Recovering from hyperemesis gravidarum (HG) takes an average of 4-6 months but may take a few years if her illness was severe or prolonged. Some women will have residual issues long-term, sometimes with vague or atypical immune or gastrointestinal symptoms that are difficult to resolve.
Women who have nausea/vomiting into late pregnancy usually find it takes months to regain their energy and restore their nutritional reserves. Food aversions may persist and take months or even years to overcome.
It will often take 1-2 months of recovery for every month she was malnourished or debilitated by HG.
Any additional complications during pregnancy should be re-evaluated postpartum by a primary care doctor to ensure complete recovery.
Families need to be aware of common postpartum issues and their symptoms to ensure women get the care they need. A mother’s health greatly impacts the development of her child(ren).
For most with HG that lasts until delivery, you can eat some food intermittently. However, for a few, severely restricted food for more than a few weeks late in pregnancy puts you at risk for refeeding syndrome which can have disastrous consequences on the mother including cardiac issues. Medical monitoring and possible hospital care may are required for refeeding syndrome. See our Malnutrition section for more information.
Risks of refeeding occur if
- You have significant, ongoing weight loss or severely restricted eating in late pregnancy or near delivery, and
- You eat significantly higher volumes of food (calories) suddenly.
This can cause a shift in your body where you suddenly retain fluids and have rapid electrolyte shifts. This is dangerous. Gradual introduction of food and lab monitoring may be needed for those at risk of refeeding syndrome.
Many children born to HG mothers have reflux or severe colic, and are notoriously fussy, poor sleepers, and may have sensory processing issues. Thus, they make recovery more challenging. Extra support and rest are crucial for the new mother.
Breastfeeding mothers will need a very healthy diet that is nutrient dense, with high quality multi-vitamin supplements, including additional B vitamins (esp thiamin) and fatty acids to restore deficiencies which may adversely impact her and her baby.
Nutrition is extremely important postpartum to correct months of deficiencies due to food aversions and nausea/vomiting. This is especially true if the mother is breastfeeding because her deficiencies can affect the child’s health. If a mother is eating extra calories and nutrient dense foods, she should not be adversely impacted by breastfeeding.
A healthy diet rich in unprocessed foods is important, along with additional support from high quality prenatals or multivitamins. Postpartum, women will need to replenish nutrient stores by eating a whole foods diet with plenty of complex carbohydrates (e.g. brown rice, quinoa, sweet potatoes), quality proteins (e.g. grass-fed beef, antibiotic-free chicken), fruits, and vegetables. This is especially true if breastfeeding and/or hyperemesis was severe/prolonged.
- Calcium from enriched whole milk products (or non-dairy sources), leafy green veggies, broccoli, nuts, quinoa, etc. is important to rebuild lost bone and tooth density.
- Smoothies with whole fruit, added fatty acids, superfoods, and protein powder or nuts can provide extra nutrients for breastfeeding.
- Quality prenatal vitamins and extra minerals, plus B complex vitamins are very important to restore deficiencies.
- Fermented foods or probiotics are especially helpful for the immune and gastrointestinal system during recovery and until the infant is weaned.
The baby will benefit greatly from breastfeeding and your high quality diet as he/she is likely to have some nutritional imbalances due to HG.
Offsite Info: What to Expect: Postpartum Nutrition
Thyroid changes are very common during pregnancy and postpartum. Women with HG often have thyroid disease or genetic thyroid abnormalities that may contribute to the severity of HG. She may need to be evaluated by an endocrinologist (a doctor specializing in care of glands such as the thyroid), especially if she has tested abnormally for thyroid levels in the past or during pregnancy. Interpreting results during pregnancy can be difficult. Mothers treated for thyroid disease/dysfunction during pregnancy, should notify their pediatricians. Some infants born to moms with thyroid disease have imbalances as well.
Women with untreated thyroid disease may be at greater risk for depression after delivery. Testing is done by a simple blood test and should be considered for women who have HG and postpartum depression.
After months of illness and complications, many women develop perinatal mood and anxiety disorders (PMADs) that may persist and require treatment. Many women even have symptoms of trauma or full criteria Posttraumatic Stress Disorder (PTSD). Be aware of the symptoms as women often don’t realize they need help while consumed by caring for their new baby(ies). These symptoms may not be noticeable for a month or two postpartum.
For women with severe postpartum mental health symptoms, medications may be required. These include antidepressants, anti-anxiety medications, and when necessary, antipsychotic medications. Most importantly, during the first year postpartum, get professional help for signs of PMADs and Posttraumatic Stress Disorder (PTSD) as the health of the mother affects her and her child as well.
Further, in those with severe symptoms or a history of trauma and high levels of stress, HG can lead to post-traumatic stress symptoms that may last for years. Recovery takes time, so it is important to seek professional help as needed and consider treatments like EMDR or Brainspotting, especially before beginning another pregnancy.