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Hyperemesis Gravidarum

What is hyperemesis gravidarum?

Most pregnant women have some nausea and sometimes vomiting in the first trimester. This is called morning sickness, as these symptoms are often more severe in the morning. Some women may have nausea and vomiting throughout the pregnancy. The cause of morning sickness may be due to the changes in hormone levels during pregnancy.

A few women develop a severe form of nausea and vomiting of pregnancy called hyperemesis gravidarum. With this condition, nausea and vomiting may be constant, and women often have weight loss, dehydration, and changes in their metabolic state.

What causes hyperemesis gravidarum?

The cause of hyperemesis gravidarum is unknown but may be hormone-related. It is more common in multiple pregnancies (twins or more) and in women with migraines. Women with a family history of hyperemesis gravidarum or who had the condition in a previous pregnancy are much more likely to have it with future pregnancies.

Why is hyperemesis gravidarum a concern?

Hyperemesis gravidarum can lead to fluid and electrolyte imbalances and nutritional deficiencies. Liver damage and jaundice (yellowing of the skin, eyes, and mucous membranes) may occur with severe hyperemesis gravidarum. Thiamine deficiency may occur.  Excessive weight loss and poor nutrition in the mother may affect fetal growth.

What are the symptoms of hyperemesis gravidarum?

The following are the most common symptoms of hyperemesis gravidarum:

  • Constant nausea, especially during the first trimester

  • Vomiting after eating or drinking

  • Vomiting not related to eating

  • Weight loss (especially 5% or more of a woman's weight before pregnancy)

  • Dehydration

The symptoms of hyperemesis gravidarum may look like other medical conditions. Always consult your doctor for a diagnosis.

How is hyperemesis gravidarum diagnosed?

In addition to a complete medical history and physical exam, weight loss and electrolyte imbalances (detected by blood tests) often aid in the diagnosis of hyperemesis gravidarum.

Treatment for hyperemesis gravidarum

The goals of treatment include the following:

  • Reducing nausea and vomiting

  • Replacing fluids and electrolytes

  • Improving nutrition and weight gain

Hospitalization is usually needed for hyperemesis gravidarum. All food and drink are stopped temporarily to give the digestive tract a rest. Intravenous (IV) fluids are almost always needed to replace fluids and correct imbalances in electrolytes. Sedatives and anti-emetic (anti-vomiting) medications are sometimes used. When other treatments do not work, steroids, tube feedings, and total parenteral nutrition (intravenous preparation of nutrients and calories) may be used.