Everything You Need to Know About Hyperemesis Gravidarum

This is way more than your run-of-the-mill morning sickness—the nausea and vomiting are unrelenting. Here’s how to manage HG in pregnancy.
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Updated February 22, 2022
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Feeling nauseous during pregnancy comes with the territory—about 70 to 80 percent of pregnant women experience morning sickness, according to research. But if you’re experiencing severe morning sickness and are retching on and off for most of the day, you may be dealing with a different beast: hyperemesis gravidarum (HG). So exactly what is hyperemesis gravidarum, what are the risks associated with it and is there treatment? Read on to learn everything you need to know about managing HG in pregnancy.

What Is Hyperemesis Gravidarum?

Derived from the Greek words for “excessive” (hyper) and “vomiting” (emesis), and the Latin word for pregnant woman (gravid), hyperemesis gravidarum is a difficult condition to pronounce and an even worse one to experience.

Hyperemesis gravidarum is defined as extreme, persistent nausea and vomiting—and it often results in dehydration and a hospital stay. The reassuring news is that it’s also relatively rare. According to the American College of Obstetricians and Gynecologists (ACOG), only about 3 percent of expectant women will experience HG in pregnancy.

Like regular morning sickness (which is very common), hyperemesis gravidarum typically shows up early in pregnancy, around the six-week mark, says Dimitry Zilberman, DO, a maternal fetal medicine specialist with Nuvance Health and Danbury Hospital in Connecticut.

Unfortunately for some, it can stick around for a while. “We’ll see hyperemesis gravidarum extend several months into a woman’s pregnancy—some for the first two to three months, but for others, it can extend throughout the entire pregnancy,” says Kelley Robrock, MD, an ob-gyn with Axia Women’s Health near Indianapolis.

Hyperemesis Gravidarum Causes

While there are no definitive hyperemesis gravidarum causes, it’s most likely associated with the hormones coursing through your body during early pregnancy, notes Zilberman. Still, there are a few hyperemesis gravidarum risk factors that may make you more predisposed to the condition. According to Robrock, these include:

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  • Twins or multiples. If you’re carrying more than one baby, you may be more likely to get hyperemesis gravidarum. (This may be due to higher levels of hCG in your body.)

  • History of the condition. If you’ve had a previous HG pregnancy, you’re likely to experience the unpleasantness again.

  • Your personal history. If you have a history of things like motion sickness or migraines, you may be predisposed to hyperemesis gravidarum. Moreover, if you have family members who’ve experienced nausea and vomiting during pregnancy, you’re more likely to endure these symptoms too.

  • A molar pregnancy. In this rare event, the tissue that would normally develop into an embryo forms as an abnormal growth in the uterus instead. It’s often associated with high levels of hCG, but there is no fetus.

Hyperemesis Gravidarum Symptoms

When it comes to hyperemesis gravidarum symptoms, there’s nausea, vomiting and more nausea. These symptoms are so severe that you can become dehydrated and, over time, you may even lose weight—even as your baby gains it. “Patients have unrelenting nausea and vomiting and a weight loss of about 5 percent of pre-pregnancy weight,” says Zilberman. “Sometimes there’s evidence of dehydration or ketones in urine.” (This is a measure related to starvation.)

Other signs of hyperemesis gravidarum include extreme fatigue, fainting, headaches and signs of dehydration. You lose fluids as you continually vomit, and if you’re unable to keep liquids down, you may become dehydrated. Signs of dehydration, according to ACOG, include:

  • Small amounts of urine that’s dark in color or an inability to urinate
  • Not being able to keep liquids down
  • Dizziness or faintness when you stand up
  • A racing or pounding heartbeat

How Is Hyperemesis Gravidarum Diagnosed?

Let your midwife or doctor know as soon as possible if you’re experiencing out-of-the-norm nausea and incessant vomiting. A physical exam can help clue your provider in to whether you’ve crossed the line from morning sickness to hyperemesis gravidarum—although there isn’t any official hyperemesis gravidarum criteria that definitively identifies the condition, says Robrock. That said, your doctor may also run some blood and urine tests to check for dehydration.

It’s important to realize that if you’re suddenly experiencing new or acute nausea or vomiting and you’re past your ninth week, you may be sick with something else, like a food-related illness or a thyroid issue, according to the ACOG. Symptoms such as abdominal pain or tenderness, fever or headache often indicate something other than hyperemesis gravidarum.

Possible Hyperemesis Gravidarum Risks to Baby

The silver lining of an HG pregnancy? Despite feeling sick as a dog, you can generally feel confident that baby is growing without issue. “Actually, patients who have more nausea and vomiting have been associated with better pregnancy outcomes because it correlates with higher levels of pregnancy hormones,” says Zilberman.

That said, if you aren’t getting adequate nutrition or hydration for a significant amount of time, there might be a risk to baby’s birth weight and development. The research is mixed, but Robrock notes that there isn’t a proven association between Mom’s low weight and a growth-restricted baby.

Possible Hyperemesis Gravidarum Risks to Mom

The most common hyperemesis gravidarum complication is dehydration, notes Zilberman. Due to the vomiting, there’s also a potential risk for a torn or bleeding esophagus and/or nutrient deficiencies if you’re unable to keep food or vitamins down.

What’s more, experiencing extreme morning sickness can mess with your emotions and take a real mental toll. Some moms-to-be have trouble working or holding down a job because of the pervasive nausea; others struggle with taking care of young children at home. It can feel like HG is consuming your life. “Having a good network of social support can help, whether it’s related to childcare or finding other ways of mitigating some of the stress on your daily life,” says Robrock.

Hyperemesis Gravidarum Treatment

Like many doctors, Robrock recommends taking prenatal vitamins when you’re trying to conceive. Research shows that having vitamins in your system can help stave off nausea and vomiting during pregnancy, she says. On the other hand, you may find that taking supplements during a bout of nausea will exacerbate the issue. To that end, she suggests taking your vitamins at night or during a nausea-free moment—if that even exists.

The initial step to hyperemesis gravidarum treatment is making small lifestyle changes, says Robrock.

  • Avoid anything that triggers your nausea. Of course, this often applies to meals and snacks (more hyperemesis gravidarum diet tips, below.) But, beyond food, try to identify and avoid other triggers; the National Library of Medicine notes that perfumed products, long car rides and even showers may send you over the edge.

  • Avoid caffeine. Unfortunately, your beloved cup of coffee isn’t doing you any favors, notes Robrock.

  • Take ginger. Ginger has been found to naturally reduce nausea. Talk to your doctor about ginger supplements, suggests Zilberman.

  • Try acupressure. Anecdotally, some women say that acupressure wrist bands help reduce nausea, though research into their effectiveness is mixed. Still, there is a pressure point that reduces nausea at the middle of the inner wrist, so it’s worth a shot. Zilberman notes that some women also try traditional acupuncture.

Hyperemesis gravidarum medications

If your severe morning sickness symptoms don’t improve with these changes, your doctor may suggest hyperemesis gravidarum medications, starting with over-the-counter options like vitamin B6, Unisom (doxylamine) or antihistamines, such as Benadryl. If those don’t work, there are other anti-nausea prescription medications that might, notes Zilberman. An antiemetic medication, such as ondansetron (Zofran), is often the next step, according to ACOG. And while this drug is commonly prescribed for hyperemesis gravidarum, studies evaluating potential risks for baby haven’t been entirely clear or conclusive. You’ll want to talk to your doctor and review benefits and potential risks together.

Hyperemesis gravidarum diet

One of the best ways to manage hyperemesis gravidarum is by modifying your diet. It’s important to try to eat small, protein-rich meals throughout the day, says Robrock. She also suggests:

  • Eating now, drinking later. Eat in one sitting and then drink a little later, so you’re not loading up your stomach all at once.

  • Eating frequently. Have mini-meals or snacks throughout the day so your stomach isn’t empty, which can spark nausea.

  • Embracing light carbs. Crackers, bread and pretzels are your friends right now.

Long-Term Outlook for Mom

While experiencing hyperemesis gravidarum may feel miserable in the moment, it’s important to remember that you and baby should be just fine. However, severe nutritional deficiencies are possible. This is why it’s so important to seek hyperemesis gravidarum treatment. Your doctor can keep a close eye on you and will decide if and when further intervention is needed.

If you’re one of the unlucky few enduring severe morning sickness or hyperemesis gravidarum beyond 20 weeks, know that it should go away soon after birth and there shouldn’t be any lingering effects. Unfortunately, if you’ve suffered through one HG pregnancy, you’ve got a roughly 20 percent chance of doing so again with any subsequent pregnancies, says Robrock. It can be a really trying time. Focus on taking care of yourself and keep your eye on the prize. The nausea will pass, and baby is coming soon.

About the experts:

Kelley Robrock, MD, is an ob-gyn with Axia Women’s Health near Indianapolis, Indiana. She received her medical degree from Indiana University School of Medicine.

Dimitry Zilberman, DO, is a maternal fetal medicine specialist with Nuvance Health and Danbury Hospital in Connecticut. He received his medical degree from New York College of Osteopathic Medicine.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

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