What is Hyperemesis Gravidarum ? Morning sickness is frequent experienced early in their pregnancy by the majority of women. This, though unpleasant and uncomfortable, is generally harmless to both mother and baby and normally goes away within 12 weeks. Hyperemesis gravidarum is something much more serious. It’s as different from ordinary morning sickness as an avalanche from a few fluttering flakes of snow. This condition is relatively rare, since it affects fewer than 3% of pregnant women.

In this IVI article we explain why this is a serious condition. We will look at some commonly asked questions:

• What is hyperemesis gravidarum?
• What causes hyperemesis gravidarum?
• At what point in pregnancy does hyperemesis gravidarum begin?
• How can it be treated?
• When can you expect it to end?

What is hyperemesis gravidarum?

Often described as a very severe form of morning sickness, hyperemesis gravidarum is exactly that. However, unless you are, or know, someone who has it, it’s difficult to imagine how much more severe it is. Normal morning sickness generally includes nausea, sometimes with vomiting. Although unpleasant, the vomiting does not cause severe dehydration. These and other symptoms, such as tiredness and slight loss of appetite, normally disappear after around 12 weeks.

Hyperemesis gravidarum involves severe and persistent nausea leading to a complete loss of appetite. This can be extremely debilitating and can mean that the patient is unable to go about her day-to-day activities. Vomiting can be so severe that it is impossible to keep any food or fluids down. This can result in severe dehydration and loss of around 5% of body weight. Other symptoms and complications can include:

• Kidneys not working well, so that you do not urinate as often as normal.
• Loss of minerals, including sodium and potassium, which can cause dizziness, weakness and blood pressure changes.
• Muscle weakness caused by malnutrition and sometimes exacerbated by the need for bed rest.
• Abnormally high saliva production, which when swallowed can aggravate the existing nausea.

It is essential to get medical help to manage this condition and its symptoms. Otherwise, there is an increased possibility of premature birth and a low birth weight, both of which can trigger health problems for the child.

What causes it?

Exact causes of this condition are unknown, although experts generally agree that it is to do with a reaction to changing hormones during pregnancy. There is also some evidence that it tends to run in families. However, if your mother, sister or aunt has had hyperemesis gravidarum during pregnancy, your risk increases. You are also more likely to experience the condition if you have had it before, and so this knowledge could help you to plan of your next pregnancy.

When does hyperemesis gravidarum begin?

The severe sickness associated with this condition usually sets in between the fourth and sixth week of pregnancy. It can gradually worsen and reach its most debilitating at around weeks 9 to 13. For many sufferers, symptoms can decline and disappear by about the twentieth week of pregnancy. However, this is not always the case and so it’s always advisable to seek medical help before this point.

For a diagnosis, your doctor will ask about your symptoms and medical history, and will carry out a standard physical examination. They will be looking for the most common signs of hyperemesis gravidarum like a fast pulse or abnormally low blood pressure. Usually, these measures are enough to confirm a diagnosis. It could also be necessary to investigate whether you are dehydrated. Other tests may be needed to rule out any other cause of the symptoms, such as gastrointestinal problems. The condition seems to be more common for women who are pregnant with twins, and so an ultrasound scan could be required.

What treatment is suitable for hyperemesis gravidarum?

There is no sure cure or one-size-fits-all treatment; what your doctor recommends will depend on your individual circumstances and how severe your symptoms are. Your medical adviser could start by trying natural methods of nausea prevention, such as ginger, pyridoxine (vitamin B6) or thiamine (vitamin B1). These may ease nausea. You can also try, if it’s possible to keep anything down, eating very small and frequent meals and drinking as much liquid as possible. If your symptoms are very severe and you can’t keep food down, hospitalization could be required so that you can get some liquids and nourishment intravenously.

Bear in mind that dehydration is the most problematic issue for you, and although it can make you feel very ill, it is unlikely to harm your baby. Therefore getting treatment is essential, because if it results in weight loss during pregnancy, there is an elevated risk of a low birth weight.

When does the condition end?

Once your symptoms are under control and you are not vomiting so much and can hold down food, treatment can stop. For most sufferers, symptoms subside at around week 20 of the pregnancy and you can look forward to the birth of a healthy baby. In any case your symptoms will disappear after the birth. In the meantime, it’s important not to suffer in silence. Talk to your doctor, and get family and friends’ help to locate a pregnancy support group in your locality, whether it’s an online forum or physical meeting. You’ll probably find it a relief to know that you’re not alone and that other people have had similar experiences and come out the other side.

If you feel any worrying symptom from the beginning of your pregnancy, you can get in touch with IVI through our online contact form. Nine out of 10 patients reach their goal of starting or extending their own family. We can probably help you reach your goals too.