Hyperemesis gravidarum (HG) is much more than a bad case of morning sickness. It's rare, but causes intense, ongoing nausea and vomiting that can make eating and drinking feel nearly impossible. If you have it, you may need extra support, medication, or even hospital care to stay hydrated and healthy throughout pregnancy.
What is hyperemesis gravidarum?
Hyperemesis gravidarum (HG) is debilitating and persistent nausea and vomiting during pregnancy. It's more severe than morning sickness, however awful that can be. Your health care practitioner may diagnose you with the condition if you've lost more than 5% of your pre-pregnancy weight.[1]
Severe cases of hyperemesis gravidarum can lead to problems like dehydration and poor weight gain, which sometimes require hospitalization. Fortunately, as miserable as it makes you feel, hyperemesis gravidarum usually does not harm your baby.
What causes hyperemesis gravidarum?
Like many pregnancy symptoms, hyperemesis gravidarum is thought to be caused by pregnancy hormones — specifically rising levels of human chorionic gonadotropin (hCG). However, researchers are identifying other specific hormones, such as GDF15, that may play a role in morning sickness and HG during pregnancy.[2]
In one study, researchers concluded that the amount of GDF15 in a woman's bloodstream is linked to how severe her morning sickness is. Women with intense morning sickness had abnormally high levels of GDF15 in their systems, but those who were exposed to GDF15 before pregnancy didn't have a strong reaction to it when they were expecting. GDF15 is released by your growing baby and also by various tissues in the body in response to stress, including infections.
Track your pregnancy, get more expert advice, and connect with other moms struggling with HG on our free What to Expect app.
What are the symptoms of hyperemesis gravidarum?
Symptoms of hyperemesis gravidarum include:
- Severe nausea that doesn't go away
- Vomiting several times per day
- The inability to keep down any food or even liquid
- Having a lot more saliva than usual
- Reduced or lack of appetite
- Lightheadedness or fainting
- Signs of dehydration, such as infrequent urination or dark yellow urine
- Weight loss of more than 5%
- Blood in your vomit
- Constipation
What's the difference between morning sickness and hyperemesis gravidarum?
Think of morning sickness as a continuum, with hyperemesis gravidarum at the extreme, severe end of the spectrum. Compared with more manageable nausea and vomiting during pregnancy, hyperemesis gravidarum symptoms are persistent and significantly more acute.
If you're unsure whether you're suffering from hyperemesis gravidarum, talk to your practitioner. They'll discuss your symptoms and may run a few tests, including checking your complete blood count and electrolyte levels, as well as looking for ketones in your urine.
Your practitioner will also rule out other potential causes for severe vomiting and nausea, including food poisoning, a thyroid or gallbladder condition, or an ulcer. (These conditions tend to cause other symptoms like headache, fever, or a swollen thyroid gland.)
When does hyperemesis gravidarum start?
Symptoms of hyperemesis gravidarum start in the first trimester, usually between week 4 and week 8 of pregnancy, with most diagnoses happening around week 9. It usually starts to lift on its own between week 12 to week 16, with most cases resolved by week 20 — though it can sometimes continue throughout pregnancy.
How common is hyperemesis gravidarum?
Hyperemesis gravidarum occurs in fewer than 3% of all pregnancies. You may be at greater risk of the condition if you are:
- A first-time mom
- Younger
- Obese
- Carrying multiples
- Prone to getting car sick or migraines
- Undergoing extreme (more than everyday) stress
- Diagnosed with hyperthyroidism (high thyroid levels)
- Deficient in vitamin B or other nutrients
- Pregnant with a girl
You're also more likely to have hyperemesis gravidarum if your mom or sister had it, or if you suffered from it in a previous pregnancy.
"I genuinely did not think my first pregnancy would be like this," says What to Expect Community member Ulloa121. "But I learned my mom had HG and so did my sister with her pregnancies."
How can you cope with mild hyperemesis gravidarum?
If your symptoms are relatively mild and you're able to keep some food and liquid down, try natural methods used to fight morning sickness, including:
- Noting and trying to avoid your hyperemesis gravidarum triggers, which may include certain foods or smells, riding in the car, bright lights, certain noises or sounds, and tight-fitting clothes
- Eating foods with real ginger, such as ginger tea, ginger candies, ginger ale, or ginger cookies
- Eliminating fatty and spicy foods, which are more likely to cause nausea
- Grazing on small, high-carb and high-protein meals throughout the day, which are easier to digest and keep acids from irritating your stomach lining
- Drinking plenty of fluids — and keeping an eye on your urinary output (dark, infrequent urine is a sign you're not getting enough liquids)
- Wearing nerve-stimulation wristbands
- Trying hypnosis, which some moms-to-be report as helpful
- Taking Epsom salt baths
- Seeing a therapist, particularly if the nausea or pregnancy in general is causing you anxiety
"I've been wearing the wristbands since I was 5ish weeks pregnant (now 10 weeks), and they've worked sooo well for me," says Community mom jackyhm96. "I used them in my previous two pregnancies as well."
If these strategies don't help, talk to your practitioner. For tough morning sickness cases, they may recommend vitamin B6 (shown to relieve nausea and stress), doxylamine (found in over-the-counter sleep aids), or a combination of the two. Both medications have been shown to be safe if taken during pregnancy.
Keep in mind that even if you've heard about other people using marijuana as a remedy for nausea and vomiting, health experts stress that using pot during pregnancy is not safe and should be avoided completely.
How can you cope with severe hyperemesis gravidarum?
You'll need your practitioner's help dealing with severe hyperemesis gravidarum. Check in with your practitioner if you:
- Can't tolerate any foods for more than 12 hours
- Feel lightheaded or dizzy
- Have signs of dehydration
- Have lost more than 5% of your pre-pregnancy weight
- Have blood in your vomit
- Have abdominal pain
Severe cases of hyperemesis gravidarum can lead to weight loss, dehydration, electrolyte imbalances, malnutrition, and bleeding in the esophagus.
In some cases, your practitioner may prescribe an anti-nausea drug. If you're severely dehydrated, you may require hospitalization, mostly for intravenous (IV) fluids and stronger anti-nausea medication. You may receive tests to check your liver and pancreas function and possibly get a feeding tube.
"Today I ended up in the ER due to being severely dehydrated from vomiting," says Community mom Saraphina-1. After receiving IV fluids, she says, "I honestly feel so much better, the best I've felt in weeks!" Community mom kelseylaite agrees, "Please consider getting IV fluids regularly if you're able!"
Once you're able to keep food down again, it's best to follow all of the same best practices that relieve less severe cases of morning sickness.
"Medical leave is a great idea," advises Community mom hkappy. "The more you can rest the better. I was much sicker whenever I had to go out places or do things."
What should you do if you have hyperemesis gravidarum during pregnancy?
Talk to your practitioner if your hyperemesis gravidarum symptoms are debilitating or even just concerning. Try to take it easy and care for yourself as best as you can.
Also be sure to talk to your practitioner if you're experiencing signs of anxiety or depression, which tend to be more common in pregnant women with hyperemesis gravidarum. You're not alone: For support from other moms who've been through it before, check out the HER Foundation.
"Just had a Zoom call with an HG support group through the HER Foundation. Highly recommend looking them up and joining them if you’re struggling," says Community mom BabyBaba. "It was so validating speaking with other women that are going through/have been through HG and truly understood the struggle."
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