Hyperemesis Gravidarum

When you’re pregnant, your body goes through a lot of changes, some expected and some not-so expected. It can be challenging to know what’s normal or when it’s time to call a doctor for help.

One such issue is extreme morning sickness, also called hyperemesis gravidarum. Nausea and vomiting are common during pregnancy, especially in the first trimester. However, when nausea and vomiting are intense enough to make eating, drinking and daily activities difficult, you should seek help. You shouldn’t have to just endure the symptoms, which could be serious enough to affect your baby.

The obstetricians and Maternal Fetal Medicine physicians at The Ohio State University Wexner Medical Center in Columbus, Ohio, can help you determine whether your morning sickness is actually hyperemesis gravidarum or something else, and treat it quickly to get you better and back to living your life.

What is hyperemesis gravidarum?

Hyperemesis gravidarum (HG) is an extreme form of vomiting that occurs during the first trimester of pregnancy, but the condition can sometimes last even longer. It affects up to 3% of pregnancies.

Unlike typical morning sickness, HG can cause persistent vomiting, significant weight loss, dehydration and an electrolyte imbalance that may require medical treatment. Having HG means your provider might treat your pregnancy as a high-risk pregnancy and monitor you more closely. Dehydration and weight loss can lead to premature birth or other health issues for your baby, so it’s important to talk to your doctor about your symptoms and have them managed properly.

What causes hyperemesis gravidarum?

There’s no known cause for HG, although it may be genetic and is linked to certain pregnancy hormones. Research shows that higher levels of a hormone called GDF15, which is produced by the fetus and found in maternal blood, is associated with vomiting in pregnancy and HG. Sensitivity to estrogen, as well as to the hormone human chorionic gonadotropin (hCG), which your body produces at its peak in the first trimester, may also contribute to hyperemesis gravidarum.

Some factors can put you at higher risk for developing extreme nausea in pregnancy, including:

• Having HG in a previous pregnancy
• Family history of HG
• Pregnancy with multiples
• History of migraines or motion sickness

What are the symptoms of hyperemesis gravidarum?

The symptoms of HG are similar to typical, pregnancy-related morning sickness. The difference is that the symptoms are significantly more extreme – enough for them to be debilitating and disruptive, sometimes even leading to hospitalization.

The following are common symptoms of hyperemesis gravidarum:

• Severe nausea
• Vomiting multiple times a day
• Inability to keep down food or fluids
• Excess saliva
• Weight loss
• Dehydration and electrolyte imbalances
• Exhaustion
• Difficulty performing daily tasks
• Headaches
• Low blood pressure or increased heart rate

How is hyperemesis gravidarum diagnosed?

You should speak with your provider if your nausea and vomiting seem more extreme than the typical morning sickness associated with pregnancy. A diagnosis of HG will depend on a detailed clinical evaluation, including:

• Review of your symptoms and pregnancy history
• An assessment of your weight and hydration
• Possible blood and urine tests to look for signs of dehydration
• Ruling out other causes of severe vomiting, such as thyroid disorders or gastrointestinal conditions

What treatments are used for hyperemesis gravidarum?

Vomiting in pregnancy isn’t dangerous, but severe vomiting that limits your ability to function and absorb the nutrition you and your baby need should be addressed to avoid any pregnancy complications, such as premature birth or low birth weight.

In some cases, people with HG require hospitalization to receive intravenous (IV) fluids. Your provider will work closely with you to monitor the progression of your symptoms and adjust treatment as needed. The good news is that symptoms of HG usually weaken over the course of pregnancy and disappear completely after your baby’s birth.

At-home symptom management

For mild to moderate cases, your provider may recommend:

• Hydration strategies
• Small, frequent meals or alternative nutrition plans
• Vitamin B6 or other supplements

Medical treatment

For more extreme symptoms, treatment may include:

• Prescription medication to control nausea and vomiting
• IV fluids for rapid rehydration
• Electrolyte replacement
• A feeding tube, if eating orally is impossible
• Hospitalization for continuous monitoring and hydration

With the right care, most people with HG recover and have healthy pregnancies.