.

Oh wait, it does...

To this day, patients hospitalized with the condition are sometimes isolated in a dark room and prohibited from having visitors or access to their cellphones. This treatment has been based in part on the theory that hyperemesis is caused by a woman’s subconscious rejection of pregnancy, and that isolation would make her accept it,
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:mad:
 
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Every Friday for 10 years, she called study participants — more than 1,500 in all — to request their medical records and consent to participate, and mailed them saliva collection kits from her home.

But Dr. Fejzo wasn’t sure how she would pay for the genetic analyses. Her grant proposals to the National Institutes of Health were rejected. Since 2007, the agency has funded only six hyperemesis studies, totaling $2.1 million.

That amount is small in comparison with the economic burden of the condition, said Kimber MacGibbon, executive director of the HER Foundation. (Amy Schumer, who publicly documented her struggles with hyperemesis, is on the foundation’s board of directors.)

Hyperemesis hospitalizations are thought to cost patients and insurers about $3 billion per year, she said, and then there are the expenses of medications, home health care, lost work and complications like postpartum depression. “The costs of it are just astronomical,” she said.
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To this day, patients hospitalized with the condition are sometimes isolated in a dark room and prohibited from having visitors or access to their cellphones. This treatment has been based in part on the theory that hyperemesis is caused by a woman’s subconscious rejection of pregnancy, and that isolation would make her accept it,
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I can't get this out of my head. It is horrifying.

If you wanted to make an already very bad, indeed potentially fatal, situation a lot worse this is how to do it. Even if it doesn't kill the patient it is going to do horrendous and probably long-term harm to both her physical and (ironically) her mental health, including generating a huge and sadly justified fear and distrust of doctors.

I say 'patient'. There are, of course, two patients in this situation: the mother and the baby.

WTF is wrong with the medical profession? At this level of sustained systemic failure there is no practical difference between wilful ignorance, profound incompetence, and psychopathic cruelty.
 
Hutan said:
Maybe this reluctance to intervene on feeding issues is a broader problem than the UK and ME/CFS.
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Yes. In Norway though pregnancy removes the requirement of a nutrition problem lasting "a substantial time" before one can get oral nutrient supplementation on prescription. So at least those guidelines are possible to point to here.

It makes me so mad the whole thing. And thinking about the women gaslit who go on to gaslit other women because that's what they've been told is the right thing to do :(
 
There are some great comments under the article.

article said:
To this day, patients hospitalized with the condition are sometimes isolated in a dark room and prohibited from having visitors or access to their cellphones.
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One of the comments is from a woman who was put in a dark room with no sound, but it was because any sort of stimulation made her feel ill. So, possibly some of the dark room stuff was because it was helpful. I find it a bit intriguing that the symptoms bear some similarity to those of people with very severe ME/CFS. That 2019 paper looking at GDF15 in ME/CFS found a positive relationship between ME/CFS severity and GDF15 levels.
 
"Recent research on the GDF15–GFRAL axis has focused on its anorectic action and suggests that it acts as a mediator of the physiological responses to visceral malaise states such as the induction of food aversion, nausea, and emesis preceding the onset of anorexia, as shown in different rodent models and shrews [31,40,41,42]. This fits with the well-known actions of the hindbrain AP in the control of nausea and vomiting [43] beside its role as a control center of food intake [44]."

A quote from this paper

https://www.mdpi.com/2073-4409/10/11/2990
 
Gosh, this is appalling i had heard of HG from when Kate (duchess of Cambridge) had it (i wonder if doctors told her she was attention seeking - i doubt it!
But i had no idea it was one of the 'considered psychosomatic' things. This is shocking but unsurprising. It affects women & doctors dont understand it - that should be next to the dictionary definition of psychosomatic.
Hutan said:
So, possibly some of the dark room stuff was because it was helpful.
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I've never been pregnanti know when my own nausea is bad (this is ME nausea, very rare instances of motion sickness as a child/adult & when i had gastroenteritis/norovirus/food poisoning), i always had to have dimly lit silence. I vividly remember on all those occasions begging those around me to go away/give me silence because sound would make me vomit. And that was all long before any ME-related sensory sensitivities came about.

Its abuse if you dont want it & clearly removing a person's phone & denying them visitors is abusive, but for some the sensory relief may have been a blessing - one wonders if that only reinforced the stupid psych ideas - being alone & no stimulation helps... ergo....

It never ceases to amaze me the utter stupidity of some doctors. Its inexcusable
 
Hutan said:
Fertile ground for another blog @ME/CFS Skeptic.
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Thanks for tagging me @Hutan.

I agree this is a good example that would fit well in the dark history of psychosomatic medicine. The blog is currently on hold due to health and other reasons (there are still a lot of stories on our list to write about). I hope to continue it somewhere in the future and take a closer look at hyperemesis.
 
I had hyperemesis in the late 1970s. I was so ill one day I called a locum who told me with great impatience that I just had morning sickness. The next day I ended up in hospital on a drip.

Apart from the first doctor, I was taken seriously as far as I know and treated appropriately.
 
Sean said:
Gosh, aren't women in the 21st century so lucky that kind of attitude no longer exists, and that being female is no longer seen as predisposing to hysterical conversion.

Oh wait, it does...


:mad:
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My first thought is that some medical professionals are so fixated on the correctness of their ideas, that they are willing to inflict what amounts to torture on their patients in order to ‘help’ them. In terms of a therapeutic model this is no different to the Inquisition inflicting torture and even sanctioned murder on their supposed heretics in order to save their immortal soul. With the Inquisition they believed that the Church had privileged access to a higher truth that justified inflicting whatever was necessary on those they were trying to help. In parallel in this example we see doctors believing their access to a higher truth justifies ignoring their patients reported symptoms and lived experience.

In terms of managing heresy the Inquisition saw it as inherently contagious, just as some of the believers in psychosomatics see hysteria as contagious through social transmission.
 
Wonderful this dedicated and very determined scientist has found the physiological cause of this.

Wow, often people have to figuratively climb mountains for years in order to get to the answer. This definitely applies to "women's issues".

Appalling history regarding this condition. Not surprising though, as women have been treated cruelly for stepping out of the norm, or even just because they are women, for maybe as long as we've had humanity.
 
The same pattern keeps holding up about everything psychosomatic: it's worse in context, and the more context you add the worst it gets.

Everything about this ideology is disgusting. It has destroyed millions of lives. And it's massively popular, beloved even. What the hell is wrong with this profession?
 
rvallee said:
Everything about this ideology is disgusting. It has destroyed millions of lives. And it's massively popular, beloved even. What the hell is wrong with this profession?
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I completely agree - but what the hell is wrong with *everyone*? People *love* this narrative about illness - about their own illnesses, even. Someone has managed to sell people on the idea that this validates their trauma. How can we combat this? I see it creeping into conversations, everyday life, the vernacular more and more. It's disturbing and I have no idea how to combat it. Anyone?
 
Merged thread
Abstract

GDF15, a hormone acting on the brainstem, has been implicated in the nausea and vomiting of pregnancy (NVP) including its most severe form, Hyperemesis Gravidarum (HG), but a full mechanistic understanding is lacking [1-4].

Here we report that fetal production of GDF15, and maternal sensitivity to it, both contribute substantially to the risk of HG. We confirmed that higher GDF15 levels in maternal blood are associated with vomiting in pregnancy and HG. Using mass spectrometry to detect a naturally-labelled GDF15 variant we demonstrate that the vast majority of GDF15 in the maternal plasma is derived from the feto-placental unit. By studying carriers of rare and common genetic variants we found that low levels of GDF15 in the non-pregnant state increase the risk of developing HG. Conversely, women with beta-thalassemia, a condition where GDF15 levels are chronically high [5], report very low levels of NVP. In mice, the acute food intake response to a bolus of GDF15 is influenced bi-directionally by prior levels of circulating GDF15 in a manner suggesting that this system is susceptible to desensitization.

Our findings support a putative causal role for fetally-derived GDF15 in the nausea and vomiting of human pregnancy, with maternal sensitivity, at least partly determined by pre-pregnancy exposure to the hormone, being a major influence on its severity. They also suggest mechanism-based approaches to the treatment and prevention of HG.

Paywall, https://www.nature.com/articles/s41586-023-06921-9
 
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