Nausea and vomiting are fairly common among pregnant people. For many, it’s one of the first symptoms they experience, sometimes before they even realize they’re pregnant. For others, however, the relentless vomiting becomes so severe that they experience dehydration and begin losing weight. This condition is known as hyperemesis gravidarum.

What is hyperemesis gravidarum?

Hyperemesis gravidarum (HG) is a severe, persistent form of morning sickness that causes extreme nausea and vomiting during pregnancy. It often requires hospitalization. If left untreated, it can become a dangerous issue that results in weight loss, malnutrition, dehydration, and debility and may cause long-term health issues for mother and baby(ies). 

What is the difference between morning sickness and hyperemesis gravidarum?

Morning sickness and hyperemesis gravidarum are not the same. Each condition has different complications and side effects. It’s essential to differentiate between these two issues in order to treat symptoms correctly.

Morning sickness

Morning sickness generally includes nausea that’s occasionally accompanied by vomiting. Despite the name, morning sickness isn’t limited to the morning. It can occur at any time. Nausea is typical in pregnancy with up to 90 percent of people experiencing it. These symptoms often disappear by the beginning of the second trimester, although for some it continues until Week 20 or longer. Morning sickness is often accompanied by a slight loss of appetite and fatigue. It may also make accomplishing regular daily activities more challenging.

Hyperemesis gravidarum

Hyperemesis gravidarum, on the other hand, is far less common, occurring in only about 0.5 to 2 percent of pregnancies. It generally includes persistent nausea and intense vomiting that leads to dehydration. Individuals with hyperemesis gravidarum are unable to keep down any fluids or foods. 

Signs of hyperemesis gravidarum usually begin within the first month and a half after conception. Hyperemesis gravidarum can be severely taxing, causing extreme exhaustion that lasts for weeks or months. For many people, the symptoms are so debilitating that it prevents them from performing regular daily activities or even working. These symptoms can eventually lead to dehydration and failure to gain weight during pregnancy. 

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What are the symptoms of hyperemesis gravidarum?

Hyperemesis gravidarum typically begins early in pregnancy, but the symptoms can come and go. For some individuals, hospitalization is necessary to manage the symptoms at their worst.

Some of the most typical symptoms of hyperemesis gravidarum include:

• persistent, relentless nausea
• intense vomiting
• loss of appetite
• dizziness or feeling faint
• low blood pressure
• decrease in urination
• weight loss greater than 5 percent of your body weight due to nausea or vomiting

What causes hyperemesis gravidarum?

Morning sickness and hyperemesis gravidarum both appear to be linked to human chorionic gonadotropin (hCG), a hormone created during pregnancy by the placenta. Blood levels of hCG and estrogen rise rapidly early in pregnancy. These levels typically plateau right around the end of the first trimester and then decrease. 

What are the risk factors for hyperemesis gravidarum?

Hyperemesis gravidarum is more common in people who are pregnant with multiple babies. It’s also more prevalent in people who get migraines. A family history of the condition or a prior pregnancy accompanied by hyperemesis gravidarum may also make you more likely to develop it. The presence of trophoblastic disease, which involves the abnormal growth of cells inside the uterus, can also trigger hyperemesis gravidarum.

How does a doctor diagnose hyperemesis gravidarum?

Your physician will review your medical history and symptoms. They’ll also examine you for other signs of hyperemesis gravidarum, like a rapid pulse or low blood pressure. They may take urine and blood samples as well to determine whether you’re dehydrated. 

Some physicians will run additional tests to eliminate other issues that could potentially be triggering the vomiting and nausea. Your doctor may also perform an ultrasound to determine whether you’re expecting multiple babies or whether there are any problems. 

What is the treatment for hyperemesis gravidarum?

Treatment for hyperemesis gravidarum depends on how ill you become. Occasionally, early treatment of morning sickness may lower your risk of developing hyperemesis gravidarum. Your healthcare provider may recommend natural nausea prevention methods, like acupressure, ginger, vitamin B6, or eating smaller, more frequent meals and dry foods, such as crackers. 

However, unlike average morning sickness, hyperemesis gravidarum requires medical treatment and, often, hospitalization. Individuals who are unable to keep fluids or food down due to persistent nausea or vomiting will have to receive them intravenously (IV). The most severe cases of hyperemesis gravidarum may require total parenteral nutrition (TPN), a complex, balanced solution of nutrients given through an IV throughout pregnancy. 

Medication may be necessary when vomiting is so severe it puts your health or the health of the baby at risk. Medicines used to prevent nausea include promethazine, meclizine, and droperidol. These medications can be taken in a variety of ways. For instance, promethazine can be taken as an injection, suppository, oral medication, or topical treatment. Some of the medications available to treat severe hyperemesis gravidarum, like methylprednisolone, can cause birth defects. That said, severe dehydration and other complications of hyperemesis gravidarum may be the more serious concern.

* When it comes to medications, it is critical to weigh the risks and the benefits to you and the development of your baby. Discuss the risks and side effects of each drug with your doctor. 

How long does hyperemesis gravidarum last?

Fortunately, the symptoms of hyperemesis gravidarum are significantly reduced after the first trimester and go away completely after childbirth. Effective treatment during pregnancy can help minimize the risk of potential complications for both you and your baby. If you think you might be experiencing this condition, it’s critical to consult with your healthcare provider to receive treatment. To get more information on hyperemesis gravidarum, visit the HER (Hyperemesis Education & Research) Foundation.

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