Pregnancy: Morning Sickness

Hyperemesis Gravidarum

What is hyperemesis gravidarum?

The majority of all pregnant women experience nausea and sometimes vomiting in the first trimester--a condition often called morning sickness, as these symptoms are often more severe in the morning. Some women may have nausea and vomiting throughout the pregnancy. The cause of morning sickness may be due to the changes in hormone levels during pregnancy.

A smaller percentage of women develop a severe form of nausea and vomiting of pregnancy called hyperemesis gravidarum. With this condition, nausea and vomiting may be constant, and women often have weight loss, dehydration, and changes in their metabolic state.

What causes hyperemesis gravidarum?

The cause of hyperemesis gravidarum is unknown but may be hormone-related. It is more common in multiple pregnancies (twins or more) and in women with migraines. Women with a family history of hyperemesis gravidarum or who had the condition in a previous pregnancy are much more likely to have it with future pregnancies.

Why is hyperemesis gravidarum a concern?

Hyperemesis gravidarum can lead to fluid and electrolyte imbalances and nutritional deficiencies. Liver damage and jaundice (yellowing of the skin, eyes, and mucous membranes) may occur with severe hyperemesis gravidarum. Excessive weight loss and poor nutrition in the mother may affect fetal growth.

What are the symptoms of hyperemesis gravidarum?

The following are the most common symptoms of hyperemesis gravidarum. However, each woman may experience symptoms differently. Symptoms may include:

• Constant nausea, especially after the first trimester

• Vomiting after eating or drinking

• Vomiting not related to eating

• Weight loss

• Dehydration

The symptoms of hyperemesis gravidarum may resemble other medical conditions. Always consult your doctor for a diagnosis.

How is hyperemesis gravidarum diagnosed?

In addition to a complete medical history and physical examination, weight loss and electrolyte imbalances (detected by blood tests) often aid in the diagnosis of hyperemesis gravidarum.

Treatment for hyperemesis gravidarum

Specific treatment for hyperemesis gravidarum will be determined by your doctor based on:

• Your pregnancy, overall health, and medical history

• Extent of the condition

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

The goals of treatment include the following:

• Reducing nausea and vomiting

• Replacing fluids and electrolytes

• Improving nutrition and weight gain

Hospitalization is usually needed for hyperemesis gravidarum. All food and drink are stopped temporarily to give the digestive tract a rest. Intravenous (IV) fluids are almost always needed to replace fluids and correct imbalances in electrolytes. Sedatives and anti-emetic (anti-vomiting) medications are sometimes used. Many women are given total parenteral nutrition, which is an intravenous preparation of nutrients and calories. Tube feedings (placement of a hollow tube through the woman's nose into her stomach) may be used to give small, continuous feedings.