Hyperemesis Gravidarum

What is hyperemesis gravidarum?

Hyperemesis gravidarum (HG) is when extreme, persistent nausea and vomiting occur during your pregnancy. It can lead to weight loss and dehydration. Hyperemesis gravidarum is sometimes called severe morning sickness.

What’s the difference between morning sickness and hyperemesis gravidarum?

Morning sickness is extremely common during pregnancy — up to 80% of people report experiencing it. It’s not as severe as hyperemesis gravidarum and doesn’t cause dehydration or weight loss. Morning sickness may cause occasional vomiting and nausea, but you should still be able to keep food and liquids down most of the day. It tends to subside or disappear completely after 12 weeks of pregnancy (the first trimester).

Hyperemesis gravidarum causes you to vomit several times per day. This can eventually lead to weight loss and dehydration. Symptoms of HG often last longer than morning sickness. You might need treatment in a hospital with IV fluids (fluids given intravenously, or through your vein) if you become dehydrated.

How common is hyperemesis gravidarum?

HG is uncommon. It affects less than 3% of pregnant people.

What are the symptoms of hyperemesis gravidarum?

Hyperemesis gravidarum usually occurs during the first trimester of your pregnancy (beginning around six weeks of pregnancy). Symptoms can last weeks, months or up until delivery. They can be debilitating, preventing you from doing your normal activities.

The most common symptoms of hyperemesis gravidarum are:

• Severe nausea.
• Vomiting more than three times per day.
• Losing more than 5% of your pre-pregnancy weight.
• Not being able to keep food or liquids down.
• Dehydration.
• Feeling dizzy or lightheaded.
• Peeing less than normal.
• Extreme tiredness.
• Fainting.
• Headaches.

Other less common symptoms include:

• Low blood pressure.
• Rapid heart rate.
• Dry skin.
• Confusion.
• Jaundice due to liver damage.
• Wernicke-Korsakoff syndrome.

What causes hyperemesis gravidarum?

Experts don’t know for sure what causes hyperemesis gravidarum. However, rising hormone levels are most likely what causes it. Specifically, HCG (human chorionic gonadotropin), which your body makes during pregnancy — very quickly and in large amounts. HCG levels peak around 10 weeks of pregnancy, which is when most people report having the most severe symptoms. Estrogen, another hormone that increases during pregnancy, may also play a role in causing nausea and vomiting.

Who is at risk for hyperemesis gravidarum?

Some people may have a higher likelihood of developing HG. Risk factors for hyperemesis gravidarum include:

• Having HG in a prior pregnancy.
• Having a multiple pregnancy (twins, triplets or more).
• Being pregnant for the first time.
• A biological family history of severe morning sickness or HG.
• History of motion sickness or migraine headaches.
• Having gestational trophoblastic disease (GTD), which involves abnormal cell growth in your uterus.

What are the complications of hyperemesis gravidarum?

Lack of fluid and nutrients (malnourishment) cause the most complications related to HG. When you’re vomiting so frequently, it’s hard for your body to get the vitamins and nutrients it needs. This could lead to complications like preterm birth or low birth weight. You may also have bleeding in your throat or other side effects from excessive vomiting.

How is hyperemesis gravidarum diagnosed?

Your healthcare provider will ask about your symptoms and medical history and perform a physical exam. This includes checking your weight to see if you’ve lost too much weight.

Your provider might order blood and urine tests to check you for dehydration. They may also use ultrasound to see if you’re carrying more than one fetus or have signs of GTD. Your provider may rule out other causes of vomiting such as gastrointestinal illnesses.

How is hyperemesis gravidarum treated?

Treatment depends on the severity of your symptoms. Be sure to discuss all your treatment options with your pregnancy care provider.

For very mild cases, possible treatments could include:

• Lifestyle changes: These changes might include wearing a pressure-point wristband (acupressure bands) or eating ginger chews and drinking ginger tea for nausea.
• Dietary changes: Small, frequent meals (every two hours) of bland, dry food can help with nausea and vomiting. Crackers, toast, white potatoes or rice are good examples. Studies show foods high in fat can contribute to nausea during pregnancy. Your provider may recommend avoiding greasy or spicy foods.
• Anti-nausea medication: Some over-the-counter (OTC) medications can help with nausea. Pyridoxine (vitamin B6) and doxylamine (Unisom®) are the most common. Your provider may suggest an antihistamine like diphenhydramine (Benadryl®) if the first two options don’t work. Don’t take any medications for nausea or vomiting without talking to your provider first. Prescription medication is also an option.
• Avoiding triggers: You may notice certain things make you more nauseated, like specific smells or riding in a car. Try to avoid activities that make you feel this way.

If your vomiting is excessive and you become dehydrated, you might need to stay in the hospital. Some of the treatments for moderate to severe hyperemesis gravidarum include:

• Prescription medication: There are several prescription medications that can relieve nausea and vomiting. Your provider will start with a prescription that combines doxylamine and B6. However, stronger medication may be necessary. The most common prescription medications for nausea and vomiting are promethazine and metoclopramide. Ondansetron is another drug that can help with nausea and vomiting. Some of these medications are available through an IV, injection or rectal suppository if you can’t take them by mouth.
• Intravenous fluids: Your provider will deliver fluids and nutrients to you using an IV in your arm. This could require hospitalization.
• Tube feeding: You’ll get nutrients from a flexible tube that your provider places in your nose or stomach. In most cases, you’ll be hospitalized for treatment.
• Total parenteral intravenous nutrition (TPN): The most severe cases of hyperemesis gravidarum might require that nutrients be given through an IV that bypasses your digestive system completely. This allows your digestive system to heal and not have to work at all.

Be sure to talk to your provider about the risks of taking certain medications for HG during pregnancy.

Can hyperemesis gravidarum go away?

Yes. It’s possible that your symptoms subside after the first trimester. It’s also possible that your symptoms last your entire pregnancy. Many people say their symptoms get less severe as time goes on. The good news is that it almost always goes away after delivery.

Can you prevent hyperemesis gravidarum?

No, you can’t prevent hyperemesis gravidarum. Knowing if you’re at risk is the best thing you can do to prepare yourself.

How does hyperemesis gravidarum affect the fetus?

If your provider is monitoring your pregnancy and you’re receiving treatment, HG usually doesn’t affect the fetus. In rare cases, losing too much weight or being dehydrated can cause your baby to be born at a lower birth weight.

Are there any long-term effects of hyperemesis gravidarum?

Most people have no effects of hyperemesis gravidarum after delivery. While you’re at higher risk for having the condition in subsequent pregnancies, you shouldn’t feel any symptoms once your baby is born. People that receive treatment for HG typically deliver healthy babies.

Is hyperemesis gravidarum a high-risk pregnancy?

Yes, your provider will likely treat your pregnancy as high-risk. This means your provider will monitor your pregnancy closer to ensure there are no complications.

What is the best thing I can do for hyperemesis gravidarum?

The best thing you can do for hyperemesis gravidarum is to get treatment from your provider. Only your provider can treat the severe symptoms of HG like dehydration.

Follow your provider’s advice on other things you can do to help yourself feel better at home. Some possible examples of things you can do include:

• Eating small meals every few hours.
• Eating bland foods. Avoid fatty foods.
• Using a pressure-point wristband, vitamin B6 and/or ginger to help with nausea.
• Avoiding triggers like riding in cars.

When should I see my healthcare provider?

Severe vomiting or being unable to keep food and liquids down isn’t a normal part of pregnancy. It may require medical care. Call your pregnancy care provider right away if you:

• Have nausea that lasts all day and keeps you from eating.
• Vomit three or more times per day for several days.
• Lose weight.
• Feel dizzy, faint or confused.
• Aren’t peeing or if your pee is very dark.

A note from Cleveland Clinic

Hyperemesis gravidarum is extreme morning sickness and causes you to vomit several times per day during pregnancy. In severe cases, it leads to dehydration and may cause premature birth. With treatment, most people can find relief from their symptoms and get the nourishment they need to support their pregnancy. Talk to your healthcare provider if you feel extremely nauseous or vomit several times a day during pregnancy. They can help you feel better and get the nutrients you need.