Nausea and vomiting are common problems during the first trimester of pregnancy. Most pregnant women experience some form of so-called morning sickness.
If nausea and vomiting are severe and long-lasting, you may have hyperemesis gravidarum (HG). It’s a rare but serious pregnancy complication that can lead to dehydration, weight loss, and other problems.
At UPMC, our pregnancy experts take hyperemesis gravidarum seriously. We treat this form of severe pregnancy nausea with medicine and IV fluids. If you are unable to stay hydrated, you may need to be seen in the emergency department.
On this page:
What Is Hyperemesis Gravidarum?
Hyperemesis gravidarum (HG) is a severe pregnancy-related condition that can lead to significant complications if not treated.
Many women have nausea during pregnancy, especially in the first trimester (roughly the first three months). Nausea doesn’t always happen in the morning; it may come and go during the day for weeks before subsiding during the second trimester.
There’s a big difference between morning sickness and HG. If you have HG, you experience relentless vomiting and nausea. It’s hard to keep fluids down, much less food.
If you have morning sickness, you can usually continue daily activities like work and chores. You may have less appetite, but you can still eat and drink some of the time.
With HG, nausea and vomiting are often persistent and affect the ability to continue daily living activities. This extreme, persistent morning sickness can lead to dehydration, weight loss, and mental health problems like depression.
You need special care if you have HG. Some women can receive treatment at home, but others may need IV fluids in the hospital.
What are the types of hyperemesis gravidarum?
There are three levels of severity in HG.
Mild HG
You may still be able to function, but you feel miserable. In mild HG, weight loss is about 5%, and recovery may take a few months or more. You may require medication and IV fluids.
Although mild HG isn’t as intense as moderate to severe HG, it is not the same as ordinary morning sickness.
Moderate HG
You will struggle to function and feel miserable. Your weight loss might be as much as 10%, and symptoms may continue beyond mid-pregnancy. You will need medicine and sometimes IV fluids or nutrition therapy.
Severe HG
You can’t function, are constantly sick, and may lose more than 10% of your body weight. You will need fluids, medication, and nutrition support, sometimes for months. Your recovery can take a month or two for every month you are sick.
How common is hyperemesis gravidarum?
While morning sickness is common, HG is rare. It occurs in only 0.5% to 2% of women during pregnancy. However, many experts believe the number of women with HG is somewhat underestimated.
What causes hyperemesis gravidarum?
Experts don’t always know what causes severe nausea during pregnancy.
For years, some health care professionals believed HG had psychological causes. This is no longer the case. It’s more likely that stress and trauma develop from having HG in the first place.
The most likely cause of HG is hormonal.
Some experts think estrogen levels may contribute to nausea and vomiting during pregnancy. Estrogen levels are highest during the first trimester, when many women experience morning sickness. Those levels decline during the second trimester, which is when morning sickness goes away for most women.
The hormone Growth and Differentiation Factor 15 (GDF15) may cause HG. GDF15 gets made in the placenta very early in pregnancy. Some women with HG have a gene variation that causes them to produce abnormal amounts of this hormone. While this variant may result in HG, we do not test for this.
Hyperemesis gravidarum risk factors
Women in their first trimester — the first three months of pregnancy — are most at risk for developing HG.
Risk factors for HG include:
- Allergies.
- Being pregnant with twins or other multiples.
- Being prone to motion sickness.
- Having a molar pregnancy.
- Having HG in a prior pregnancy.
- Having a family member who had HG.
- High blood pressure.
- A history of menstrual pain.
- Liver or kidney disease.
- Migraine headaches.
- Nausea before your period.
- Sensitivity to oral contraceptives.
- A weight of more than 170 pounds.
Complications of hyperemesis gravidarum
HG can lead to serious complications. They include:
- Abnormal electrolytes.
- Anxiety.
- Dehydration in pregnancy.
- Depression.
- Malnutrition.
- Premature or low-birthweight babies.
- Tears in the wall of the esophagus caused by continual vomiting and dehydration.
- Weight loss.
- Wernicke encephalopathy, a rare and life-threatening neurological condition.
How can I reduce risks of hyperemesis gravidarum?
There is no way to prevent HG.
If you had HG during a previous pregnancy, it’s likely to occur again. It recurs in about 75% of those who have had HG.
Taking good care of yourself before the next pregnancy may ease your symptoms. Patients planning pregnancy should focus on healthy eating, exercise, and getting good sleep. Organize your life and home in such a way as to make your pregnancy easier.
Talk to your medical provider about taking vitamins and anti-nausea medicine before symptoms start. This may decrease the severity of HG.
What Are the Signs and Symptoms of Hyperemesis Gravidarum?
HG symptoms include:
- Constipation.
- Dehydration.
- Electrolyte imbalance.
- Fast heart rate.
- Fatigue.
- Headaches.
- Low blood pressure.
- Not being able to keep fluids down.
- Salivating more than usual.
- Severe, relentless nausea.
- Signs of dehydration, including dark urine, dry skin, lightheadedness, fainting, or weakness.
- Vitamin deficiency.
- Vomiting more than three times a day.
- Weight loss of more than 5% of your pre-pregnancy weight.
Unlike morning sickness, HG can last a short period of time or continue throughout your pregnancy. Symptoms may change as the weeks go by, becoming more severe or less severe at different times.
When should I see a doctor about my hyperemesis gravidarum symptoms?
It’s important to know when to seek care for excessive vomiting during pregnancy. You should call your provider if you have:
- Belly pain.
- Blood in your vomit.
- Dizziness or confusion.
- Inability to keep fluids down for more than 12 hours.
- Severe nausea and vomiting.
- Signs of dehydration, including dark urine, dry skin, lightheadedness, fainting, or weakness.
- Sudden weight loss.
How Do You Diagnose Hyperemesis Gravidarum?
Your obstetrician will ask about your symptoms, paying special attention to the frequency and severity of your nausea and vomiting.
They will perform a physical exam, checking for:
- Low blood pressure.
- Signs of dehydration.
- Weight loss.
Tests to diagnose hyperemesis gravidarum
Your provider may order the following tests to diagnose or rule out HG.
- Blood tests — To measure electrolytes, dehydration, kidney and liver function.
- Ultrasound — To rule out other causes of vomiting. A pregnancy with multiples or a molar pregnancy may cause severe nausea.
- Urine tests — To check your hydration.
Hyperemesis gravidarum outlook
If you get medical help early, the outlook is good for both you and your baby. Left untreated, HG increases the risk of having a premature or low-birthweight baby. Untreated HG also increases the risks of maternal complications.
Once you give birth and your body recovers from bed rest and lack of nutrition, you should recover completely.
How Do You Treat Hyperemesis Gravidarum?
The goal of HG treatment is to alleviate the nausea and vomiting so you and your baby can stay hydrated and nourished.
How to treat HG safely depends on the severity of your symptoms.
At-home remedies
Women with mild HG may find relief through remedies such as bed rest, ginger or peppermint, and acupressure. Motion sickness wristbands that apply continuous pressure to your wrists may also help.
Medicine to treat hyperemesis gravidarum
If nausea and vomiting continue, your provider may prescribe an anti-reflux medicine to help control your symptoms. They may also prescribe anti-nausea medications and Vitamin B6 or doxylamine.
Hospitalization for hyperemesis gravidarum
A hospital stay is necessary if you become severely dehydrated, can’t absorb nutrients, and continue to lose weight. Intravenous therapy can help your body rest and re-hydrate by providing key nutrients to your system.
Is hyperemesis gravidarum treatment right for me?
If you have persistent nausea and vomiting during your pregnancy, you should talk to your medical provider. It may be more than morning sickness, and you could benefit from HG treatment.
How long does it take to recover after treatment for hyperemesis gravidarum?
Your recovery may depend on how serious your HG symptoms were. Some women continue to have symptoms throughout their pregnancies, despite treatment.
After you deliver, you can expect your symptoms of nausea and vomiting to go away. But it may take months to feel completely normal. Your body needs to regain muscle mass and rebuild energy.
Some providers recommend a month or two of recovery for every month you had severe HG symptoms.
Why Choose UPMC for Hyperemesis Gravidarum Care?
UPMC has long been a leader in women’s health care. At UPMC, you can expect:
- Expert care — Our women’s specialties have been nationally ranked by both the U.S. Department of Health and Human Services and U.S. News & World Report. More than 25,000 babies are born at our network hospitals each year.
- Advanced treatments — We pursue new treatments for women. The Magee-Womens Research Institute was the first and largest U.S. research institute devoted exclusively to women’s health and reproductive biology.
- Locations close to home — Our women’s health network includes women’s imaging centers, specialty care offices, outpatient clinics, and hospital-based services. You can find excellent care throughout Pennsylvania and surrounding states.
