When Is Morning Sickness Classed As Hyperemesis Gravidarum?

When Is Morning Sickness Classed As Hyperemesis Gravidarum?

With nearly 85% of pregnant women experiencing morning sickness, it seems as if nausea is nature’s hazing into motherhood.

Even the name is a bit of trickery, as pregnancy nausea and vomiting can extend well beyond the morning hours.

For 0.5-2% of pregnant women, their pregnancy nausea goes far beyond morning sickness and becomes a severe form known as hyperemesis gravidarum.

Even the mildest form of morning sickness can catch mothers off guard, especially first time mothers.

Never before have you felt ill while being told it’s normal, healthy and a good sign.

However, when the nausea becomes something far beyond morning sickness, it’s hard to know if what you’re experiencing is in fact healthy.

So what’s the difference between hyperemesis gravidarum (HG) and morning sickness (MS)? Here are 10 things to help you know when morning sickness should be classified as HG:

#1: HG Symptoms Vary From Woman To Woman

There isn’t one test or qualifying symptom across the board to diagnose HG. However, most sources agree on the following:

  • Weight loss ≥ 5% of body weight
  • Nausea and vomiting interferes with daily life
  • Symptoms lasting beyond the first trimester
  • Dehydration leading to ketones in the urine
  • Nutritional deficiencies

The severity of HG can vary greatly, just as morning sickness. Some women with HG are fortunate to receive medical care early on, and cope well with oral medications. Other women with HG require hospitalisation, frequent IV treatments, or even IV or feeding tube nutrition.

#2: With HG You Experience Excessive Weight Loss

You can be experiencing a healthy pregnancy with typical morning sickness and lose some weight during the first trimester.

However with HG, your weight loss is excessive and often rapid.

If you’re losing at least an average of 1-2% of your body weight per week, or if you experience greater than 5% weight loss in a month span, it’s possible you’re suffering from HG.

While some women can lose weight without HG, most women experiencing morning sickness lose little if any weight, and often less than 5%.

As weeks turn into months, some women with HG may even lose greater than 10% of their body weight – especially if they aren’t receiving treatment.

#3: With HG Your Vomiting Is Out Of Control – Sometimes Vomiting Only Bile

It’s common for pregnant women to vomit once to a few times per day in the first trimester, and randomly throughout pregnancy.

However, in most cases of morning sickness, after vomiting, a woman feels a little better, can sip some water or eat a cracker, and then go about her day.

With HG, women may be unable to stop vomiting, even once their stomach is empty. They might vomit bile, and regardless of whether they eat or drink, the vomiting continues. In severe cases, especially in women not properly treated for HG, women may even vomit blood.

#4: HG Nausea Is Relentless, Occurs Around The Clock And Interferes With Daily Life

Nausea is an expected pregnancy symptom. As unpleasant as it is, MS tends to slow women down, but not fully stop their lives. With HG, the nausea is so severe women are unable to go about their day. Simply lifting their head, getting up from a seat or even the sound of a television can trigger nausea so severe that coping with the feeling is impossible.

Some women with HG are able to control the vomiting (often with medication), but the nausea leaves them unable to eat, drink or function. Even with vomiting, many HG women say the constant feeling of nausea is the hardest symptom to cope with.

#5: HG Nausea And Vomiting Lead To Severe And Chronic Dehydration

Pregnant women are prone to dehydration due to the increase in blood volume and fluid necessary to support pregnancy. Often adding in more water, sipping electrolyte beverages after a bout of nausea and vomiting, and listening to their body’s thirst signal is enough to fix or prevent dehydration.

For women with HG, the nausea and vomiting make it impossible to stay orally hydrated. Either whatever they drink quickly comes back up, or the nausea and aversions make it impossible to swallow adequate amounts of liquid.

Many women with HG become so dehydrated their urine is spilling with ketones, which signals a need for IV treatment. Women with HG often need at least the occasional IV hydration treatment, while others require hospitalisation or continual homecare for regular IV hydration.

#6: HG Often Means An Inability To Work, Care For Yourself Or For Your Children

When women are experiencing MS, it isn’t uncommon to miss work here and there, need to go to bed earlier, or ask for extra help around the home.

For women with HG, working can become impossible. The nausea and vomiting greatly interfere with the ability to perform expected tasks. There’s often a need to get extra help to care for children. In some severe cases, a woman may even need assistance with basic hygiene help.

It isn’t uncommon for HG families to need to hire help or even move in with family, for round the clock support.

#7: With HG, The Second Trimester Doesn’t Always Bring Relief From Symptoms

For many women experiencing morning sickness, the second trimester often means no more, or at least greatly reduced symptoms. Many pregnant mothers report feeling like themselves as soon as the second trimester begins. They might have a moment of queasiness here and there, but for the most part, they no longer experience nausea and vomiting.

For women with HG, symptoms might slightly lessen but there’s still significant nausea until at least week 16, halfway through the pregnancy, or even until birth. HG tends to peak during weeks 9 and 11, so the second trimester might feel slightly better than the peak period, but HG symptoms still impact them on a daily basis.

#8: Natural Remedies, Dietary Changes and Lifestyle Changes Don’t Relieve HG Symptoms

When a woman has morning sickness, one of the first things that comes to mind is peppermint tea, ginger chews and salty crackers. These are tried and true remedies that help many mothers cope with MS symptoms. While it might not fully stop their symptoms, it helps them to cope and be able to function regularly.

When a woman has HG, peppermint and ginger chews not only don’t help, they may even make her sicker. Eating lighter foods, blander foods, more protein and other ‘pregnancy’ diets bring little to no relief. While lemon products can help with coping, it’s very unlikely to replace medical treatment.

#9: HG Requires Medical Care

Occasionally a mother with MS might need medication or IV treatment to help cope with symptoms. However, for the majority of women experiencing MS, medical treatment is never needed.

For women with HG, anti-emetics (such as Zofran), anti-nausea or motion sickness medications (certain antihistamines, Diclegis, etc), and other medications (such as Reglan) become necessary to not only cope with symptoms, but make it possible to get adequate nutrition and hydration. For some women, oral medication is sufficient. For other women with HG, suppositories, pumps, IV medications and even feeding tubes become necessary to ensure mother and baby get some, and hopefully adequate, nutrition and hydration.

Some traditional remedies (such as acupressure, acupuncture or essential oils) may bring some relief and may help with coping, but they’re rarely, if ever, substitutes for medical care.

#10: HG Leads To Many Food Aversions And A Very Sensitive Sense Of Smell

It isn’t uncommon for pregnant women to have a few foods, textures of food or smells that make them queasy. For some women, disliking a food or a strong sense of smell are early signs they may be pregnant.

When a woman experiences HG, she may develop aversions to many foods, and even water. Perhaps the frequent vomiting leads to self-preservation and a fear of even the most common ‘safe’ for nausea foods, but for many HG sufferers the list of ‘no’ foods quickly grows. A woman with HG may become extremely hungry but be unable to find a food she finds appealing enough to swallow. Aversions can become so strong, it’s like trying to force yourself to swallow dog food.

Pregnant women frequently develop a strong sense of smell. With HG, however, the sense of smell can become so strong that simple odors can trigger relentless nausea and vomiting. Some women with HG can even become sick from the normal smell of a loved one, a certain room in her home or a ‘phantom’ odor only she smells. A few find relief by wearing a scarf they can cover their nose with when odors become unbearable – it doesn’t solve the issue completely but it may help them cope just a little bit.

What Do Women Say About HG vs Morning Sickness?

Some women experience typical morning sickness in one pregnancy and HG in another, or they experience MS symptoms early on that turn into HG symptoms. For women that have experienced both, it’s easy to identify the difference between typical MS and HG. In my own experience, MS meant getting sick but washing your face and going about your day; HG meant going about your day was impossible.

“Morning sickness you can cope; HG is the devil.” – Jenna

“Debilitating and constant is a huge difference. With morning sickness there were moments of nausea. With hg there’s no relief ever. I wake up from a dead sleep nauseous and puking.” – Karri

“Before HG hit, I only had morning sickness. Ginger gum took care of it completely. Then HG started… I was going to the bathroom every 10 minutes to dry heave. The next day, HG vomiting set in and I threw up 25 times by 11:30. My world was entirely different.” – Caroline

“MS a little under the weather a vomit in the morning. HG nonstop nausea and vomiting requiring medical intervention to save yours and baby’s lives” – Laura

“This time with the HG when I was right in my worst days I felt no joy and I cried pretty much every night. I had never felt so alone and helpless.” – Lisa

“With HG, nothing worked, I couldn’t care for even myself, took multiple trips to the hospital and could not stop losing weight.” – Morgan

“MS is like 75% functionality; HG is like 5%.” – Amanda

I Think I Have HG, What Do I Do?

Anytime you are concerned about your wellbeing, or the wellbeing of your baby, it’s important to contact your maternity care provider. There are many treatment options for HG.

Reproductive and Women’s Health Specialist, Doctor Andrew Orr says his best tips for both morning sickness and HG are: “Try eating small meals more often. Keep up the protein and avoid cold foods or cold water. Acupuncture is awesome and the results are documented. I notice a significant difference with just 1-3 treatments — even with women who have been hospitalised, I can get them feeling better quickly. Electrolytes are probably the most important thing a pregnant woman should be taking, but hardly ever do. Because women urinate so much with a normal pregnancy, they lose electrolytes more than any other time in their lives. Add in HG, vomiting etc, and it’s very easy to get dehydrated. So this is my number one go to.”

Some healthcare providers aren’t familiar with up-to-date information regarding HG, as it might not be something they need to frequently treat. If you don’t think you’re getting adequate treatment, there are resources available for you as well as your provider, including:

Last Updated: October 26, 2015


Maria Silver Pyanov is the mom of four energetic boys, a doula, and a childbirth educator. She is an advocate for birth options, and adequate prenatal care and support. She believes in the importance of rebuilding the village so no parent feels unsupported.

One comment

  1. I had HG when I was pregnant with my twins I had to quit my job wasn’t able to lift my head a lot was either in the hospital or home in bed.i had lost 25 pounds before I finally started gaining. Everyday I was living day by day. I ended up getting permit iv called a pick line just so I could get my meds and the nutritional I needed. I was in the doctors at least once a week and she either let me go home but most time she put me in the hospital. I felt very alone praying to God to take care of me and my babies. They came out healthy and we are doing well now.

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