Beyond Morning Sickness: Hyperemesis Gravidarum
by Pregnancy.org Staff
Most women experience nausea and vomiting during pregnancy, but for a few unfortunate souls, it becomes an uncontrollable monster that dictates their lives. This condition, hyperemesis gravidarum, typically begins early in the first trimester, extends into second trimester and may last the entire pregnancy. HG can make you feel like all the joy of your pregnancy is literally going down the toilet. Hang in there, there's help!
"My friends don't understand how awful this condition is. They dismiss it by reminding me that most women have morning sickness during pregnancy. Hyperemesis isn't simply morning sickness. It's like constant food poisoning -- for months." ~Melissa, Utah
What is Hyperemesis Gravidarum
Hyperemesis gravidarum is a severe form of unrelenting nausea and vomiting in pregnancy. It results in weight loss, dehydration and sometimes electrolyte disturbance. Severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line.
Hyperemesis gravidarum's exact cause isn't known. Recent research strongly suggests a genetic link. Three times as many women suffer from HG is their mother was diagnosed during one of her pregnancies. Other risk factors include:
- Hyperemesis gravidarum during a previous pregnancy
- Being overweight
- Having a multiple pregnancy
- Being a first-time mother
The table below illustrates the differences between normal morning sickness and HG:
| Morning Sickness | Hyperemsis Gravidarum |
|---|---|
| You don't lose much weight | You lose more than 5% of your prepregnancy weight |
| You're able to eat and drink enough each day | Because of nausea and vomiting you're able to eat very little and get dehydrated |
| You don't vomit often and your nausea seems linked to triggers | you vomit often and vomit blood or bile if not treated. Nausea is moderate to severe and constant |
| You improve after the first trimester although you might be a little queasy at times later in pregnancy | You usually feel better by mid-pregnancy, but might continue to be nauseous or vomit throughout pregnancy |
| You're able to continue working and caring for your family | You are probably unable to work and might need help caring for yourself |
"I was so sick from 6-15 weeks. I started pregnancy at 140 pounds and dropped to around 130 pounds in my first trimester. I was on Diclectin and it barely helped. I lived on ginger-ale and bread. I was so happy the first time I could eat rice and soup I cried. But now, in my third trimester, I've gained what I should and I'm right on track. There's still a few foods I have to avoid or risk puking, but overall, it is much, much better." ~CharleneDokter
Diagnosis
Diagnosis is usually made by measuring your weight loss, checking for ketones, and assessing your overall health. If you meet the criteria and you're having difficulty performing daily activities, you and your caregiver can brainstorm together to find an effective treatment.
Most past myths surrounding HG have been debunked but a few still prevail. Often women are undertreated and left feeling stigmatized by a provider who assumes it's a psychosomatic disorder and vomiting is a symbolic way of getting rid of your pregnancy.
We know that dynamic care early in pregnancy can prevent life-threatening complications. Many new medications seem to be more effective and don't appear to endanger your baby. Balancing the risks of potential complications and misery with the risks of effective anti-nausea medication continues to challenge providers. Effective medications might be postponed until more conservative measures fail, however, the delay in treatment might make your vomiting more difficult to control.
Treating Hyperemesis Gravidarum
The type of treatment required depends on how ill you are. Your plan to prevent nausea and vomiting might include:
