12232 Hyperemesis Gravidarum

Overview

Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting during pregnancy. It is not just 'morning sickness' – it can make it hard to keep any food or fluids down and can lead to dehydration, weight loss, and poor nutrition.

About 1 in every 100 pregnant women experiences hyperemesis gravidarum. It is much more severe than regular morning sickness and can make daily life very difficult.

It usually affects people in the first few months of pregnancy. Some people are more likely to get it if they have had it before, if they are pregnant with twins or more, or if a close family member (like a mother or sister) has had it.

Symptoms

Common symptoms

• Severe nausea that does not go away
• Repeated vomiting that can happen many times a day
• Being unable to keep food or fluids down
• Weight loss
• Dehydration – signs include dark urine, dry mouth, and feeling very thirsty
• Low blood pressure or feeling dizzy
• Headaches
• Tiredness or weakness
• Feeling faint or lightheaded

Symptoms in children

• This condition only affects pregnant people. If a child is vomiting severely, see a doctor to find the cause – it is not hyperemesis gravidarum.

Symptoms in older adults

• This condition only occurs during pregnancy and does not affect older adults.

Causes

Main causes

• The exact cause is not fully understood.
• Hormonal changes during pregnancy, especially high levels of the pregnancy hormone hCG.
• Genetics – some people are more prone to it.
• Changes in the digestive system and how the stomach empties.

Risk factors

• Previous hyperemesis gravidarum in an earlier pregnancy
• Carrying twins, triplets, or more
• A family history of hyperemesis gravidarum
• A history of motion sickness or migraines
• Being pregnant for the first time

When to see a doctor

See a doctor urgently if:

• You are unable to keep any fluids down for more than 24 hours.
• You notice signs of dehydration like dark urine, dry mouth, or feeling very thirsty.
• You are losing weight.
• You feel faint or dizzy when standing up.

Book a routine appointment if:

• You have nausea and vomiting most days that make it hard to eat or drink.
• You feel sick and are worried about your pregnancy or your own health.
• Your symptoms do not improve with rest and simple diet changes.

Diagnosis

Your doctor or midwife will diagnose hyperemesis gravidarum based on your symptoms, a physical examination, and simple tests. There is no single test for it.

Tests that may be done

• Urine test to check for dehydration and ketones (a sign that your body is using fat for energy)
• Blood test to check your general health and levels of important salts (electrolytes)
• Ultrasound scan if there is any question about the pregnancy, for example to check if you are carrying twins

What to expect at your appointment

Your healthcare provider will ask about your symptoms and how they affect your daily life. They may test your urine and blood to see how dehydrated you are. They will also check your weight and make sure you and your baby are safe.

Treatment

Treatment for hyperemesis gravidarum starts with simple measures like eating small, frequent meals, drinking little and often, and resting. If this is not enough, your doctor or midwife may prescribe anti-sickness medicines that are considered safe in pregnancy. In severe cases, you may need to go to hospital for fluids through a drip and careful monitoring.

Self-care at home

• Eat small, frequent meals rather than large ones.
• Take sips of fluid throughout the day, like water, clear soups, or oral rehydration drinks.
• Avoid strong smells, cooking smells, and greasy or spicy food.
• Rest when you can – tiredness can make nausea worse.
• Talk to your healthcare team early, before symptoms become severe.

Medical treatments

Medical treatment includes prescription medicines to reduce nausea and vomiting (anti-sickness drugs). These are chosen because they are considered safe in pregnancy. If you cannot keep medicines down, they may be given as a suppository or injection. If dehydration is severe, you may be given fluids directly into a vein in hospital. You may also be offered a B vitamin if you have been vomiting for a long time. All treatment options should be discussed with your doctor or midwife.

When is surgery considered?

Surgery is not a treatment for hyperemesis gravidarum. In very rare and severe situations, a doctor may need to discuss the overall safety of the pregnancy, but this is not routine.

Living with this condition

Living with hyperemesis gravidarum can be exhausting and isolating. It can affect your ability to work, care for your family, and enjoy your pregnancy. You may need to take time off and ask for help from family and friends. Remember that this is a medical condition and you deserve support.

Lifestyle tips

• Plan your day around times when you feel less nauseous.
• Open windows to keep fresh air moving.
• Keep plain crackers or dry biscuits by your bed to eat before getting up.
• Rinse your mouth with water after vomiting to protect your teeth.
• Wear loose, comfortable clothing.

Diet and exercise

At first, you may only manage small amounts of bland food like dry biscuits, toast, rice, or bananas. Sips of fluid are better than large glasses. Do not push yourself to eat or exercise if you feel very unwell. When symptoms improve, gradually add more variety and try gentle activity, like walking, if you feel up to it. Always check with your midwife before starting any new exercise during pregnancy.

Mental health and emotional wellbeing

It is completely normal to feel anxious, low, frustrated, or guilty when you have hyperemesis gravidarum. The condition can be very stressful and may make you feel isolated. Please be kind to yourself and talk about how you are feeling. If you have thoughts of harming yourself or your baby, get help immediately – you deserve urgent support.

Prevention

It is not possible to prevent hyperemesis gravidarum completely. But starting treatment early and being closely monitored can reduce the risk of complications. If you have had HG before and are planning another pregnancy, talk to your doctor beforehand – they can help you prepare.

Vaccines

There is no vaccine to prevent hyperemesis gravidarum.

Screening programmes

There is no routine screening test for hyperemesis gravidarum. You will be monitored based on your symptoms and how well you are keeping food and fluids down.

Complications

If left untreated

• Dehydration and low levels of important salts (electrolytes) in the blood
• Weight loss and poor nutrition
• Difficulty carrying out daily activities and work
• Emotional stress, anxiety, and depression
• In severe cases, a higher chance of low birth weight in the baby or preterm birth

Long-term outlook

Most people with hyperemesis gravidarum start to feel better by 16 to 20 weeks of pregnancy, although some continue to have symptoms for longer. With the right care, support, and treatment, most people and their babies do very well. You will not feel like this forever.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.