Hyperemesis gravidarum (HG) is an uncommon condition characterized by frequent, persistent, and severe vomiting and nausea during pregnancy. As a result, you may be unable to take in a sufficient amount of food and fluids. It can cause a weight loss of more than 5% of your pre-pregnancy body weight. This can also cause dehydration and vitamin and mineral deficiencies. Treatment may require hospitalization.
HG is a more severe form of nausea and vomiting of pregnancy (NVP, morning sickness). Morning sickness affects anywhere between 70% to 80% of pregnant women. HG is estimated to occur in up to 2% of pregnancies.
There are many theories about the causes of HG, but none have been confirmed. HG is a complex disease that is likely caused by many factors. Some of these include:
The Brain May Be Cause of Nausea
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Factors that may increase your chance of HG include:
HG may cause:
Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include the following:
Treating HG symptoms early in pregnancy can make you less sick in the long run and can decrease recovery time. Because HG is caused by many factors that vary among women, it is difficult to find a treatment that works for everyone. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Try to eat frequent, small meals, bland or dry foods, high-protein choices.
Reducing nausea, and thus allowing eating and drinking, will hasten recovery. Due to the risk of stating that a drug is safe for use during pregnancy, very few pharmaceutical manufacturers will say that their drugs are intended for a pregnancy condition like HG. However, doctors often recommend that women with HG take certain anti-nausea medications, balancing the potential benefits and risks. Talk to your doctor about the right medications for you.
A common and safe remedy is to take supplemental vitamin B6 (pyridoxine). The American Congress of Obstetricians and Gynecologists recommends that first-line treatment of nausea and vomiting of pregnancy should start with pyridoxine with or without doxylamine. Pyridoxine has been found to be effective in significantly reducing severe vomiting.
In urgent doctor visit situations, HG can be managed by IV fluids and vitamins. This can sometimes be done without hospitalization. Very rarely, some people require IV fluids throughout the entire pregnancy.
If you are unable to tolerate food by mouth, you may need to receive nutrition through an IV. This is called parenteral nutrition. A special kind of catheter is placed in a large vein and liquid nutrition is given. This can sometimes be done without hospitalization.
Acupressure may help to reduce nausea. Acupressure is when pressure is applied to acupuncture points.
In extreme cases, induced abortion may be considered.
The American Congress of Obstetricians and Gynecologists
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada (SOGC)
About hyperemesis. HER Foundation website. Available at: http://www.helpher.org/hyperemesis-gravidarum. Updated April 18, 2013. Accessed June 6, 2016.
Acupuncture. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/biomedical-libraries/natural-alternative-treatments. Updated February 26, 2016. Accessed June 6, 2016.
Herrell HE. Nausea and vomiting of pregnancy. Am Fam Physician. 2014;89(12):965-970.
Morning sickness: nausea and vomiting of pregnancy. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq126.pdf?dmc=1&ts=20130806T1444487894. Updated December 2015. Accessed June 6, 2016.
Nausea and vomiting in pregnancy. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114643/Nausea-and-vomiting-in-pregnancy. Updated August 26, 2016. Accessed June 6, 2016.
Practice Bulletin No. 153: nausea and vomiting of pregnancy. Obstet Gynecol. 2015;126(3):e12-e24.
Last reviewed June 2016 by James Cornell, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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