Hyperemesis gravidarum (HG) is an extreme form of morning sickness, with severe nausea and vomiting. It leads to dehydration, disturbances in metabolism (abnormal levels of chemicals called electrolytes and ketones), and rapid weight loss. These changes can mean a hospital stay. It’s rare, so even though 70% to 85% of women have morning sickness, only about 1% to 2% will have HG. HG may mean you have a multiple pregnancy (twins or more). Complications of HG may be serious and related to kidney, nervous system, and liver damage.
The cause is unknown, but factors that may be involved include hormones called human chorionic gonadotropin and estrogen. Other possibilities are younger age of the mother, body weight (obesity), no previous completed pregnancies, first pregnancy, and history of HG in prior pregnancies. Biological, psychological, and social factors may all play a role.
Symptoms usually begin between the fourth and eighth week of pregnancy and last until 16 weeks or more. Most women vomit often throughout the day, with few if any symptom-free periods. Other symptoms include severe nausea, weight loss, reduced urination, headaches, confusion, fainting, and jaundice. Dehydration is indicated by ketones in urine, increased pulse rate, and lower blood pressure.
The health care provider makes a diagnosis when severe nausea and vomiting lead to weight loss, dehydration, or disturbances in the body’s chemistry. To be sure that nothing else is causing these symptoms, the health care provider may do blood and urine tests. Ultrasonography may also be done.
When symptoms aren’t too bad, eating dry foods such as crackers and small, frequent meals may be enough. Drinking more fluids may help. (If you drink fizzy drinks such as seltzer or other sparkling water, pour it over ice and let it sit for a bit to let some of the fizz out.) Women with HG may need intravenous fluids and vitamins and hospitalization. Medicines to prevent nausea (antiemetics) are for women with severe and long-lasting vomiting. Once fluids can be taken, eating small bland meals and then more food may be possible. If these methods don’t work, drugs or a method of feeding called total parenteral nutrition may be used.
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