What is hyperemesis gravidarum?

Hyperemesis gravidarum is the most severe form of nausea and vomiting in pregnancy. The condition is rare, affecting about two percent of pregnant women. Nausea and vomiting during pregnancy are common and occur in about 70-80% of pregnant women, usually before 9 weeks of pregnancy. They typically fade away as the first trimester leads into the second trimester. While nausea and vomiting can feel severe during pregnancy, there is a difference between having one bad day of nausea and vomiting and having the more serious (and life-threatening) condition of hyperemesis gravidarum.

Hyperemesis gravidarum is often a medical emergency and requires hospital admission and treatment.  There is no single accepted definition of hyperemesis gravidarum. It is a diagnosis of exclusion, which means you need to exclude other medical conditions that may be associated with hyperemesis first before you make this diagnosis. Women are diagnosed as having hyperemesis gravidarum with the following symptoms:

• significant weight loss (usually around 5% or more of total body weight),
• dehydration (sometimes severe),
• ketones in the urine
• trouble completing normal, daily tasks.

Hyperemesis gravidarum typically lasts until the second trimester of pregnancy, but there are cases where pregnant women suffer throughout the pregnancy.

Take this quiz to see if your nausea and vomiting is severe.

How do you treat severe morning sickness?

If severe nausea and vomiting in pregnancy is a problem that lasts longer than a few weeks, your doctor should be notified of the symptoms and issues. You are usually evaluated for other medical condition which may be associated with nausea and vomiting. Keep track of the foods and drinks you consume during the day and how many times you vomit. Also, note how many times you use the bathroom or have a bowel movement each day. Diarrhea is common during pregnancy and can increase the effect of severe NVP leading to hyperemesis gravidarum.

Medical professionals can offer advice on a proper pregnancy diet for severe morning sickness and prescribe medication to stop nausea. The cause of hyperemesis gravidarum is not known nor is the condition well understood. There are different theories of the etiology of nausea and vomiting in pregnancy which include:

• Hormone stimulus
• Psychologic disposition
• Evolutionary adaptation

In certain cases, treatment will require hospitalization for dehydration and malnutrition.

What are the consequences of hyperemesis gravidarum?

Studies have shown that there is no significantly increased risk of adverse pregnancy outcome in pregnancies with hyperemesis gravidarum. However, there are several studies which showed long-term consequences of hyperemesis gravidarum:

• Abnormal fetal brain development
• Increased incidence of psychological disorders in adulthood

• Increased risk of psychological and behavioral disorders in adulthood

How do you treat severe nausea and vomiting?

1. Treatment for nausea and vomiting begins by preventing it in the first place. Studies have shown that women who took a multivitamin at the time of conception were less likely to need medical treatment. The general recommendation is to start taking a prenatal vitamin at least 3 months prior to conception.
2. Treat nausea and vomiting of pregnancy with vitamin B6 or a combination of vitamin B6 plus doxylamine.
3. Frequent small meals every 1-2 hours to avoid a full stomach are recommended. Avoiding spicy or fatty food, eating bland or dry food is recommended. A small study showed that eating protein instead of fat or carbohydrate may help. 
4. Keep crackers and water next to the bedside to consume before getting out of bed. It is also important not to drink when eating as this can increase nausea. Gentle foods like chicken broth or vegetable broth offer a good source of nutrition and tend to minimize nausea.
5. Ginger can help decrease symptoms.
6. Nausea and vomiting of pregnancy should be treated effectively to prevent progression to hyperemesis gravidarum.
7. Admission to the hospital and intravenous hydration may be necessary for dehydrated pregnant women who cannot tolerate oral liquids.