Hyperemesis Gravidarum | More Than Morning Sickness

Morning sickness is one of the earliest signs of pregnancy. It’s almost a rite of passage into this new stage of your life.

Sometimes, ‘morning’ sickness lasts all day. Sometimes it doesn’t happen in the morning at all but in the afternoon or evening.

For some women, morning sickness becomes extreme nausea and vomiting in pregnancy. This has a special name – hyperemesis gravidarum.

This name comes from the Greek words hyper (excessive) and emesis (vomiting), and the Latin gravidarum (pregnant).

This article looks at hyperemesis gravidarum (HG) and what can be done to treat it.

Hyperemesis gravidarum

Hyperemesis gravidarum (HG) is not just morning sickness or pregnancy nausea.

Many women going through pregnancy nausea can feel sick and even vomit, but HG is the severe end of this pregnancy symptom.

HG is identified as severe nausea and vomiting in pregnancy that results in weight loss, electrolyte imbalance and dehydration. This can cause HG sufferers to lose between 5 and 10% of their pre-pregnancy body weight.

Although not every mother will experience the worst difficulties, all mothers with hyperemesis gravidarum need treatment and support.

What causes hyperemesis gravidarum?

Despite it being the second leading reason why pregnant women are hospitalised, years of research hasn’t found the cause of hyperemesis gravidarum. Several possbilities have been put forward.

The most recent evidence looks at a relationship between appetite genes and the placenta.

Other theories point to the sudden changes in human chorionic gonadotropin (hCG), estrogen and progesterone in early pregnancy contributing to HG.

Other research has explored the relationship between hyperemesis gravidarum and thyroid hormones. Many women with HG have higher levels of thyroxine, a hormone created by the thyroid gland.

There also seems to be a link between HG and molar pregnancy (hydatidiform mole). Molar pregnancy is caused by chromosomal abnormalities resulting in abnormal growth of placental tissue.

Hyperemesis gravidarum symptoms

Around 75% of women have morning sickness in the first trimester of pregnancy. It usually starts around week 6 and resolves around week 12-13 of pregnancy.

Hyperemesis gravidarum (HG) occurs in about 0.3–2% of all pregnancies. This severe type of nausea and vomiting during pregnancy has symptoms such as:

• Constant nausea
• Vomiting more than three or four times per day
• Loss of appetite
• Dizziness and lightheadedness
• Dehydration
• Loss of more than 4.5kg, or 5% of body weight, due to nausea and vomiting.

How long does hyperemesis gravidarum last?

Morning sickness often fades by the end of the first trimester, but hyperemesis gravidarum usually lasts longer.

HG may be at its worst around week 9 but will usually resolve at about 20 weeks of pregnancy.

Unfortunately, up to 20% of sufferers will have HG symptoms that last until they give birth.

Does hyperemesis cause miscarriage?

Many pregnant women worry about miscarriage, especially in the first trimester. Extreme nausea and vomiting can lead them to think there’s something wrong with the pregnancy.

The positive news is that research hasn’t found that HG causes miscarriage. In fact, the opposite seems to be true.

Mothers with HG appear to have a lower risk of miscarrying, due to increased hormone levels showing the pregnancy is doing well.

Is hyperemesis gravidarum a sign of twins?

Levels of the pregnancy hormone hCG (human chorionic gonadotropin), which triggers morning sickness, tend to be higher in mothers who are pregnant with twins or multiple babies.

Although all mothers pregnant with twins won’t experience HG, it does seem to be more common in multiple pregnancies.

What should I eat if I have hyperemesis gravidarum?

Many women who’ve had HG report feeling frustrated with well-meaning suggestions to try different things to get rid of the nausea and vomiting.

The important thing is to maximise nutrition and prevent dehydration in any way you can.

We’re not suggesting they will stop HG, but you could try following these tips:

• Fast absorption of nutrition is important, so think shakes and smoothies, soups etc. Sipping through a straw might also help reduce nausea
• Electrolytes help prevent dehydration so make your fluids count. Plain water can trigger more nausea. Try coconut water, or check with your care provider about appropriate electrolyte supplements
• Frozen foods have less smell and flavor, and they melt slowly. Try freezing fruit juice as popsicles. Ice chips can also be a life saver when nothing stays down
• Eat tiny amounts, as frequently as you can. Small amounts of food are less likely to trigger nausea and vomiting. Try a tablespoon of food or a sip of liquid every 10 minutes
• Stick to bland foods that won’t trigger more nausea when it reappears
• As much as possible, opt for the healthiest and most nutritious food you can tolerate.

Hyperemesis gravidarum treatment

How HG is treated will depend on how severe your symptoms are. Usually your doctor or midwife will recommend trying a hyperemesis diet and, possibly, supplementation with vitamin B6.

There are medications that can be used to alleviate HG symptoms.

The drugs most often prescribed for hyperemesis gravidarum are:

• Serotonin antagonists
• Corticosteroids
• Antihistamines
• Phenothiazines
• Anti-reflux medications
• Antispasmodics
• Prokinetic agents.

No drug is completely safe in pregnancy but in severe cases of hyperemesis the benefits of medications outweigh the risks.

Talk to your health care provider to find out whether medication is appropriate for you.

If HG has caused severe dehydration, you might need intravenous rehydration, which is usually given in hospital.

Bed rest is often recommended, as HG can cause extreme fatigue.

When should I go to hospital with hyperemesis?

Your doctor could recommend hospital if your symptoms of hyperemesis gravidarum are so severe you’re unable to keep food and fluid down.

Women with persistent nausea and vomiting can lose as much as 2-9kg in weight and be unable to maintain even a low level of hydration. IV and electrolytes hydration is necessary and, in some cases, tube or nasal feeding might be needed.

Continuous and severe nausea and vomiting during pregnancy can also lead to extreme emotional and mental distress. HG is extremely debilitating. It interferes with your normal daily activities and you will need assistance.

Who is at higher risk for hyperemesis gravidarum?

Although we don’t know what causes HG, we do know there are a number of factors that increase your chances of developing the condition.

These risk factors include:

• Giving birth for the first time
• HG in a previous pregnancy
• Being pregnant with multiple babies
• Being under the age of 35
• High or low pre-pregnancy weight.

These risk factors don’t mean you will definitely have HG but it’s important to be aware of them.

Hyperemesis gravidarum vs morning sickness

Nearly half of pregnant women suffer from nausea and vomiting during pregnancy. This will usually resolve, without treatment, by the end of the first trimester.

Although it might be challenging, morning sickness isn’t as incapacitating as HG.

Pregnancy nausea typically doesn’t cause weight loss or affect your ability to eat and drink enough each day. Although you might vomit occasionally with morning sickness, diet and lifestyle changes tend to help you feel better.

For more information be sure to read When Is Morning Sickness Classed As Hyperemesis Gravidarum?

Complications of hyperemesis gravidarum

Most women don’t have any lasting health consequences from hyperemesis gravidarum, but some women suffer rare complications.

These include:

• Kidney stones and possible kidney failure from ongoing severe dehydration
• Wernicke encephalopathy, caused by vitamin B1 deficiency
• Damage to the esophagus from forceful vomiting
• Muscular atrophy from severe fatigue
• Liver disorders
• Blood clots.

These are very rare complications, as most women with hyperemesis gravidarum receive treatment for the severe nausea and vomiting to avoid long term health problems.

Is hyperemesis a high risk pregnancy?

Women with HG don’t have normal pregnancies and there are several short and long term complications that are linked to the condition.

The HER Foundation says hyperemesis gravidarum has been shown to increase the risk of preeclampsia, stillbirth and preterm birth.

Although the risk of having these complications is low, your doctor should be monitoring you closely, even if treatment has controlled or resolved your symptoms of HG.

Suffering from hyperemesis can also have a devastating impact on women’s mental health.

Many women experience extreme mental distress during their pregnancy. Some consider pregnancy termination because the extreme nausea and vomiting become unbearable.

HG can result in women experiencing post traumatic stress disorder and extreme guilt.

Does hyperemesis gravidarum affect baby?

The mental impact of severe nausea and vomiting during pregnancy can cause chronic stress for women.

There is some thought that maternal stress can affect the baby’s future health but the main concern is the impact of weight loss and low nutrition.

There have been no studies looking at the long term health of babies born to women with HG, but it’s believed the condition increases the risk of:

• Preterm birth
• Low birthweight
• Heart defects
• Neural tube defects.

Will I have HG in every pregnancy?

No one knows what causes hyperemesis gravidarum and it can’t be prevented. But having gone through it once, you can be prepared if it happens in your next pregnancy.

Some women will wait a few years before becoming pregnant again, as dealing with extreme nausea, vomiting and fatigue with a young child can feel impossible to manage.

You’ll be more likely to recognize the symptoms and seek help sooner with subsequent pregnancies. Early treatment may lessen the severity of HG.

Your family and friends will also be more aware and more able to support you.

How to support someone with hyperemesis

Partners and other support people might question whether your symptoms are actually as severe as they seem.

It’s important they’re made aware, early on, that hyperemesis gravidarum is a very real complication of pregnancy and their support can make all the difference.

Don’t be afraid to ask for help.

Support might include:

• Advocating for treatment as early as possible
• Organizing in home health care, if appropriate, for IV fluids and medication
• Taking over the daily tasks, such as organizing a cleaner, childcare etc
• Preparing meals or food that you can tolerate.

The absolute best resource for mothers experiencing hyperemesis gravidarum is the Hyperemesis Education and Research Foundation.

Visit their website at www.helpher.org for mother-to-mother forums, research, blog posts, and more.