Hyperemesis Gravidarum (HG): Extreme Morning Sickness

Nausea and throwing up are common during the first twelve weeks of pregnancy, but for some women, morning sickness feels much more severe and the sickness continues for weeks. 

If you’re experiencing excessive vomiting and nausea that prevents you from eating normally or gaining weight in the second half of your pregnancy, you may be suffering from hyperemesis gravidarum (HG).

HG is a severe form of morning sickness that can have serious consequences for both the mother and baby. It is important to recognize the symptoms and seek medical attention to manage the condition effectively.

Read on to learn more about the signs and symptoms of HG and what to do if it affects you.

What is Hyperemesis Gravidarum in Pregnancy?

HG is classified as severe nausea and vomiting that persists throughout the entire pregnancy, rather than wrapping up shortly after the end of the first trimester – as is the case with typical morning sickness 

Pregnant women who suffer from HG vomiting during pregnancy may find it difficult to keep food and water down. This may lead to complications for both mom and baby. HG is a serious illness that can impede your ability to eat normally and may lead to severe dehydration as well as weight loss throughout the pregnancy. 

Sometimes, management is enough to keep you and your unborn child healthy when you have HG, but medical intervention may also be needed.

Causes and Risk Factors for HG

We don’t yet know the true cause of HG, but experts believe that a combination of factors contributes to this condition. 

Rising human chorionic gonadotropin (hCG levels) are the likely culprit in early pregnancy nausea and vomiting. It's likely that hormone fluctuations play a role in HG as well.

Slowed metabolism and, later in pregnancy, a smaller stomach due to being compressed by the growing fetus and placenta may also contribute to vomiting and the inability to eat or drink enough.

HG tends to run in families, so there may be some genetic component to why some people are more likely to suffer from it. It could be the way that hormones rise during pregnancy, or how the gastrointestinal system reacts to these hormones.

You may be more likely to have HG if it’s your first pregnancy, you are carrying twins or multiples or if you experienced HG in a previous pregnancy.

Symptoms of HG in Pregnancy 

Severe vomiting that lasts longer than the first half of pregnancy is the primary symptom of HG. You may also experience intense nausea and not be able to keep food or liquids down.

These symptoms can lead to secondary symptoms. Weight loss, including failing to gain or possibly dropping to a body weight lower than your pre-pregnancy weight, is a telltale sign. Not getting enough food or water into your body can also lead to dehydration, low blood pressure and malnutrition.

Possible symptoms of HG include:

• Frequent vomiting
• Severe nausea
• Taste and smell aversions
• The inability to eat or drink or to keep food or fluids down
• Weight loss of 5% or more of your pre-pregnancy weight, according to the American College of Obstetrics and Gynecology (ACOG)
• Low blood pressure
• Headaches or migraines
• Dizziness and fainting
• Ketosis
• Rapid heart rate

Potential Complications of HG 

If HG is not treated or managed, complications may occur. It’s important to reach out to your healthcare professional if you are suffering, so they can help you avoid harm to you or your baby.

Possible complications include:

Dehydration

Not getting enough fluids can cause electrolyte imbalances, fainting and dangerously low blood pressure. Signs of dehydration include dry mouth and skin, dark yellow urine, dizziness, sunken eyes or headache. Severe dehydration may require intravenous fluids.

Malnutrition

Not getting enough food or enough healthy foods can impact your overall health and wellness. Your fetus will take what he or she needs first, leaving you vulnerable if there is not enough left to nourish you. 

The need for tube feeding is unlikely, but may be possible.

Complications of Pregnancy

Often, mothers suffer from HG while the baby grows and develops fine. Your body knows to nourish the child first, but in severe cases, your fetus may be seriously affected by HG.

Lack of weight gain, hydration and nutrition can reduce your blood volume and make it difficult for your fetus to develop properly. HG may lead to complications for your baby, including fetal growth restriction, low birth weight and preterm labor.

Babies who are born early or small are at a higher risk of further complications, including jaundice, breathing problems or even death. Always seek medical attention if you are suffering from HG symptoms or you have any concerns about getting enough food and water during pregnancy.

Tips for Managing HG

Every HG case will be unique, but there are a few things you can try to keep your symptoms at bay. Just make sure you’re consulting with your healthcare provider as well.

Try the following lifestyle changes to combat HG symptoms:

1. Prioritize Hydration First

Dehydration is one of HG’s most serious complications. Not having enough fluids can lead to serious concerns for both mom and baby. For this reason, it’s important to make sure you are drinking enough.

To get enough water, drink something at the start of your day and wait a little while before eating. Space out your fluids throughout the day and separate them from mealtimes. Drink small amounts at a time and aim for a total of 8 full glasses per day.

If you cannot keep your fluids down, getting IV fluids may be necessary.

2. Eat Small, Frequent Meals

Eating too much at a time can trigger vomiting and stomach upset when you have HG. Don’t underestimate how small each meal should be. To stop yourself from throwing up, eat a little bit at a time and don’t drink fluids at the same time. Try to keep about an hour between eating and drinking times.

Focus on nutrient-dense foods such as scrambled eggs, Greek yogurt, nut butter or salmon to get the calories you need in smaller quantities of food.

3. Eat Bland Foods

You may find it easiest to tolerate plain foods like milk, cereal, yogurt, cheese, avocado or apple sauce if you’re suffering from HG. When you find a food that works, stick with it.

It’s best if the food you eat is somewhat nutritional, but don’t worry too much about that. Those with HG should stay focused on consuming enough food to keep themselves functional while keeping their symptoms to a minimum.

You may worry about whether your baby is getting the nutrition they need from your diet if you’re sticking with only certain foods. Take comfort in knowing that your fetus will draw what it needs from your blood supply and focus on keeping yourself fed and feeling as good as possible.

4. Avoid Trigger Foods

Common trigger foods with HG include fried foods, spicy foods or foods high in fiber such as beans or vegetables. You will probably figure out which foods don’t agree with you soon enough and you may have aversions to these foods to start with.

Don’t eat the foods that make you feel nauseous or trigger vomiting. If you’re suffering from HG, foods that were formerly your favorites may now be your worst enemies! Avoid these foods, and know that once your HG clears up, you will be able to eat and enjoy them again.

Smells may also trigger nausea and vomiting. Try to avoid strong smells like food cooking or anything else that makes you want to retch. This might mean avoiding restaurants or asking your family to accommodate your sensitivities for a while while cooking at home.

5. Try Supplements and Antihistamines 

You might want to try supplements. A high dose of Vitamin B6 combined with an antihistamine called doxylamine may help improve nausea and vomiting. 

These medications are generally safe to take during pregnancy under a doctor’s supervision. You must get a prescription and tell your provider about any other medications you may be on. Your provider will discuss side effects and whether these medications are right for you.

6. Use Acupressure Bands

Try an acupressure or sea band. This is a bracelet that is worn to reduce feelings of nausea or motion sickness. While it doesn’t work for everyone, it’s definitely worth a try. You can bind an acupressure band at your local drugstore.

HG during pregnancy can have serious consequences for you and your baby. Always consult with your doctor if you are suffering from HG and have an ongoing conversation about how you are managing your symptoms.