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; pregnancy nausea and vomiting can extend well beyond the morning hours.
For 0.5-2% of pregnant women, pregnancy nausea goes far beyond morning sickness and becomes a severe form known as hyperemesis gravidarum (HG).
Even the mildest form of morning sickness can catch mothers off guard, especially in a first-time pregnancy.
Never before have you felt so ill while being told it’s normal, healthy and a good sign.
However, when nausea becomes something far more than morning sickness, it’s hard to know whether what you’re experiencing is in fact hyperemesis gravidarum.
So what’s the difference between hyperemesis gravidarum (HG) and morning sickness (MS)?
Here are 10 things to help you know when severe morning sickness is classed as HG:
#1. Hyperemesis gravidarum symptoms vary from woman to woman
There isn’t one test or qualifying symptom across the board to diagnose hyperemesis gravidarum. However, most sources agree on the following:
- Weight loss ≥ 5% of pre-pregnancy weight
- Nausea and vomiting interfere with daily life
- Severe nausea and vomiting last beyond the first trimester
- Dehydration, leading to ketones in the urine
- Nutritional deficiencies.
The severity of HG can vary greatly, just as morning sickness can. Some women with HG are fortunate to receive medical care early on and they cope well with oral medications. Other women with HG require hospitalization, IV treatments or even IV or feeding tube nutrition.
#2. With hyperemesis gravidarum you experience excessive weight loss
You can be experiencing a healthy pregnancy with typical pregnancy sickness and lose some weight during the first trimester.
However, with HG, your weight loss is excessive and often rapid.
If you’re losing an average of at least 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.
Although some women can lose weight without HG, most women who experience what’s called morning sickness lose little, if any, weight and often less than 5% of body weight.
#3. With hyperemesis gravidarum, vomiting is out of control – sometimes you vomit only bile
In most cases of morning sickness, a woman feels a little better after vomiting and can sip some water or eat a cracker, and then go about her day.
With hyperemesis gravidarum women might be unable to stop vomiting, even once their stomach is empty. They might vomit bile and, whether or not they eat or drink, the vomiting continues. When severe vomiting persists, some women might even vomit blood, especially those not properly treated for HG.
#4. Hyperemesis gravidarum 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, there is severe nausea and vomiting and 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 severe sickness.
Some women with HG are able to control the vomiting (often with medication), but nausea leaves them unable to eat, drink or function. Even with vomiting, many HG women say the persistent nausea is the hardest symptom to cope with.
#5. Hyperemesis gravidarum 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 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 avoid dehydration.
For women with HG, nausea and vomiting make it impossible to stay hydrated. Either whatever they drink quickly comes back up, or nausea and aversions make it impossible to swallow adequate amounts of liquid.
Many women with HG become so dehydrated their urine is spilled with ketones, which signals the need for IV hospital treatment. Women with HG often need at least the occasional IV hydration treatment; for others the right treatment requires hospitalization or continual homecare for regular intravenous fluids.
#6. Hyperemesis gravidarum often means an inability to work or care for yourself or others
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. Nausea and vomiting greatly interfere with the ability to perform expected tasks.
It isn’t uncommon for HG families to need hired help or even to move in with family, for round-the-clock support.
#7. With hyperemesis gravidarum 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 lessen slightly 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 have an impact on a daily basis.
#8. Natural remedies and dietary and lifestyle changes don’t relieve hyperemesis gravidarum symptoms
When a woman has morning sickness, the first things that come to mind are peppermint tea, ginger chews and salty crackers. These are tried and true remedies that help many mothers cope with MS symptoms.
When a woman has HG, peppermint and ginger chews not only don’t help, they might even make her sicker. Eating lighter foods, blander foods, more protein and other ‘pregnancy’ diets bring little to no relief. Although lemon products can help women cope, they are very unlikely to replace medical treatment.
#9. Hyperemesis gravidarum requires medical care
Occasionally a mother with MS might need medication or IV treatment to manage symptoms. For the majority of women experiencing MS, however, medical treatment isn’t needed.
For women with HG, anti-sickness drugs (anti-emetics or motion sickness medication) become necessary to cope with symptoms and get adequate nutrition and hydration. For some women, oral medication is sufficient. For others 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) might bring some relief and help with coping, but they’re rarely, if ever, substitutes for medical care.
#10. Hyperemesis gravidarum 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, avoiding some foods or a developing a strong sense of smell are early pregnancy signs.
When a woman experiences HG, just the thought of food makes her feel sick. 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 might become extremely hungry but be unable to find food (not even bland foods) she finds appealing enough to swallow .
Hyperemesis gravidarum – causes
Here are some of the risk factors of hyperemesis gravidarum:
- Hormonal changes. Although research isn’t conclusive about this, it is believed that estrogen fluctuations and the rise of human chorionic gonadotropin (hCG) could cause hyperemesis gravidarum
- History of HG. If you’ve suffered HG in a previous pregnancy, there’s an increased risk of developing it again
- Multiple pregnancy. If you’re expecting more than one baby there’s an increased risk of developing HG
- History of motion sickness and migraines
- Mood disorders
- Previous gastrointestinal problems, such as IBS or H. Pylori
Hyperemesis gravidarum – treatment
Treating hyperemesis gravidarum can make a huge difference for the woman who’s suffering from it.
There are many treatment options for HG.
Reproductive and Women’s Health expert, Doctor Andrew Orr, gives his best tips for both MS and HG:
‘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 hospitalized, 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 during a normal pregnancy, they lose electrolytes more than at 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 treat frequently. If you don’t think you’re getting adequate treatment, there are resources available for you, as well as for your provider, including:
- HelpHer – Hyperemesis Gravidarum Education And Research
- Beyond Morning Sickness
- Pregnancy Sickness Support UK.
Will hyperemesis gravidarum harm my baby?
Rest assured that your baby will suffer the consequences of HG much less than you will.
Baby’s development happens mostly in the first trimester. It is common for women, especially those with severe morning sickness, to lose weight before the second trimester and that doesn’t hinder the baby’s development at all.
It is possible that your baby will be born with low birth weight. But don’t worry, low birth weight can be easily corrected once the baby is born.
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