Pregnancy can be a joyous time. There is excitement, curiosity, wonder, and love. But pregnancy brings a host of symptoms, challenges, and changes.
Feeling bloated, nausea, food aversions, sleep difficulties, hormonal shifts, and physical changes are just a few of the many changes that pregnancy brings. No two pregnancies are the same, just as pregnancy symptoms will vary from person to person.
Morning sickness, also known as pregnancy sickness, is the most common pregnancy symptom. Pregnancy sickness is described as a combination of nausea and vomiting. It is estimated about 80% of those who are pregnant experience some morning sickness. Pregnancy sickness is most common during the first trimester, and many find relief once they enter the second trimester (13-28 weeks).
Some pregnant individuals report severe nausea and vomiting that presents more frequently and intensely than typical morning sickness. If you fall into this category, you may suffer from Hyperemesis Gravidarum. The severity can be so intense that individuals report not being able to leave the bathroom or end up in the hospital.
So, how do you know if your symptoms are more than typical pregnancy sickness, and when do the symptoms warrant further evaluation?
What Is Hyperemesis Gravidarum?
With pregnancy sickness being such a common experience, it can be tricky for some providers and patients to recognize that what they are experiencing is Hyperemesis Gravidarum (HG) and not the typical bout of nausea and vomiting.
Hyperemesis Gravidarum is described as “Extreme, persistent nausea and vomiting occurring during pregnancy.” The Cleveland Clinic reports that HG “Can lead to weight loss and dehydration” and that vomiting can occur several times a day.
While it is normal to have nausea, vomiting, and food aversion during pregnancy, distinguishing the difference between morning sickness and Hyperemesis Gravidarum is important.
With typical pregnancy sickness, pregnant individuals can usually keep some food and liquid down. This is more challenging if experiencing Hyperemesis Gravidarum. The Cleveland Clinic reports that “If you lose more than 5% of your pre-pregnancy weight, you may have HG.” For many, this nausea and vomiting lingers past the first trimester and is a constant feeling. Without treatment, some may experience symptoms until the baby is born.
Hyperemesis Gravidarum affects about 3% of pregnancies. Dr. Marlena Schoenber Fejzo, Associate Faculty Researcher at UCLA and USC, has reported about 100,000 women per year suffer from Hyperemesis Gravidarum in the US annually, and HG accounts for over 167,000 ER visits per year.
Hyperemesis Gravidarum Symptoms
It is important to note that if you are pregnant, you should meet with your doctor regularly to discuss any symptoms or concerns. Discuss any treatments or medications you are considering before taking them. If you think you may be experiencing Hyperemesis Gravidarum, be sure to share your concerns with your provider.
The FDA warns, “If you are pregnant and have severe nausea (for example, you are unable to drink for more than 8 hours or eat for more than 24 hours), seek medical care immediately.”
Symptoms of Hyperemesis Gravidarum include:
- Severe, persistent nausea and vomiting more than three times a day.
- Salivating more than normal.
- Weight loss
- Dehydration
- Not being able to keep food or liquids down
- Constipation
- Headaches
- Feeling dizzy or lightheaded
- Fainting
- Extreme tiredness
As shared by Shara Lessley in an article on NBC News, “If my husband rolled over during his sleep or even adjusted a blanket, I felt like a Dory in plunging waves.”
Actor Amy Schumer, who shared her experience with Hyperemesis Gravidarum, reported, “I threw up violently and felt sick mostly every day of my pregnancy. Hyperemesis is real and it’s awful.”
Dr. Marlena Schoenber Fejzo shared her experience with HG, stating, “Every living moment was torture.”
Hyperemesis Gravidarum Risk Factors
Research indicates that Hyperemesis Gravidarum may be caused by a hormone produced by the fetus/placenta known as GDF15. The severity of the sickness can be caused by the women’s sensitivity to this hormone.
Research has shown that “HG can happen in any pregnancy, but is a little more likely if you are pregnant with twins or multiple babies, or if you have a hydatidiform mole (molar pregnancy).
The Cleveland Clinic outlines additional risk factors of experiencing HG in a prior pregnancy, being pregnant for the first time, and having a history of motion sickness or migraines. They also highlight that if a pregnant person has a biological family history of severe morning sickness or Hyperemesis Gravidarum or has gestational trophoblastic disease (GTD), it can also increase risk. GTD is a rare condition that includes a group of rare tumors growing in the uterus from placental tissue.
According to the FDA, you may also be at higher risk if you weigh more than 170 pounds (77 kilograms) or have a history of menstrual pain, sensitivity to oral contraceptives, nausea before your period, allergies, high blood pressure, or kidney or liver disease.
Those who experience Hyperemesis Gravidarum have a higher risk of experiencing mental and emotional distress. The exhaustion and fatigue, lack of sleep, and dehydration can all have a significant impact on one’s mental health.
There are also social challenges, as individuals experiencing HG often have difficulty leaving the house or gathering for social situations due to their symptoms. Going to work, household tasks, and caring for children can also prove to be difficult.
According to COPE, “Research has found that having severe morning sickness increases the risk of depression both during and after pregnancy.” They highlight one study that found 50% of women experiencing Hyperemesis Gravidarum experienced antenatal depression, and 30% of women experiencing HG in pregnancy experienced postnatal depression.
Hyperemesis Gravidarum Treatment
While there is no known cure for Hyperemesis Gravidarum, just as there is no known specific cause of HG, treatments may help relieve symptoms. According to the FDA, there are currently no medications approved by the FDA to treat Hyperemesis Gravidarum.
Medications reported by The Cleveland Clinic may include Pyridoxine (Virtami B6), Doxylamine (Unisom) or an antihistamine such as Benadryl. Always consult with your doctor before taking a medication and to confirm what medications are safe to take during pregnancy.
According to the Cleveland Clinic, “The most common prescription medications for nausea and vomiting are Promethazine (Phenergan) and Metoclopramide (Reglan). Ondansetron (Zofran) is another drug that can help with nausea and vomiting.” They note that these medications may be available through an IV, injection, or rectal suppository.
The HER Foundation says taking Zofran for Hyperemesis Gravidarum “Is effective for >60% of HG patients.” If nausea and vomiting cause dehydration, hospitalization may be required to receive extra nutrients either through an IV or feeding tube.
Total Parenteral Intravenous Nutrition (TPN) can also be used, but only in the most extreme and severe cases of HG. This might require that nutrients be given through an IV that bypasses your digestive system completely. TPN allows your digestive system to heal and not have to work at all.
Ginger products such as ginger lollipops or ginger tea may also be beneficial. Ginger has been shown to help with nausea, as reinforced by John Hopkins Medicine, which notes, “Ginger benefits gastrointestinal motility ― the rate at which food exits the stomach and continues along the digestive process. Eating ginger encourages efficient digestion, so food doesn’t linger as long in the gut.” Ginger also encourages stomach emptying which provides relief from nausea.
Other lifestyle changes may help with managing symptoms. Avoiding certain things that you know add to nausea, such as triggering scents, movements, riding in a car for prolonged periods, or avoiding foods that aggravate your stomach, such as spicy foods. Small amounts of bland, dry food such as crackers or toast may be helpful. Studies show foods high in fat can contribute to nausea during pregnancy.
Resources
With Hyperemesis Gravidarum being such a rare condition and impacting only 3% of pregnancies, information and resources are limited. However, research on HG is gaining attention, and advocates are helping to spread awareness and information about Hyperemesis Gravidarum. Listed below are a few resources for additional information and support.
- HER Foundation
- Centre of Perinatal Excellence (COPE)
- Hear Her Campaign
- Maternal Mental Health Alliance
- The American College of Obstetricians and Gynecologists (ACOG)
This article is meant for informational purposes and should in no way be a replacement for medical care or advice. Do not take any medications without consulting with your healthcare provider first. You should always consult your doctor or healthcare professional for recommendations and proper treatment.