Severe vomiting during pregnancy (hyperemesis gravidarum)

What is hyperemesis gravidarum?

Hyperemesis gravidarum (HD) refers to severe nausea and vomiting experienced during pregnancy. It more severe than morning sickness and makes it difficult to eat and drink enough. Untreated, it can lead to weight loss, malnutrition and dehydration can significantly affect your quality of life.

What are the symptoms of hyperemesis gravidarum?

The main symptoms of HG are severe, persistent nausea and vomiting. It may not improve with simple remedies used for morning sickness, such as over-the-counter medicines.

Some people may also have excessive saliva production.

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How is hyperemesis gravidarum different to morning sickness?

Morning sickness refers to occasional nausea and vomiting experienced during pregnancy throughout the day. During pregnancy, most people experience some level of morning sickness.

With morning sickness, you may experience changes to your appetite and food preferences. Symptoms may come and go and may improve with dietary changes. You can usually still manage to eat and drink enough, and you won't usually lose much weight.

Hyperemesis gravidarum is more severe and persistent. You may struggle to eat and drink enough, resulting in dehydration and weight loss. You may have to take time off work and need help with your daily activities. It can also affect your mood and increase your risk of developing post-traumatic stress disorder (PTSD) after your baby is born.

Both morning sickness and hyperemesis gravidarum usually begin between 4 and 10 weeks of pregnancy, and improve by around 20 weeks, for most people. Some people continue to have symptoms throughout pregnancy.

What causes hyperemesis gravidarum?

The cause of hyperemesis gravidarum isn't clear, but factors that may increase your risk include:

• younger age
• being pregnant with a female baby
• twin or higher order multiple pregnancy
• a family history of HG
• high levels of hCG
• high levels of thyroid hormones
• Helicobacter pylori infection

When should I see my midwife or doctor?

Contact your midwife or doctor if you:

• experience frequent or uncontrollable vomiting
• have ongoing nausea that makes it difficult to eat and drink enough
• you are losing weight

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How is hyperemesis gravidarum diagnosed?

Hyperemesis gravidarum is diagnosed based on your symptoms such as ongoing vomiting and weight loss. Your doctor will ask about your symptoms, perform a physical examination and may refer you for tests to assess your and your baby's wellbeing.

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How is hyperemesis gravidarum treated?

You should receive treatment from a doctor with special expertise in this area. You'll be monitored closely and may need to go to hospital for ongoing care.

There are many dietary and lifestyle measures that can reduce nausea and vomiting. More intensive treatment is usually needed if you suffer from severe vomiting during pregnancy.

Medicines

There are medicines available to treat nausea and vomiting. Your symptoms may not disappear completely, but the aim is for you to manage some food and water during the day without vomiting.

If taking multivitamins make you feel sick, talk to your doctor about stopping pregnancy multivitamins to see if this helps. If possible, try to continue taking a folate supplement.

Hydration

It's important to drink enough fluids to prevent dehydration, though this can be difficult with HG. You can try to sip on a drink containing sugar or electrolytes every 15 minutes. You can also suck on ice blocks or try drinking fizzy water. Some people find very cold or frozen drinks easier to tolerate.

Go to your local emergency department if you can't keep fluids down at all. In the hospital, the staff can give you intravenous (IV) fluids to treat dehydration and replace electrolytes lost during vomiting. It may also help improve nausea and vomiting.

Nutrition

Try to eat small amounts regularly. Eat any food that you can tolerate as long as it's safe in pregnancy. If you have HG, any food you can tolerate is better than no food, even if it's not ‘healthy'.

It may be helpful to see a dietitian for specific nutrition advice. If you have low vitamin levels, they may recommend supplements.

If your symptoms are very severe, your doctor may offer to place a feeding tube, if you're unable to eat enough due to HG. This can cause complications and needs careful monitoring.

Treatment of related conditions

Other treatments may include:

• antacids or other medicines to treat reflux
• laxatives for constipation
• medicines to reduce saliva production

Rinse your mouth out with water after vomiting to protect your teeth from damage from stomach acid. If you can tolerate it, add some baking soda to the water you rinse with to reduce the acidity of your mouth after vomiting.

Living with hyperemesis gravidarum

HG can significantly affect your quality of life and ability to manage daily activities.

Sources of assistance and support may include:

• relatives or friends who may be able to help with day-to-day tasks or prepare meals for your family
• paid services such as cleaners and supermarket delivery
• a social worker
• a psychologist or counsellor for help with depression and anxiety

What are the complications of hyperemesis gravidarum?

Hyperemesis gravidarum can lead to other health problems, such as:

• dehydration or malnutrition
• low vitamin levels and an imbalance of salts or acid in your body
• kidney damage
• a tear in your oesophagus
• reflux
• constipation
• dental erosion

Other possible effects of hyperemesis gravidarum include:

• a higher incidence of depression, anxiety and post-traumatic stress disorder
• breastfeeding difficulties
• relationship problems
• financial problems, if you are unable to work due to HG
• difficulty with daily activities
• reluctance to plan future pregnancies

In severe situations, people may choose to have a termination of pregnancy (abortion), if they have tried intensive treatment without relief.

Can hyperemesis gravidarum affect my baby?

If you have hyperemesis gravidarum, your placenta may not be working as it should. This can affect your baby. Your baby may be more likely to be small and to be born early. It's not clear if your baby has a higher risk of stillbirth.

Can hyperemesis gravidarum be prevented?

There's no sure way to prevent hyperemesis gravidarum.

If you have a history of HG and are planning another pregnancy, it may help to start taking medicine for nausea and vomiting early in the pregnancy — even before you conceive. Ask your doctor whether this is recommended for you.

Resources and support

Talk to your maternity care provider if you experience severe vomiting during pregnancy.

You can also visit Hyperemesis Australia for more information and support.

Perinatal Anxiety & Depression Australia (PANDA) can give you advice and support if you feel that your mental health is affected by HG.