Hyperemesis gravidarum (HG) is a severe form of morning sickness during pregnancy, characterised by intense nausea, vomiting, and potential dehydration. Unlike typical morning sickness, HG can persist beyond the first trimester and may lead to weight loss, electrolyte imbalances, and other complications. Prompt diagnosis and treatment are crucial for managing symptoms and ensuring the well-being of both the mother and the baby.
Last updated on : 26 Mar, 2025
Read time : 9 mins
Pregnancy is a time of significant physical and emotional changes for women, and while some discomfort is expected, certain conditions can greatly impact a woman's quality of life. One such condition is hyperemesis gravidarum, a severe form of morning sickness that affects a small percentage of pregnant women. It is essential for expectant mothers to be aware of this condition, its symptoms, and when to seek medical attention to prevent potential complications.
Hyperemesis gravidarum (HG) is a condition in pregnancy where you have severe and constant nausea and vomiting. It can cause weight loss and dehydration. HG is sometimes known as extreme morning sickness.
Category | Details |
Also Referred as | Nausea - hyperemesis, Vomiting - hyperemesis, Morning sickness - hyperemesis |
Commonly Occurs In | Pregnant women, especially those with multiple pregnancies or a history of HG |
Affected Organ | Stomach, oesophagus, kidneys (due to dehydration and electrolyte imbalances) |
Type | Severe pregnancy complication |
Common Signs | Severe, persistent nausea and vomiting, weight loss (>5% of pre-pregnancy weight), dehydration, constipation, excessive salivation |
Consulting Specialist | Obstetrician, Gastroenterologist |
Treatement Procedures | Intravenous fluids, antiemetics (e.g., pyridoxine, metoclopramide), temporary suspension of oral intake, vitamin and electrolyte repletion |
Managed By | Healthcare providers, including obstetricians and gastroenterologists |
Mimiciking Condition | Urinary tract infection, high thyroid levels, morning sickness |
Hyperemesis gravidarum (HG) usually starts in the first trimester of pregnancy, around six weeks in. It can last for weeks, months, or even until birth. The symptoms can be very strong and may stop you from doing your daily activities.
The exact causes of hyperemesis gravidarum are unknown, but it is likely due to the rise in pregnancy hormones. One key hormone is HCG (human chorionic gonadotropin), which your body produces in high amounts during pregnancy. HCG levels are highest around the 10th week of pregnancy, which is when symptoms are usually the worst. Another hormone, estrogen, also increases during pregnancy and may contribute to nausea and vomiting.
While any pregnant woman can develop hyperemesis gravidarum, certain factors may increase your risk, including:
Preventing hyperemesis gravidarum (HG) with complete certainty is not currently possible. Although there are no known methods to entirely prevent HG, some steps can be taken to potentially reduce its severity or prepare for its impact. Women who have experienced HG in a previous pregnancy have an estimated 89% chance of recurrence. Taking a multivitamin containing vitamin B6 before getting pregnant may help reduce the severity of symptoms. Early, pre-emptive use of vitamin B6 supplements and first-line medications has shown effectiveness in preventing the deterioration of HG symptoms. Maintaining a healthy diet rich in nutrient-dense foods and ensuring adequate levels of essential vitamins like thiamine (B1) may also help mitigate the severity of HG. Lifestyle changes, such as eating small, frequent meals high in protein and avoiding spicy, fatty, or oily foods, can be beneficial. However, it is crucial to note that these measures do not guarantee the prevention of HG but can assist in managing and reducing its impact. If you suspect symptoms of HG or have a history of it, consult your healthcare provider promptly.
Diagnosing hyperemesis gravidarum (HG) involves a combination of clinical evaluation, medical history, and physical examination. The healthcare provider will assess the severity of the patient's symptoms, such as severe morning sickness that impairs their ability to eat and drink normally, affecting daily activities. These hyperemesis gravidarum symptoms typically begin between the 4th and 6th week of pregnancy and can persist throughout the first trimester or longer. Blood and urine tests may be ordered to check for dehydration, electrolyte imbalances, and ketonuria, although the presence of ketonuria is no longer considered a necessary criterion for diagnosis. The provider may also perform tests to rule out other causes of nausea and vomiting, such as gastrointestinal illnesses or urinary tract infections. An ultrasound may be used to determine if the patient is carrying multiple fetuses or has other conditions like trophoblastic disease, which can also cause HG. Once diagnosed, appropriate hyperemesis gravidarum treatment can be initiated to manage the condition and alleviate the debilitating morning sickness in pregnancy.
The treatment for hyperemesis gravidarum depends on how bad your symptoms are. Talk to your doctor about the best options for you.
Some medications may have risks during pregnancy, so discuss all options with your doctor.
Consulting a healthcare provider as soon as possible is essential if symptoms of hyperemesis gravidarum are suspected or if there is a history of HG in previous pregnancies. Symptoms that warrant a doctor's consultation include persistent and severe nausea and vomiting that interferes with daily activities and nutrition, weight loss exceeding 5% of pre-pregnancy weight, dehydration indicated by excessive thirst or decreased urine output, electrolyte imbalances identified through blood tests, and psychological distress or significant impact on daily life due to symptoms. If you have a history of HG, discussing your previous experiences and developing a care plan with your healthcare provider before becoming pregnant is advisable. This plan should include pre-emptive treatments such as vitamin B6 supplements and first-line medications for morning sickness. Ensure that your healthcare provider understands your medical history and is prepared to support you with a cohesive hyperemesis gravidarum treatment plan. If symptoms of HG start during pregnancy, seek medical attention promptly, as early treatment can help manage symptoms and prevent complications such as malnutrition, dehydration, and electrolyte imbalances.
Hyperemesis gravidarum (HG) is a severe form of morning sickness that affects approximately 0.5-2% of pregnant women.
Symptoms of HG include persistent and severe nausea and vomiting, weight loss, dehydration, and electrolyte imbalances.
While the exact cause of HG is unknown, it is believed to be related to hormonal changes during pregnancy.
Treatment for HG may include dietary changes, medications, and in severe cases, hospitalization for intravenous fluids and nutrition.
Although preventing HG with certainty is not currently possible, steps such as taking a multivitamin containing vitamin B6 before pregnancy and maintaining a healthy diet may help reduce the severity of symptoms.
If symptoms of HG are suspected or there is a history of HG in previous pregnancies, it is essential to consult a healthcare provider promptly for proper diagnosis and treatment.
Recent studies suggest that the hormone GDF15, produced by the fetus and placenta, plays a significant role in causing hyperemesis gravidarum symptoms.
Treatment for hyperemesis gravidarum focuses on managing symptoms and ensuring adequate nutrition and hydration through IV therapy, anti-nausea medications, nutritional support, and hospitalization in severe cases.
Severe dehydration or malnutrition due to hyperemesis gravidarum may lead to complications like preterm birth or low birth weight, but proper medical care can minimize risks.
While morning sickness causes mild to moderate nausea and vomiting, hyperemesis gravidarum results in severe, persistent symptoms that can cause significant weight loss, dehydration, and electrolyte disturbances.
The first line treatment for hyperemesis gravidarum usually involves administering anti-nausea medications and ensuring proper hydration through intravenous fluids to correct dehydration and electrolyte imbalances.
Diagnosis of hyperemesis gravidarum is based on severe nausea and vomiting, weight loss exceeding 5% of pre-pregnancy weight, dehydration, and electrolyte disturbances.
While severe cases of hyperemesis gravidarum may increase the risk of preterm birth or low birth weight, proper management and treatment can help minimize potential harm to the baby.
Currently, there are no guaranteed methods to prevent hyperemesis gravidarum; however, maintaining a healthy lifestyle and managing stress may help reduce the severity of symptoms.
Eating small, frequent meals, avoiding strong-smelling or fatty foods, and consuming bland, easy-to-digest foods like crackers, rice, and bananas may help manage hyperemesis gravidarum symptoms.
Fiaschi, L., Nelson-Piercy, C., & Tata, L. J. (2016). Hospital admission for hyperemesis gravidarum: a nationwide study of occurrence, reoccurrence and risk factors among 8.2 million pregnancies. Human Reproduction, 31(8), 1675–1684. https://doi.org/10.1093/humrep/dew128
London, V., Grube, S., Sherer, D. M., & Abulafia, O. (2017). Hyperemesis Gravidarum: A Review of Recent Literature. Pharmacology, 100(3-4), 161–171. https://doi.org/10.1159/000477853
Committee on Practice Bulletins—Obstetrics. (2018). ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy. Obstetrics and Gynecology, 131(1), e15–e30. https://doi.org/10.1097/AOG.0000000000002456
Dean, C., Bannigan, K., & Marsden, J. (2018). Reviewing the effect of hyperemesis gravidarum on women's lives and mental health. British Journal of Midwifery, 26(2), 109–119. https://doi.org/10.12968/bjom.2018.26.2.109
Boelig, R. C., Barton, S. J., Saccone, G., Kelly, A. J., Edwards, S. J., & Berghella, V. (2016). Interventions for treating hyperemesis gravidarum. Cochrane Database of Systematic Reviews, 2016(5), CD010607. https://doi.org/10.1002/14651858.CD010607.pub2
Einarson, T. R., Piwko, C., & Koren, G. (2013). Quantifying the global rates of nausea and vomiting of pregnancy: a meta analysis. Journal of Population Therapeutics and Clinical Pharmacology, 20(2), e171-83.
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