Hyperemesis Gravidarum: Causes, Symptoms & Treatment

Hyperemesis gravidarum is the medical term used for severe nausea and vomiting (morning sickness) during the time of pregnancy. The symptoms can be very uncomfortable. You might vomit more than three times a day, become dehydrated, feel constantly dizzy and lightheaded and also lose weight.

It’s a common thing to experience morning sickness (nausea) during the time of pregnancy. This is generally harmless. While morning sickness can be quite uncomfortable, it typically goes away within 12 weeks.

While a severe state of morning sickness is known as hyperemesis gravidarum. It is a rare condition, which only occur in about 0.5 to 2 percent of all pregnancies. It typically includes nausea that doesn’t go away and severe vomiting that can leads to dehydration. This will not allow you to keep any food or fluids down in your body.

Signs and symptoms typically start within the first 6 weeks of pregnancy. It can be extremely debilitating and cause fatigue that lasts for weeks or months. Those with HG may not be able to work or perform their day to day normal activities.

Symptoms of hyperemesis gravidarum

The most common symptoms of HG include:

• Vomiting more than three times per day.
• Severe nausea.
• Dehydration.
• Losing more than 5% of your pre-pregnancy weight.
• Not being able to keep food or liquids down.
• Feeling dizzy or lightheaded.
• Peeing less than normal.
• Extreme tiredness.
• Headaches.
• Fainting.

Less common symptoms of HG include:

• Dry skin.
• Low blood pressure.
• Confusion.
• Rapid heart rate.
• Wernicke-Korsakoff syndrome.
• Jaundice due to liver damage.

Causes of hyperemesis gravidarum

The causes of severe morning sickness is not fully understood. Research suggest rising hormone levels are most likely what causes it. Specifically:

• Human chorionic gonadotropin (HCG). Which your body makes during pregnancy very quickly and in large amounts. HCG levels peak around 10 weeks of pregnancy, which is when most people report having the most severe symptoms.
• Estrogen. Another hormone that increases during pregnancy, may also play a role in causing nausea and vomiting.

Every pregnant woman experience some degree of morning sickness each. Morning sickness is nausea and vomiting during pregnancy. Despite the name, it isn’t confined to the morning only. It can occur at any range of time. While hyperemesis gravidarum (severe morning sickness) is rare.

You can also read about symptoms and causes of Oligohydramnios (amniotic fluid deficiency)

Risk factors of hyperemesis gravidarum

Pregnant women that are more likely to experience this condition include:

• Those having HG in a prior pregnancy
• Those having a multiple pregnancy
• Those with first time pregnancy
• Those having gestational trophoblastic disease
• Those with family history of HG
• Those pregnant with a female child

Complications of hyperemesis gravidarum

Some of the complications of severe nausea and vomiting may include:

• Lack of bodily fluids (dehydration).
• It also may lead to an electrolytes imbalance, the salts in blood that control the balance of fluids in the body.
• Severe nausea and vomiting may result in less urine output.
• This could lead to complications like preterm birth or low birth weight.
• You may also have bleeding in your throat or other side effects from excessive vomiting.

You can also read about risk factors and complications of preeclampsia

Prevention of hyperemesis gravidarum

There’s no any known ways to prevent this condition. But taking a daily vitamin supplement before and during pregnancy might help and knowing if you’re at risk is the best thing you can do to prepare yourself.

Diagnosis of hyperemesis gravidarum

A healthcare provider will perform a standard physical exam to diagnose most cases of severe morning sickness. Your provider will ask about your medical history and symptoms. He or she will look for common signs of HG, such as abnormally low blood pressure or a fast pulse.

Other additional tests may include:

• Blood and urine samples. This may also be necessary to check for signs of dehydration.
• Ultrasound. This might be necessary to find out whether you’re pregnant with twins or whether there’s are any problems. This test uses sound waves to create an image of the inside of your body.

You can also read about Prevention and diagnosis of ectopic pregnancy

Treatment of hyperemesis gravidarum

The treatment of HG depends on the severity of your symptoms. You can discuss with your doctor which treatment plan is best for you.

Some of the treatment of severe morning sickness include:

• Dietary changes. Small, frequent meals (every two hours) of bland, dry food can help with nausea and vomiting. Crackers, toast, white potatoes or rice are good examples. Studies show foods high in fat can contribute to nausea during pregnancy. Your provider may recommend avoiding greasy or spicy foods.
• Lifestyle changes. These changes might include wearing a pressure-point wristband (acupressure bands) or eating ginger chews and drinking ginger tea for nausea.
• Anti-nausea medication. Some over-the-counter (OTC) medications can help with nausea. Pyridoxine (vitamin B6) and doxylamine (Unisom) are the most common. Your provider may suggest an antihistamine like diphenhydramine (Benadryl) if the first two options don’t work. Don’t take any medications for nausea or vomiting without talking to your provider first. Prescription medication is also an option.
• Avoiding triggers. You may notice certain things make you more nauseated, like specific smells or riding in a car. Try to avoid activities that make you feel this way.

Your healthcare provider will recommend staying in the hospital if your vomiting is excessive and you look dehydrated.

Treatment from moderate to severe hyperemesis gravidarum may include:

• Prescription medication. There are several prescription medications that can relieve nausea and vomiting. Your provider will start with a prescription that combines doxylamine and B6. However, stronger medication may be necessary. The most common prescription medications for nausea and vomiting are promethazine and metoclopramide. Ondansetron is another drug that can help with nausea and vomiting. Some of these medications are available through an IV, injection or rectal suppository if you can’t take them by mouth.
• Intravenous fluids. Your healthcare provider will deliver fluids and nutrients to you using an IV in your arm. This could require hospitalization.
• Tube feeding. You’ll get nutrients from a flexible tube that your provider places in your nose or stomach. In most cases, you’ll be hospitalized for treatment.
• Total parenteral intravenous nutrition (TPN). The most severe cases of hyperemesis gravidarum might require that nutrients be given through an IV that bypasses your digestive system completely. This allows your digestive system to heal and not have to work at all.

You should ask your provider about any side effects of medication or risks involved during your treatment. The symptoms of HG will disappear before or after delivery depending on the time of pregnancy and treatment method.

Note: Treating severe morning sickness during pregnancy can help reduce the risk of having complications and your baby.

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