The majority of all pregnant women experience nausea and sometimes vomiting in the first trimester--a condition often called morning sickness, as these symptoms are often more severe in the morning. Some women may have nausea and vomiting throughout the pregnancy. The cause of morning sickness may be due to the changes in hormone levels during pregnancy.
A smaller percentage of women develop a severe form of nausea and vomiting of pregnancy called hyperemesis gravidarum. With this condition, nausea and vomiting may be constant, and women often have weight loss, dehydration, and changes in their metabolic state.
The cause of hyperemesis gravidarum is unknown but may be hormone-related. It is more common in multiple pregnancies (twins or more) and in women with migraines. Women with a family history of hyperemesis gravidarum or who had the condition in a previous pregnancy are much more likely to have it with future pregnancies.
Hyperemesis gravidarum can lead to fluid and electrolyte imbalances and nutritional deficiencies. Liver damage and jaundice (yellowing of the skin, eyes, and mucous membranes) may occur with severe hyperemesis gravidarum. Thiamine deficiency may occur. Excessive weight loss and poor nutrition in the mother may affect fetal growth.
The following are the most common symptoms of hyperemesis gravidarum. However, each woman may experience symptoms differently. Symptoms may include:
Constant nausea, especially during the first trimester
Vomiting after eating or drinking
Vomiting not related to eating
Weight loss (especially 5% or more of a woman's weight before pregnancy)
The symptoms of hyperemesis gravidarum may resemble other medical conditions. Always consult your doctor for a diagnosis.
In addition to a complete medical history and physical examination, weight loss and electrolyte imbalances (detected by blood tests) often aid in the diagnosis of hyperemesis gravidarum.
Specific treatment for hyperemesis gravidarum will be determined by your doctor based on:
Your pregnancy, overall health, and medical history
Extent of the condition
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
The goals of treatment include the following:
Reducing nausea and vomiting
Replacing fluids and electrolytes
Improving nutrition and weight gain
Hospitalization is usually needed for hyperemesis gravidarum. All food and drink are stopped temporarily to give the digestive tract a rest. Intravenous (IV) fluids are almost always needed to replace fluids and correct imbalances in electrolytes. Sedatives and anti-emetic (anti-vomiting) medications are sometimes used. When other treatments do not work, steroids, tube feedings, and total parenteral nutrition (intravenous preparation of nutrients and calories) may be used.