Hyperemesis gravidarum

Overview

Hyperemesis gravidarum is an extreme form of nausea and vomiting during pregnancy that is much worse than typical morning sickness. It can cause dehydration, weight loss, and severe discomfort, and often requires medical treatment.

It is not very common — it affects roughly 1–3% of pregnancies. But it is a serious condition that needs medical attention.

It affects pregnant women, especially those in their first trimester. Women who have had it in a previous pregnancy, are pregnant with multiples (twins, triplets), or have a family history of the condition are more likely to experience it.

Symptoms

Common symptoms

• Constant, severe nausea that does not ease with rest or home remedies
• Vomiting many times a day, often unable to keep any food or fluids down
• Significant weight loss (more than 5% of pre-pregnancy body weight)
• Feeling lightheaded, dizzy, or faint
• Severe tiredness or weakness
• Dehydration — signs include dark urine, dry mouth, and extreme thirst
• Loss of appetite or aversion to certain smells or foods

Symptoms in children

• Hyperemesis gravidarum does not affect children; it only occurs during pregnancy.

Symptoms in older adults

• Hyperemesis gravidarum only occurs during pregnancy, so older adults are not affected.

Causes

Main causes

• Rapidly rising hormone levels during early pregnancy, especially human chorionic gonadotropin (hCG) and estrogen.
• A sensitive stomach or digestive system that overreacts to pregnancy hormones.
• Genetic factors — having a mother or sister with hyperemesis gravidarum increases your risk.

Risk factors

• Past history of hyperemesis gravidarum in a previous pregnancy.
• Being pregnant with more than one baby (twins, triplets).
• Family history of the condition.
• History of motion sickness or migraine headaches.
• Having a molar pregnancy (a rare abnormal growth in the uterus).

When to see a doctor

See a doctor urgently if:

• You cannot keep down any fluids for more than 12 hours.
• You have lost a lot of weight without trying.
• You feel very dizzy, faint, or confused.
• You have severe abdominal pain or vomit blood.

Book a routine appointment if:

• You have nausea and vomiting that interferes with your daily life, even if mild.
• You are worried about your symptoms or your baby's health.
• You have tried home remedies but they are not helping.

Diagnosis

A healthcare provider will diagnose hyperemesis gravidarum based on your symptoms, a physical exam, and tests to rule out other causes. They will ask about your vomiting, weight loss, and how much you can eat and drink.

Tests that may be done

• Urine test to check for ketones (a sign of dehydration and starvation).
• Blood tests to measure electrolyte levels and check for nutritional deficiencies.
• Ultrasound to confirm the pregnancy and check for multiple babies or molar pregnancy.

What to expect at your appointment

Your doctor will explain your condition and work with you to create a treatment plan. They may ask you to monitor your weight and the amount you can drink. You may need follow-up visits to track your progress.

Treatment

Treatment for hyperemesis gravidarum focuses on relieving symptoms, preventing dehydration, and supporting nutrition. The plan depends on how severe your case is. Mild to moderate cases may be managed at home, while severe cases often require hospital care.

Self-care at home

• Rest as much as possible — fatigue can make nausea worse.
• Eat small, frequent meals instead of large ones, focusing on bland foods like crackers, toast, or rice.
• Avoid strong smells, spicy foods, and greasy dishes that may trigger vomiting.
• Stay hydrated by sipping fluids slowly throughout the day, such as water, clear broth, or ice chips.
• Try ginger or peppermint tea (check with your doctor first) to soothe the stomach.
• Ask your doctor about acupressure wristbands or other non-drug options.

Medical treatments

If home remedies are not enough, your doctor may prescribe anti-nausea medications that are safe to use in pregnancy. These include vitamin B6 combined with doxylamine (an antihistamine) or other prescription antiemetics. If dehydration is severe, you may need intravenous (IV) fluids and electrolytes in a hospital. In rare cases, a feeding tube may be necessary.

When is surgery considered?

Surgery is not a treatment for hyperemesis gravidarum. In very rare, extreme cases where the mother's life is at risk, termination of pregnancy may be considered, but this is a last resort and not a routine option.

Living with this condition

Living with hyperemesis gravidarum can be exhausting, but small changes can help. Plan your day around times you feel less sick. Accept help from family and friends for household tasks. Keep a sick-day kit with crackers, water, and a cool cloth nearby.

Lifestyle tips

• Get plenty of rest and sleep — your body needs energy to cope.
• Avoid triggers like strong food smells, perfumes, or stuffy rooms.
• Stay cool — heat can worsen nausea.
• Talk to your employer about flexible work arrangements if needed.
• Practice gentle relaxation techniques like deep breathing or meditation.

Diet and exercise

Eat whatever you can keep down, even if it is not perfectly balanced. Focus on bland, easy-to-digest foods. Sip fluids between meals rather than with them. Avoid vigorous exercise, but gentle walks or stretching may help if you feel up to it. Always check with your doctor before starting any new activity.

Mental health and emotional wellbeing

Hyperemesis gravidarum can be emotionally draining. You may feel isolated, anxious, or depressed. It is important to talk to your healthcare provider about your feelings. They can refer you to a counsellor or support group. If you have thoughts of harming yourself or your baby, call emergency services immediately.

Prevention

There is no sure way to prevent hyperemesis gravidarum. However, if you had it before, you can talk to your doctor about starting treatments early in your next pregnancy to reduce the severity. Taking prenatal vitamins before pregnancy may also help.

Vaccines

Vaccines do not prevent hyperemesis gravidarum.

Screening programmes

There is no routine screening test for hyperemesis gravidarum. But if you have risk factors, your doctor may monitor your symptoms more closely during early pregnancy.

Complications

If left untreated

• Severe dehydration and electrolyte imbalances
• Nutritional deficiencies that can affect your health and your baby's development
• Weight loss and muscle wasting
• Vitamin B1 (thiamine) deficiency, which can lead to neurological problems like Wernicke's encephalopathy
• Increased risk of depression or anxiety
• Low birth weight or preterm birth in severe cases

Long-term outlook

With prompt and appropriate treatment, most women with hyperemesis gravidarum recover completely and have healthy babies. The condition usually improves by the second trimester, although some women continue to have symptoms throughout pregnancy. Your healthcare team will support you to manage the condition and protect both your health and your baby's.

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