Hyperemesis Gravidarum: Excessive Vomiting in Pregnancy
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What is Hyperemesis Gravidarum (HG)
70-80% of women experience morning sickness but hyperemesis gravidarum is found in only 1% of pregnancies. HG is s condition characterized by severe and excessive nausea and vomiting, electrolyte imbalances and weight loss. Symptoms usually begin between the 4th and the 6th week of pregnancy and usually improve between the 15th and 20th week.
Women suffering with HG have many episodes of vomiting in one day and constant nausea. Many women with HG tend to experience symptoms or have relapses throughout the entire pregnancy.
What Sets Apart HG from Morning Sickness?
Morning Sickness
| Hyperemesis Gravidarum
|
|---|---|
Nausea and vomiting
| Nausea with SEVERE vomiting
|
Nausea that goes away after 12 weeks or a little after
| Nausea that does not go away
|
Vomiting without dehydration
| Vomiting with severe dehydration
|
Able to keep some food down
| Not able to keep any food down
|
The Nature of HG symptoms
The symptoms of HG usually begin between the 4th and 6th week with the climax between the 9th and 13th weeks. Some women even begin sensing early symptoms (i.e. taste and smell changes, nausea, vomiting and fatigue) a few days after conception. Between approximately the 14th and 20th weeks, there's usually an improvement in symptoms but at least 10-20% of HG patients continue to be nauseous and to vomit. Those 10-20% of women may even vomit up until the delivery of the fetus.
Severe Symptoms:
- Nausea and vomiting at the sight, smell or thought of food
- Motion sickness
- Food intolerance and avoidance (can lead to anorexia)
- Oversensitive gag reflex
- Dizziness / fainting
- Inability to maintain an upright position
- Dehydration
- Pale, waxy, dry (and sometimes jaundice [yellow]) skin
- Hemorrhages in the retina
- Headache
- Confusion
- Lethargy and extreme fatigue
- Excessive salivation
- Constipation
- Sleep disturbance (i.e. insomnia)
- Tearfulness
- Excessive thirst
Secondary symptoms
- Anxiety
- Depression
The Progression of vomiting: first of mucus, then bile and then blood.
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Recognizing HG
You know when normal morning sickness is transitioning to hyperemesis gravidarum when there is rapid wright loss (5% or more of pre-pregnancy weight) and frequent, severe nausea and vomiting.
Risk Factors
Bear in mind that these are not causes of HG. The exact cause of HG is unknown. These are just statistical risk factors:
- More common in first pregnancies
- More common in women with a pre-pregnancy weight of 170 lbs
- Those with multiple pregnancies (e.g. twin pregnancies)
- Those less than 20 years old. Risk may decrease after the age of 35.
- Often occurs in subsequent pregnancies
- Those with a history of miscarriages
- Those with untreated asthma
- Excessive stress (makes the condition worse)
- Those with PTSD
- Those with epilepsy
Hospitalization and Treatment
Women with HG are usually hospitalized at least once over the course of their pregnancy. Sometimes nausea and vomiting is so severe it must be treated with anti-emetic medications. The first line treatment for HG is making sure the affected woman gets plenty of rest and strictly managing small meals (avoiding spicy or fatty foods). It is recommended that women with HG increase their intake of high-protein foods.
At the hospital, HG patients receive intravenous replacement fluids to hydrate the patient and get their electrolytes, vitamin and nutrients back in balance. Some patients require tube feeding until they are able to tolerate eating food and keeping the food down. HG patients must be constantly monitored.
What about the Fetus
Studies have shown no profound effect on the fetus from the mother having HG. However, some medications used to manage HG can affect the fetus. Maternal stress and complications of HG can also affect the fetus, but if the condition is handled well, fetuses are born just as healthy as they would in a normal pregnancy.
Sometimes medical abortion is recommended for patients with HG, but that's only in extremely severe cases. Some mothers who are unable to handle the torment of HG my choose to abort the fetus.
Psychological Component of HG
Depression and anxiety is a secondary symptom of hyperemesis gravidarum. HG doesn't just take a toll on the mother's body but on her emotions, even more so than in normal pregnancies.
At times, hypnosis and psychotherapy is required to "train" the woman with HG not to vomit at the thought of food. Cognition (thought process) is an important factor in the severe nausea and vomiting experienced in HG.
A woman with HG needs a lot of support from her friends and family. Some women require counseling and psychological assistance to cope with HG. I've read stories about women who were so plagued by the constant vomiting and nausea of HG that they developed cued panic attacks when thinking about food. I've even heard stories of women suffering from Post Traumatic Stress Disorder (PTSD) following the pregnancy.
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Tips for those with HG
- Get plenty of rest: will lower your level of stress
- Separate foods and drinks: increases the chances of you keeping your food down
- Make ginger your friend: ginger may help ease nausea and vomiting
- Drink Gatorade (or another similar drink): to keep your electrolytes up
- Tea party: drinking herbal teas such as ginger and peppermint may help ease nausea
- Crackers: keep crackers at the side of the bed to prevent worsening of nausea in the morning
- Small, frequent meals
- Drink milkshakes and smoothies: if you're still having trouble keeping solid foods down
For More information, check out these sites:
- Help HER - Hyperemesis Education Research
- Pregnancy, Hyperemesis Gravidarum: eMedicine Emergency Medicine
Overview: Nausea and vomiting are common in pregnancy, occurring in 70-85% of all gravid women. - Hyperemesis Gravidarum : American Pregnancy Association
Hyperemesis gravidarum is a condition that occurs during pregnancy and is a severe form of morning sickness.
Comments? Questions?Loading...
Oh, hello, marvalous. Nice to see you back. Thanks for your comment. I'm glad it was worth it all (wink, wink).
Thanks Kimberly ... is valuable advice for all the mommies to be who suffer from nausea which is a very real problem. I can identify with this as I am chronically nauseous after a total gastrectomy ... I pity my nausea does not ascribe to 'simple' solutions such as ginger (excellent for seasickness as well and always in our house), crackers and frequent meals.
Aww, I'm sorry about your chronic nausea, Marijana. I hope something works out for you. Thanks for commenting again. I really appreciate it.
You are very informative. I wish you were my nurse or midwife when I was having my babies. Thank God though that I did not suffer from this condition. But my Mom did during the entire SIX month pregnancy that she had when she was pregnant with me.
Thank God we both lived through it,:).
Hello, CM. Thank you for wishing I was your nurse or midwife. You know... I've always wanted to deliver a baby... still do. So, your mother suffered with HG for her entire 6th month? Wow. I can't even imagine... but yes, you both lived through it! Thank God! =)
Thanks for commenting!
My heart goes out to women who suffer from this syndrome. I feel blessed that I didn't throw up even one time during pregnancy.
Thanks for a very informative article. I'm sure many women and their partners will find it helpful. MM
Wow, you didn't throw up even once during pregnancy. You really are Mighty Mom. :D
Thank you for commenting! I'm glad you think others will find my article helpful as well.
As soon as I saw the title of this hub I had to read. My wife suffered form this condition for our first child (we had four). It was horrendous, vomiting every day, many times; and I would add to the list of symptoms 'extremely tense', she would jump at the slightest provocation. She didn't suffer with this for any of the others. Thanks for a very interesting hub
Hello, parrster. Wow, sorry about your wife. I'm glad she didn't suffer with HG for any of your other children though. That's good.
Thanks for reading and commenting!
Thanx for all ur medical advices. My wife is currently in her 6weeks preg and she vomits,loss of appetite and not able to sleep at night.pls what do i do.
Hello Odunlami. At six weeks, insomnia and nausea is very common. If it gets to the point when you feel something is definitely wrong, then I advice that you contact a doctor. Mint tea is a good natural anti-emetic (helps settle a sick stomach). You should definitely contact a doctor.
Congratulations by the way. I wish you two the best of luck.
Hi.. I had HG in my first pregnancy 4 years ago, had given birth to a healthy baby boy.. I was pregnant again last year had HG again this time was worse - had to have an abortion couldnt handle it no more - had gone through depression - weight loss etc.. I want another baby but too scared to get pregnant do not want to go through HG pregnancy again.. is there anything anyone know that can prevent HG from occuring or is it likely for me to have HG again in my 3rd pregnancy ?
Hello, NJ,
I am so sorry to hear about your experience. There is always a chance of HG reoccuring if you had it once before. However, with the advancements in medicine lately, there is a lot you can do. There is also a lot of holistic and natural treatments. You should definitely discuss all the options with your doctor. That is the best answer I can give you. I wish you all the best of luck.
-K. Alto
Thank you so much !! what kind of holistic and natural treatments are there available for HG ? I will surely talk to my GP I did go lately but I didnt know that this severe volmiting is called HG - I was hospitalized last year and was on drips and had keytons in my urine so - Im sure they will know I had HG.
I dont know if any of you were anemic before getting pregnant if being anemic is a cause to HG ? Cuz I am anemic and asthmatic too..
Psychological relaxation techniques and imagery can help, I've heard. Ginger is a natural 'treatment' that my mother highly recommends. She had a bout of HG when she was pregnant with me. Having asthma is apparently a risk factor for HG although it is not ALWAYS the case. Statistics have shown that people with asthma, especially untreated asthma, have a higher risk for HG. I'm not sure about anemia. My mother, however, does have anemia and she did have HG.
I know I'm not being too much of a help but I hope I've helped at least a little. There is a lot of research out there available to the public now. You should look more into it. :)
Hello all,
I really appreciate your advices much, but I m now in my 6th month of pregnancy and still have a very bad nausea till now , kindly advice as it's causing me not to eat properly, no going to work and I m really depressed
Hello Lily,
Have you been to the doctor and discussed it with him or her? That's the best thing you can do. Or even a nutritionist. Ginger is a good natural remedy for nausea along with other things I previously mentioned. I'm sorry about the constant nausea, Lily. I hope you feel better soon so you can enjoy the rest of your pregnancy.
-K. Alto
I also experineced excessive vomiting in my first pregnancy for six months. I had every sympttom that idenitfies HG but was never formely diagnosed. I was on a few prescribed severe anti-nausea medications in additon to a restricted diet. I delivered a happy and healthy baby boy who is now three years old. I swore I would never get pregnant again as it was so traumnatic. I had ovarian torsion and my right ovary was removed two years later via emegergency surgery. I had contmeplated having another child as I always desired a a least two children but felt like I had already gone through enough. I finally convinced my husband as he knew how difficult the 1st pregnancy was for me to try for a second. Everyone told me my second pregnancy would be much better and differnt. They were wrong. I suspected in December 2010 that I was pregnant. At four weeks I beagn to show all signs of being pregnant again. I was dizzy, extremly fatigued, nauseas and light headed. Around the end of the fourth week into the fifth week my senses grew increasingly diffcult to bear with. Every smell and scent gave me a feeling of naseau and I began vomit profusely. I could not even keep crackers or fludis down. I began to vomit bile and had endless sleepness nights crying throughout the night. No medications helped that were prescribed. It progressively got worse to the point I was hospitalized twice to be rehydrated with fluids and medications to decrease the vomitting. I called my docor begging to be helped. The only option was a D&C. It was the hardest decison of my life but both physically and mentally I could not bear the agnony. I feel like I gave up on the pregnancy due to being desperate. I continue to struggle emotionally and physically with my decision and wonder if something could have been done differnt to help me or avoid a D&C. Also, I question how my doctor never dignosed me with HG when I experinecd ever symptom and more.
Maje, I'm so, so, so sorry to hear that. My mother also had a similar experience to yours and she was never diagnosed. It definitely sounds as though that's what you were experiencing but I don't know why you were't diagnosed. Unfortunately a D&C is also an option for HG if it is very severe. I know it had to be a hard decision to make but in some circumstances it really is the only option. If the condition worsened it would be fatal even to your unborn child.
Once again, I am very sorry. I hope that time will heal. Take care.
-K. Alto
i am 14 weeks pregnant and have hg, this is my 3rd time in hospital within 4 weeks
ive been told now im in my 2nd trimester it should ease of!!! Its horrible thing to have
and i cant tolerate water or any kind of food!! Wish you all well and hope we all get
better soon!!! Xxx
Hello Karleigh,
It has been proven that optimism can help in the midst of any illness. I admire you optimism and I hope you get well soon also! :)
-K. Alto
hi thank you so much for this article so insightful i have been through this and it has been the hardest thing i have had to endure!
Many many a nights and days i have felt soooo lonely and sooo misunderstood! i have cried many tears. I have lost 10kgs and have been hospitalised 4 times due to dehydration but guess what at 18 wk and 1 day today is the FIRST day i have not thrown up at all!!!!! i can relate and sympathise with any women/mother to be who has or is going thru HG it is nasty but let us try our best every day and keep our chins up!!
Mikki,
Your optimism is just awesome! I'm happy to hear that today you haven't thrown up at all. You're right, keep your chin up and good luck with the rest of your pregnancy. God bless!
-K. Alto
The first line treatment for Hyperemesis Gravidarum is making sure the affected woman gets plenty of rest and strictly managing small meals.. but is there any medicine which she can take in emergency or some home remedy to stop vomiting immediately or to control them if in case the medical facility is not available.
I suffered from this with my son in 2001. It was the worst any of the doctors had seen in years. I was in the hospital for 3 months because i couldn't keep food down, i couldn't sleep, the worst headaches. After being released I had to carry a 5 pound backpack filled with a liquid that looked like lard that attached to my arm (feeding tube) still have scars from that. This lasted until i was 8 1/2 months..
I have always been scared to have another child due to how sick i was.
My husband is now wanting me to have more kids, but i am so worried that I will go threw this again? Does anybody know if it happens with each pregnancy?
I wouldn't want to wish HG on my worse enemy! I had HG with both of my pregnancies, my first pregnancy I lost 30lbs and had to be hospitalized 2x because of dehydration. When I delivered I weighed 20lbs less than what I did when I became pregnant, but I still had a very healthy 7 lb 4 oz little girl. My second pregnancy was just as bad but since I knew what I had I was able to get medicine in time so I didn't lose as much weight; only 15lbs this time. So my heart goes out to ones that are plagued with this condition, but be strong and find a Dr that understands and you will welcome the best thing that God has ever given you.
how-to-make, yes there are antiemetics that can control vomiting. Sometimes it's given my IV because at time the mother cannot even keep oral medications done. But all medication should be managed in the hospital. In some occurences, medications such as these can be monitored at home, but with a physician's permission.
Hello, Tish!
I'm sorry about your experience. No, it doesn't necessarily happen with each pregnancy. Honestly, it is possible, but there have been women who had healthy pregnancies following an HG pregnancy. Also, now that you've experienced it, you can be sure that your doctors are aware and you can be monitored closely to possibly prevent this, or at least lessen it significantally.
I wish you all the best!
Suzie,
I am also sorry for your experience, and may I say congratulations on the baby. Thank you for your encouraging comment. I hope the others who have posted here will see it. Thank you :)
i had hg with my first pregnacy up till 6 mnths was hospitalised for 8 days it was horrible but as it was my first i didnt no any different i was vomiting constantly and was badly dehydrated but thought threw it and had a healthy baby girl :)when i fellpregnant with my son i had a normal pregnancy,they are 5 and 4 now and in novemeber i fell pregnant with my 3rd child straight away i started vomiting and just felt really ill and spent most of my time in the toilet or in a&e but i didnt have enough keytones in my urine for them to keep me in i didnt understand this as i felt like i was dying! finally the hospital kept me in as i had maxium keytones in my urine,at this point i just wanted it all to end i stayed in hospital for 3 days not feeling any better still vomiting i missed my daughter and son terribly so i made the decition to have a termination.i feel like i made a deal with the devil as it was the worse thing i have done after the termination i felt beter straight away i ate a biscuit and it had stayed down,but then normality kicked in and just what i had done my baby was gone and i felt better i felt like i could do it all again ive had a rest from it but it was too late.it put a lot of pressure on my relationship but thankfully things are a lot better but i still think about having another baby wich i no is selfish but i cnt help but think i could not have hg next time? i wish there was a cure for this as it really is horrible and can ruin peoples lives
Great article and great links to information and books. I had HG with my first two children, worse the first time spent 5 weeks in hospital and vomiting literally only stopped after I gave birth. with me second the vomiting stopped at about 25weeks and i only spent about a week in hospital. I am now terrified because i am just over 5 weeks pregnant with my third and my youngest is only 10months old (lol this one was a bit of an accident!) I am just trying to stay positive and keep everything crossed that i don't suffer with HG again.
I know this is an old article but after reading it I just had to share my story. I had absolutely every symptom mentioned. I noticed a change in my taste buds within 2 weeks of conception when I couldn't drink a can of diet coke. It tasted all wrong. 5 weeks into my pregnancy I had my first hospital stint where I was fortunate enough to have been diagnosed with HG early on in my pregnancy. When the extremes 24/7 nausea and vomitting didn't stop for a moment I was offered an abortion to end my suffering which I refused straight out. I had to stop working 5 weeks into my pregancy it was so bad! I had several hospital stints throughout my entire pregnancy, the last was in my final trimester when I began getting serious anxiety attacks. I was then referred to a psychiatrist when I stopped sleeping, had major panic attacks and became obsessed with walking...at all hours of the night! I could not sit or lie still for more than a few minutes at a time. I was exhausted. Till this day I am so furious that the shrink told me, not asked, that I was suicidal and drew a picture of a cliff on a white board and said the average person suffering depression was standing at the top of the cliff whilst I was beyond that and was lying at the bottom! He wanted to put me into a psych ward when all I wanted was to get some seriously needed sleep. My husband and I refused hospitalisation as I had all the support I needed at home. I flat out denied feeling suicidal as the idea of ending my life and my baby's was shocking beyond words or even contemplation! I said I wanted this baby more than anything and I knew the pregnancy came with an end date with the birth. I was too exhausted to argue with him and accepted the sedating antidepressant drugs they gave me. A few weeks later, with eventual sleep, I ended up having the most amazing healthy 8 3/4 pound boy at the end of it and every painful day was totally worth it! Afterwards I discovered a lot of the anti nausea and hormonal drugs they gave me in my first trimester triggered a chemical imbalance in my brain which had a follow on effect once I stopped taking them later in the pregnancy. I still threw up several times even after giving birth and sadly when I tried to go back to see the shrink to help wean me of the drugs, I conveniently could not get an appointment and ended up weaning myself of them. Yes, I got the baby blues after the birth but luckily I had a ton of support and was very determined to beat it.
I am now expecting again (6th week in) and am surprised at how easy it feels this time around. I haven't thrown up once....yet! I get nauseous but it passes quickly and I get quite fatigued but I can still get out and about with daily activities. So now I am scared that something must be wrong because it feels too good to be true!
marvalousnj 23 months ago
Oh yes I remember those days, but it was worth it all! One thing I did learn during my pregnancy was to eat a little at a time.