I’ve been thinking about morning sickness recently. More specifically I’ve been thinking about why despite covering maternal health extensively on Femtech Insider, we've never dedicated space to this a condition that affects 70% of pregnancies. This oversight first struck me after I attended the White House Conference on Women's Health Research back in December, where I heard geneticist Dr. Marlena Fejzo share her groundbreaking research.
Her story has stayed with me since then and. I kept thinking about how this Harvard-trained scientist had to fight an uphill battle to research one of pregnancy's most common conditions, and what that reveals about our blind spots in maternal health innovation.
Why has the innovation community largely overlooked one of pregnancy's most common and debilitating conditions? Let’s talk about it.
"Every Living Moment Was Torture" – A Scientist's Personal Journey
Dr. Fejzo's story begins not with research, but with personal tragedy. In 1999, during her second pregnancy, she experienced hyperemesis gravidarum (HG) so severe she had to lay completely still on my back as even rolling to her side triggered violent vomiting.
"I suffered nausea and vomiting so severe I could not eat, drink, or move without violently vomiting," she shared at the White House Conference. "Every living moment was torture."
Despite her obvious physical deterioration, Fejzo's doctor suggested she was "exaggerating her symptoms for attention." By the time a feeding tube was finally ordered around 11 weeks, it was too late. She lost her pregnancy at 15 weeks.
What happened next reveals both the problem and the potential in women's health innovation. Fejzo, already an accomplished geneticist who had discovered genes linked to uterine fibroids during her PhD at Harvard, channeled her grief into scientific purpose. But when she tried to get support for her HG research, she hit institutional barriers.
"I couldn't get support for my work," Fejzo explained, "so I had to work on weekends and nights and Fridays, recruiting over 1,000 patients to study. During the day I worked on ovarian cancer for 20 years."
A mentioned her experience and story stayed with me long after the conference ended. I kept wondering: If a condition affects millions of women annually and has such severe consequences, why wasn't there institutional support to study it? And what other opportunities are we missing in maternal health innovation?
The $2.2 Billion Problem with No FDA-Approved Solution
Fast forward to last week, when I stumbled upon data that added another piece to this puzzle. According to recent GoodRx data, medications for morning sickness top the list of out-of-pocket prescription costs for female-only conditions at $37.87 per prescription—exceeding treatments for endometriosis ($29.38), menopause ($16.95), and birth control ($3.07).
The economic impact extends far beyond prescription costs. HG costs the US economy $2.2 billion annually through lost productivity, with affected women missing approximately 23 days of work per pregnancy (or 60 days for severe cases).
Yet remarkably, the FDA notes there are currently no FDA-approved medications specifically for HG. This represents a significant unmet need and market opportunity that has somehow remained under the innovation radar.
I find this disconnect pretty startling. One of the most expensive, common, and debilitating pregnancy-related conditions was also one of the least researched and most underserved by innovation.
The Breakthrough: Decades of Persistence Lead to Discovery
Despite the lack of institutional support, Fejzo's persistence eventually paid off. After years of collecting samples and data, often working with 23andMe to gather genetic information from thousands of women, she published a breakthrough study in Nature in 2023. Her research identified GDF15, a hormone produced by the fetus/placenta, as the primary cause of HG.
The discovery was elegant in its clarity: People with HG tend to have high blood levels of GDF15 during pregnancy yet produce lower-than-average amounts prior to pregnancy. When GDF15 levels naturally rise after conception, this sudden shock to the system results in severe nausea and vomiting.
"We now have potential ways to both treat and prevent it," Dr. Fejzo announced at the White House Conference. "So now it is all hands on deck."
This scientific breakthrough creates multiple innovation pathways that should excite the women’s health innovation community:
- Prevention: Potentially raising GDF15 levels pre-pregnancy in high-risk women to prevent the shock when levels naturally increase after conception
- Treatment: Developing targeted therapies to modulate GDF15 levels during pregnancy
- Diagnostics: Creating tests to identify women at high risk before or early in pregnancy
- Digital Health: Developing monitoring tools for GDF15 levels and related biomarkers
Fejzo had been applying for funding to test whether metformin (which raises GDF15 levels) could work as a preventive therapy and had been serving as chief scientific officer at Harmonia Healthcare, which planned to open HG-focused treatment centers (though the company has seemingly since closed - their website is down and Google Maps lists them as permanently closed).
The Market Opportunity
Harmonia Healthcare may not have worked out (seemingly), but I still believe there are a few reasons why HG and morning sickness
- No dominant players in the morning sickness treatment market
- The biological mechanism has been identified, creating a scientific foundation for innovation
- The condition affects millions of women annually
- Current solutions are inadequate
- Women are increasingly vocal about demanding better solutions
- Regulatory and funding environments are becoming more supportive
The Curious Question: Why Did Innovation Take So Long?
The most intriguing question though (and one I've been turning over in my mind since December) is why such a common, costly condition remained so underserved by innovation for so long.
One hypothesis I keep returning to: When pregnant women are viewed primarily as vessels for healthy babies rather than as patients with their own health needs, conditions that primarily affect maternal quality of life (rather than fetal outcomes) become secondary priorities.
I see this pattern reflected even in how we visually represent pregnant women - often as "headless torsos" in medical imagery and marketing materials. This subtle but pervasive framing reduces women to their reproductive function, potentially influencing which maternal health problems receive attention and funding.
Just like in many other spaces in women’s health, a condition like HG highlights untapped markets where scientific breakthroughs, increased funding attention, and shifting cultural attitudes are currently creating favorable conditions for innovation.
The curious case of morning sickness reminds us to question our blind spots in women’s health innovation - and to look for opportunities where women's needs have been historically overlooked. And after months of reflection, I believe this is one area where innovation is long overdue.
