Nausea and vomiting is a common occurrence in pregnancy, with at least 70 percent of women experiencing some form of it, according to the March of Dimes. It’s typically referred to as morning sickness, though it can happen at any time of day.

But sometimes the symptoms are so extreme — severe, persistent nausea, vomiting, and weight loss during pregnancy — that it may be diagnosed as a less common disorder known as hyperemesis gravidarum.

Hyperemesis gravidarum can lead to dehydration and nutrient loss, affecting both the health of a pregnant woman and the fetus she's carrying. The nausea can be debilitating, interfering with daily activities and quality of life.It usually subsides at between 14 and 20 weeks of gestation.
Women with hyperemesis gravidarum have an increased risk of preterm labor and preeclampsia, among other complications, but the risk is low.

Signs and Symptoms of Hyperemesis Gravidarum

The primary symptom of hyperemesis gravidarum is severe nausea and vomiting, meaning more than four episodes a day.This vomiting can lead to:
  • Feeling dizzy, lightheaded, and faint
  • Losing more than 5 percent of body weight
  • Becoming dehydrated, with signs of dehydration such as dark urine and dry skin
  • Electrolyte and nutritional imbalances
  • Increased salivation
  • Rapid heart rate
  • Low blood pressure
  • Headaches
  • Yellowing of the skin and eyes (jaundice)
  • Depression and anxiety

How Is Hyperemesis Gravidarum Diagnosed?

Your doctor will perform a physical exam and order the following lab tests to assess signs of dehydration.

  • A complete blood count
  • A serum electrolyte test (blood test)
  • Ketones urine test (when the body isn't getting enough nutrients, it begins to break down fat, which leads to an increase in waste products known as ketones)
An ultrasound can confirm if you are carrying twins or multiples and can diagnose a molar pregnancy.
How to Stay Hydrated

12 Science-Backed Ways to Help You Avoid Dehydration

Prognosis of Hyperemesis Gravidarum

According to the Merck Manual, it's uncommon for hyperemesis gravidarum to last beyond 16 to 18 weeks. But if it does persist, it may cause serious liver damage and other complications (see Complications, below).

Treatment and Medication Options for Hyperemesis Gravidarum

If you have severe symptoms of hyperemesis gravidarum, you may need to be hospitalized. According to the National Organization for Rare Disorders, hyperemesis gravidarum is the second leading cause of hospitalization in early pregnancy.

For less severe cases, you may be able to seek treatment at home or at a doctor's office.

While the course of treatment for hyperemesis gravidarum varies from person to person, your doctor may recommend one or more of the following:

  • Vitamin B6
  • Small, frequent meals that include dry, bland foods such as crackers
  • Intravenous fluids to help with dehydration
  • For severe cases, parenteral nutrition, in which an intravenous (IV) solution of vitamins and nutrients is given as a substitute for food

Medication Options

First-line medications shown to be effective in treating vomiting and nausea and safe for pregnancy are pyridoxine and doxylamine. If a particular patient doesn't respond well to this treatment, a combination of other medications may be tried, including antihistamines such as Antivert (meclizine), diphenhydramine, and dopamine antagonists such as Inapsine (droperidol), or Reglan (metoclopramide).

RELATED: 8 Surprising Health Benefits of B Vitamins

Alternative and Complementary Therapies

Evidence concerning the effectiveness of the following therapies for hyperemesis gravidarum remains inconclusive. But when used in addition to traditional medical interventions, they may help alleviate symptoms. They include:
  • Acupuncture and acupressure
  • Hypnosis
  • Light therapy (to help with depression)
Ginger, whether taken in tea or through a capsule, is also thought to be helpful.Before trying any of the above, make sure to discuss their use with your healthcare provider.

Prevention of Hyperemesis Gravidarum

While there's no way to completely prevent hyperemesis gravidarum, Harvard Health Publishing notes that women who take a multivitamin before getting pregnant, such as a prenatal vitamin, are less prone to severe symptoms.If morning sickness develops during pregnancy, you may reduce the severity and duration of symptoms by eating small, frequent meals of bland foods rather than spicy ones, waiting to take any iron supplements until the nausea has passed, and, on your doctor's recommendation, trying acupressure, vitamin B6, or ginger.

Research and Statistics: Who Gets Hyperemesis Gravidarum?

More than 192,000 hospital visits or admissions for hyperemesis occur annually in the United States.
The condition is estimated to occur in .5 to 2 percent of pregnant women.

Resources We Love

Essential Organizations

HER (Hyperemesis Education and Research) Foundation

This nonprofit organization is devoted to supporting and educating women who are experiencing hyperemesis gravidarum or have gone through it in the past. HER offers comprehensive info on what the condition is, how to manage it physically and emotionally, and the latest research. Different sections for pregnant women as well as their friends and family target and address a range of needs.

National Organization for Rare Diseases (NORD)

NORD works with individual patients and organizations to bring awareness to rare disorders. In addition to a highly informative, up-to-date page on hyperemesis gravidarum, this nonprofit also has a resource center for patients and caregivers.

Favorite Podcast

The BMJ Podcast

The BMJ (British Medical Journal) podcasts focus on a variety of health issues. The episode on hyperemesis gravidarum, "The Bone-Crushing Nausea of Hyperemesis," features of panel of experts — women who have had hyperemesis gravidarum themselves and also research or treat it — discussing what the condition is like and how to manage it.

Helpful App

HG Care

UCLA Health partnered with the HER Foundation on this free iOS app for women experiencing hyperemesis gravidarum. It tracks how little (or how much) you've eaten and whether your treatments are working, sends alerts if your weight drops or you're getting dehydrated and need medical attention, reminds you to take meds, and more.

Editorial Sources and Fact-Checking

  • Hyperemesis Gravidarum. National Organization for Rare Disorders (NORD). 2020.
  • About Hyperemesis Gravidarum: Assess and Diagnose. HER Foundation.
  • Is an HG Pregnancy High Risk? HER Foundation.
  • Hyperemesis Gravidarum (Severe Nausea and Vomiting During Pregnancy). Cleveland Clinic. November 4, 2016.
  • Hyperemesis Gravidarum. MedlinePlus. November 23, 2020.
  • Fejzo M, Sazonova O, Sathirapongsasuti JF, Hallgímmsdottír, et al. Placenta and Appetite Genes GDF15 and IGFBP7 Are Associated With Hyperemesis Gravidarum. Nature Communications. March 21, 2018.
  • Jennings L, Krywko D. Hyperemesis Gravidarum. StatPearls. November 21, 2020.
  • Explaining the Cruel Injustice of Morning Sickness. Cleveland Clinic. June 26, 2020.
  • About Hyperemesis Gravidarum: Causes. HER Foundation.
  • Hyperemesis Gravidarum. Merck Manual Consumer Version. October 2020.
  • Hyperemesis Gravidarum. Merck Manual Professional Version. October 2020.
  • Nausea and Vomiting of Pregnancy: Treatment and Outcome. UpToDate. October 2020.
  • Ginger for Morning Sickness. Michigan Medicine. May 29, 2019.
  • About Hyperemesis Gravidarum: Complementary Therapies. HER Foundation.
  • Farid H. Hyperemesis: (Way) Beyond Morning SicknessHarvard Health Publishing. July 9, 2019.
  • Hyperemesis Gravidarum (Severe Nausea and Vomiting During Pregnancy): Prevention. Cleveland Clinic. November 4, 2016.
  • About HG for Mothers. HER Foundation.
  • Wernicke-Korsakoff Syndrome. MedlinePlus. November 23, 2020.
  • Morning Sickness. March of Dimes. September 2017.
  • Is Psychiatric Illness a Risk Factor for Hyperemesis Gravidarum? Massachusetts General Hospital Center for Women’s Mental Health. July 13, 2017.


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