Hyperemesis Gravidarum

What is hyperemesis gravidarum?

Many pregnant women have some nausea and sometimes vomiting in the first trimester. This is called morning sickness. Symptoms are often more severe in the morning. But nausea and vomiting with pregnancy can happen at any time of the day. Some women may feel sick throughout the pregnancy.

A few pregnant women have a severe kind of nausea and vomiting called hyperemesis gravidarum [hy-puhr-EM-uh-sis grav-ih-DAHR-um]. With this condition, nausea and vomiting may be all day long. These women often lose weight, and get dehydrated. They may also have changes in the body's chemical processes.

What causes hyperemesis gravidarum?

Healthcare providers don't know what causes hyperemesis gravidarum. It may be related to pregnancy hormones. 

Who is at risk for hyperemesis gravidarum?

The condition is more common in women who are pregnant with twins or more. It’s also more common in women with migraines. Women with a family history of the condition or who had the condition in a past pregnancy are more likely to have it with future pregnancies.

What are the symptoms of hyperemesis gravidarum?

These are the most common symptoms:

• Constant nausea, especially during the first trimester
• Vomiting after eating or drinking
• Vomiting not related to eating
• Weight loss. This especially true if it is 5% or more of what you weighed before pregnancy.
• Signs of dehydration. These include dry mouth, thirst, small amounts of dark urine, and feeling lightheaded.

The symptoms may look like other health conditions. Always see your healthcare provider for a diagnosis.

How is hyperemesis gravidarum diagnosed?

Your healthcare provider will review your health history and do a physical exam. He or she will also look for other signs, such as weight loss and dehydration. Blood tests can check for too little or too much of the body's minerals (electrolytes).

How is hyperemesis gravidarum treated?

Treatment aims to:

• Relieve nausea and vomiting
• Replace fluids and electrolytes
• Improve nutrition and weight gain

You will likely need to stay in the hospital. All food and drink are stopped temporarily. This gives the digestive tract a rest. You will usually need Intravenous (IV) fluids to replace fluids you have lost. The IV fluids also fix problems with minerals (electrolytes) in your body. You may need a sedative and anti-vomiting medicine. If other treatments do not work, you may need steroids or tube feedings.

What are the complications of hyperemesis gravidarum?

The condition can lead to:

• Fluid and electrolyte problems
• Poor nutrition
• Liver damage and yellowing of the skin, eyes, and mucous membranes (jaundice)
• B vitamin (thiamine) deficiency  
• Poor growth of the developing baby

Key points about hyperemesis gravidarum

• The condition is a severe form of nausea and vomiting of pregnancy that affects a small number of women. Nausea and vomiting may be constant. You may lose weight, get dehydrated, and have changes in the body's chemicals (electrolytes).
• The cause may be related to pregnancy hormones. 
• You may need to stay in the hospital for treatment.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.