Hyperemesis Gravidarum
Severe Nausea And Vomiting During Pregnancy

Severe morning sickness

In 2012 hyperemesis gravidarum came to the attention of the public when Kate Middleton suffered from it in her first pregnancy.

Hyperemesis Gravidarum


What Is Hyperemesis Gravidarum?
What Are The Symptoms?
Do I Have Morning Sickness or Hyperemesis Gravidarum?
What Causes It?
Who Is Likely To Get It?
How Is It diagnosed?
How Is It Treated?
Everyday Survival Techniques

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What Is Hyperemesis Gravidarum?

Hyperemesis gravidarum is the medical term to describe severe vomiting and nausea which is persistent and debilitating during pregnancy. It is not to be confused with morning sickness, even in bad cases. Hyperemesis gravidarum usually appears in the first trimester and disappears between weeks 12 to 16, although it can continue into the third trimester of pregnancy. 22 percent of women in fact experience the condition throughout the three trimesters, while others experience it in the first only to experience it again in the third. If untreated it can lead to dehydration, weight loss and malnutrition. In extreme cases it can cause liver damage and Wernicke's encephalopathy (brain disorder) and in such cases the pregnancy may need to be terminated. Fortunately in the vast majority of cases, although the woman may feel very ill, their baby is unlikely to be affected. Most studies show that babies born to women who suffer hyperemesis gravidarum show no health or development problems compared to those who are born to mothers who were healthy.

What Are The Symptoms?

• Severe vomiting, which is considered several episodes a day, most days.
• Continual nausea between bouts of vomiting.
• The inability to keep any liquid or foods down.
• Pale, waxy skin.
• Headaches.
• Sleeping problems.
• A feeling of anxiousness and depression.

When Hyperemesis gravidarum is severe or inadequately treated it may result in:

• Signs of dehydration such as infrequent urination or dark yellowish urine.
• Dehydration resulting in ketosis and constipation in pregnancy.
• Weight loss of more than 5 percent of pre-pregnancy body weight. Some women lose as much as 30 percent of their body weight.
• Subconjunctival hemorrhage (the blood vessels in the eyes burst).
• Hallucinations, lightheadedness and fainting (see also dizziness while pregnant).
• Ptyalism or hypersalivation, uncontrollable dribbling or drooling caused by excess saliva.
• Hyperolfaction or extreme sensitivity to odors. This may be the body's way of telling a pregnant woman to seek a cleaner, more temperate environment.

Your doctor may note:

Low blood pressure.
Anemia related to pregnancy.
• Jaundice.
• Rapid heartbeat.

Usually symptoms occur in the first trimester of pregnancy, between weeks 4 to 6. Some women even experience signs before a pregnancy test confirms they are expecting. Symptoms gradually disappear by week 16. This is the case with about 90 percent of patients. Vomiting which occurs after week 9 of pregnancy should be investigated, this is not a common sign of hyperemesis gravidarum, and other causes will need to be considered such as placenta abruption, bacterial infections, bowel disorders, food intolerances and HELLP Syndrome.

Do I Have Morning Sickness or Hyperemesis Gravidarum?

The vast majority of pregnant women will experience morning sickness. However if you find yourself vomiting every day and losing weight rapidly, contact your pregnancy healthcare team immediately. Sometimes a bout of severe morning sickness can progress to hyperemesis gravidarum if proper medical care is not given.

Morning Sickness vs. Hyperemesis Gravidarum Comparison

Morning Sickness Hyperemesis Gravidarum
You lose very little weight, if any. You lose weight rapidly, over 5 pounds of your pre-pregnancy weight, and up to 30 pounds.
Vomiting or nausea do not interfere to hold down enough food or drink every day. Nausea is constant and ranges from moderate to severe. You vomit everyday and if not treated there may be traces of blood in the vomit.
Dietary changes and some lifestyle changes improve symptoms. You vomit most food and liquid back up and become dehydrated unless you receive medical care.
Symptoms start to disappear by the second trimester, although you may continue queasy throughout your pregnancy. You will hopefully feel better by the middle of the second trimester, but symptoms can persist until childbirth.
You can continue to operate relatively normally, working and taking care of your family. You are unlikely to be able to carry on as normal, unable to work or look after yourself.
You are not likely to be prescribed any medications. You will probably need fluids via an IV and anti-nausea medications.

What Causes It?

The causes have not yet been identified, but several factors may be at play. Through genetic testing, scientists know that genes are a factor. This is because women in the same family tend to have a higher incidence. Nausea and vomiting in pregnancy has also been linked to the hormone HCG (human chorionic gonadotropin) which is emitted by the placenta. Rapidly rising levels of this hormone in the first trimester can upset the mothers natural body balance. Fluctuating levels of thyroid hormones may also be another factor. Doctors think there may be a link between severe nausea, and thyroid disease and pregnancy.

Who Is Likely To Get It?

Hyperemesis gravidarum is relatively rare, occurring in about 0.5 to 2 percent of pregnancies in America. Before the invention of an IV drip for hydration, it was a major cause of maternal death. Fortunately today, the death of a mother is highly rare. If it does occur it is likely to be connected to Wernicke's encephalopathy (damage to the brain due to lack of vitamin B1), Mallory-Weiss tears (gastrointestinal bleeding caused be excess vomiting), esophageal rupture pneumothorax (stomach complications) or acute tubular necrosis (leading to kidney failure).

Hyperemesis gravidarum is more common in non-white women, and those who are expecting a baby under the age of 30 as well as those pregnant with twins. It is also more common in first time moms and obese women.

Women with a history of migraines, motion sickness, pregestational diabetes (diabetes present before pregnancy), hyperthyroidism and gastrointestinal disorders are also at increased risk. It can also occur in tandem with other minor problems such as pregnancy cravings and the presence of a metallic taste in the mouth.

How Is It diagnosed?

Your doctor will perform a physical examination. He will ask you about your symptoms, their frequency and severity. He will also perform some tests to send to a lab to check for signs of dehydration and starvation. Specifically he will want to check for the presence of increased ketones. He will also check the concentration of chemical particles in your urine (known as a urine specific gravity test) and the levels of urea in the blood (if the kidneys are not doing their job, there will be a rise in blood urea nitrogen). It may be noted that your thyroid levels are abnormal, but these usually return to normal after the first trimester. An ultrasound scan should be carried out to check for the possibility of twins or a molar pregnancy. Armed with the results of all these tests a diagnosis should be possible.

How Is It Treated?

If you think you may be experiencing symptoms, contact your healthcare provider immediately for advice. Additionally you can buy a Ketostix at most pharmacies without a prescription. This device tests your urine levels for ketones levels. If you have ketones, the result will be positive which means you are displaying signs of dehydration and starvation. If your healthcare provider is not available, and it is late at night you should ask your partner to take you to the ER. You will need to receive fluids through an IV drip. If you have been vomiting for several weeks you will probably be malnourished and will also need B-vitamins added to your fluid intake. You may also be hooked up to an electrocardiogram test (ECG) to monitor your heart rate. After rehydration the woman is normally given small but frequent amounts of liquid or bland foods. Treatment then focuses on gradually reintroducing normal foods. Symptoms can still reoccur causing the cycle of dehydration to start again. This may mean the woman needs continual care. In such incidences a doctor can order total parenteral nutrition (TPN) for her. TPN involves receiving fluids and nutrition through an IV for 10-12 hours a day, 5 days a week. It can be administered at home which reduces the overall cost of care.


Few manufacturers state that their drugs are safe to use on pregnant women. However if a woman is severely debilitated her doctor may still prescribe anti-nausea medications which have been deemed safe by use over the years. These include the brands Unisom, Compazine and Phenergan. Many doctors will only consider using these older drugs, even though the HER Foundation (Hyperemesis Education & Research) states "they are often found to be less effective than newer medications" such as Reglan, Zofran and Kytril. It is not that these newer drugs are necessarily more dangerous, it is more that not as many studies to their safety have yet been carried out. If for any reason your doctor will not prescribe medication, it is worth seeking a second opinion from a perinatologist or high-risk obstetrician.

To find out more about other pregnancy symptoms, see our guide to hemorrhoids in pregnancy, as well as back pain while pregnant and stretch marks.

Everyday Survival Techniques

Common Nausea Triggers

It is worth avoiding some of the following common triggers:

• Traveling in a car or avoiding any forms of travel motion.
• Toothpaste.
• Bright or blinking lights.
• Odors, in particular artificial scents in cosmetics.
• Any pressure on the tummy.
• Standing or sitting upright for too long.
• Sight or smell of food, even those eating on TV.

Other Tips

• Get plenty of rest and ask others to take over daily tasks for a while.
• If you need to travel somewhere in a car, ask someone else to drive so that you can lie down in the back seat.
• Try eating cold foods and drinks, they tend to have less smell.
• Wear loose clothing and keep your clothes comfortable. See maternity clothes.
• Contact other women online who have experienced hyperemesis gravidarum for emotional support and advice.

Will I Get It Every Time I'm Pregnant?

Unfortunately studies indicate that you are likely to experience it again in future pregnancies if you experienced it in a prior one. In fact there is a 50 percent likelihood. It also seems to occur in similar patterns and severity. If you are planning a pregnancy, do read our Prenatal care guide and our advice on preparing for pregnancy.

RESEARCH: Depression Linked To HG

According to a study published in the Journal of Developmental Origins of Health and Disease (2011), adults may be significantly more likely to suffer effects of depression, anxiety and bipolar disorder if their mother had extreme morning sickness while pregnant with them. In fact American researchers found that the rate of all types of depression were four times more common in such cases. As HG is a relatively under-studied pregnancy complication, scientists are still not clear why this should be. It may possibly be that the fetus's brain is affected if the mother becomes dehydrated and malnourished.

  Related Articles on Hyperemesis Gravidarum

For more pregnancy symptoms and advice, see the following:

Pelvic pain during pregnancy : Read about the signs and treatment.
• Prone to swollen veins? Varicose veins in pregnancy
• Not sure who the father is? Paternity testing
Digestive problems in pregnancy: Constipation, acid reflux and more.
• Are you worried about pregnancy cramps?

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