Morning Sickness / Hyperemesis Gravidarum

Most women experience some form of morning sickness (nausea) during pregnancy. This condition is generally harmless, and while morning sickness can be quite uncomfortable, it typically subsides within 12 weeks. Hyperemesis gravidarum (HG) is an extreme form of morning sickness that causes severe nausea and vomiting in pregnancy. While similar, morning sickness and hyperemesis gravidarum are very different conditions, and carry different complications and side effects for pregnant women.

It’s important to distinguish between these two conditions in order to properly treat symptoms.

Morning sickness is characterized by:

  • nausea that is sometimes accompanied by vomiting

  • nausea that subsides after 12 weeks

  • vomiting that does not cause severe dehydration

Hyperemesis gravidarum is characterized by:

  • nausea that does not subside

  • nausea accompanied by severe vomiting

  • vomiting that causes severe dehydration and does not allow you to keep any food down

Morning sickness typically begins in the first month of pregnancy and subsides by the third or fourth month. Pregnant women experience fatigue and slight loss of appetite, and may have some difficulty in performing daily activities. Symptoms of HG begin within the first six weeks of pregnancy, and nausea often does not subside. HG can be extremely debilitating, causing fatigue that lasts for weeks or months. Women with HG may experience a complete loss of appetite and may not be able to work or perform daily activities. If untreated, HG can lead to dehydration and poor weight gain during pregnancy. There is no known way to prevent morning sickness or HG, however there are ways to manage the symptoms.

Causes of hyperemesis Gravidarum

Almost all women experience some degree of morning sickness during their pregnancy. “Morning sickness” is a term used to describe nausea and vomiting during pregnancy. Despite the name, morning sickness is not confined to the morning and can occur at any time. It is believed that the morning sickness and the extreme nausea associated with hyperemesis gravidarum are connected to a hormone created during pregnancy called human chorionic gonadotropin (HCG). HCG is created by the placenta, which feeds the baby during pregnancy. Women’s bodies produce a large amount of this hormone at a rapid rate early in pregnancy—HCG levels typically double every 48 to 72 hours and continue rising throughout the entire pregnancy

Am I at risk?

Some factors that could increase your risk for developing HG during your pregnancy are:

  • having a history of HG

  • being pregnant with more than one baby

  • being overweight

  • being a first-time mother

What are the Symptoms?

HG usually starts during the first trimester or the first 12 weeks of your pregnancy. In about half of HG cases women experience symptoms their entire pregnancy. Some of the most common symptoms of HG are:

  • vomiting more than three or four times per day

  • becoming dehydrated

  • feeling light-headed

  • losing more than 10 lbs. or five percent of your body weight due to vomiting

  • nearly constant nausea

How will I be diagnosed?

Your doctor or midwife will start your diagnosis by asking you about your medical history and the symptoms you’ve been experiencing. Most cases can be diagnosed with a standard physical exam. Your doctor or midwife will be looking for common signs of HG, such as abnormally low blood pressure or a faster-than-normal pulse. Blood and urine samples may also be collected to check for signs of dehydration. Additional tests might be ordered to rule out gastrointestinal problems as a cause of your vomiting.

An ultrasound, which uses sound waves to create an image of the inside of your body, might be performed to find out if you are pregnant with twins.

What are my treatment options?

How your HG is treated depends on the severity of your symptoms. Your doctor may recommend natural nausea-prevention methods such as vitamin B6 or ginger. Try eating smaller, more frequent meals and dry foods (such as crackers), and drink plenty of fluids to stay hydrated. Severe cases may require hospitalization. Pregnant women who are unable to keep fluids or food down due to constant vomiting will need to have them administered intravenously (through the veins). Medication is prescribed in cases in which vomiting poses a threat to the mother or child.