Frequently Asked Questions for family and friends who know a mother with hyperemesis gravidarum
The exact cause of HG is still not fully understood and many theories exist. It is, however, a real disease. Too little research has been done, and that which is done is often inconclusive, inclusive of a small number of women, or only identifies commonality among half of research participants. What is known is that hormonal changes, dehydration, nutritional deficiencies, and the overall stress on the body’s chemistry and functioning contribute to nausea and vomiting in pregnancy.
The cause is likely due to several factors that may differ for each woman. Some women may be more likely to vomit due to genetic differences. It is not a woman's fault, and she cannot control whether or not she vomits, nor can she control the severity of her nausea or her response to treatment. Vomiting is often triggered by a place in the brain known as the vomiting center. It may also be stimulated by changes in the stomach and intestines that are caused by pregnancy such as slowed transit of food. Emotional distress may worsen symptoms, but is not the cause. Some causes of hyperemesis are related to the various hormonal changes of pregnancy to which some women are more sensitive, and malnourishment increases her sensitivity. Some known contributors include the following:
- Altered sense of taste
- Sensitivity of the brain to motion
- Food leaving the stomach more slowly
- Increased sense of smell
- Insufficient fluids or nutrition
- Rapidly changing hormone levels during pregnancy
- Stomach contents moving back up from the stomach
- Physical and emotional stress of pregnancy on the body
- Vitamin deficiencies
- Genetic differences
- Thyroid changes
- Immune dysfunction
Studies vary, but most find that women have a good chance of experiencing HG in future pregnancies. Statistics suggest 50-85% will have it with every pregnancy, and those with more than one experience of HG have a greater risk of HG in future pregnancies. It also seems to occur in similar patterns and severity, though it is not always consistent and may worsen each time. Those with mothers, grandmothers, or sisters who had HG will usually have some nausea and vomiting during pregnancy, and are at much higher risk of HG.
Read more about Risks and Outcomes
In most women, it will begin within 2-5 weeks after conception, and peak around 8-10 weeks. The nausea/vomiting will generally ease after 14 weeks and may mostly resolve by 20 weeks. However, about 10-20% of these women will find nausea and vomiting last until delivery, though it is usually less severe. If a woman had HG in previous pregnancies, it will often follow a similar pattern of duration and severity, but may worsen each time or, rarely, skip a pregnancy.
Due to the risk of stating a medication is safe for use during pregnancy, few if any drug manufacturers will say their drugs are intended for use during pregnancy or for a pregnancy condition such as HG. However, due to the misery and complications women with HG face, physicians will often treat it with medications deemed safe due to their history of being used for pregnancy nausea and vomiting (e.g. Compazine, Phenergan, Unisom).
It is unfortunate that many health professionals will only consider the older medications, as they are often found to be less effective than newer medications (Zofran, Kytril, Reglan). This is especially true for those with moderate to severe HG. Newer medications are not necessarily unsafe, they just don't have as many studies to demonstrate their safety. The risk of treating a mother with drugs that are most effective is often less risky than not treating her or treating her with ineffective medications. Chronic dehydration and malnutrition worsen her symptoms and can adversely affect the baby.
Above all, know that effectively treating symptoms early in pregnancy can make a woman less sick and decrease the time it takes to recover. Delaying treatment until she has been vomiting for several weeks makes it harder to control the vomiting cycle. You have the right to adequate health care. Consult with another health professional and advocate for her if she is very sick and not improving. If she loses more than 10% of her pre-pregnancy weight and her doctor is unwilling to give her effective medications or other treatments such as IV fluids with IV vitamins, talk to a high-risk obstetrician or perinatologist.
Our Referral Network lists health professionals recommended by other women with HG or those who have requested to be included. You will also find information on how to find a practitioner experienced in treating HG if one is not listed in your area.
Read more about Treatment Options
First of all, understand that she is really sick and no one except those who have had HG will truly understand what she is experiencing. You may have a better idea if you imagine having food poisoning for weeks (or months). Most people know how miserable and exhausting just a day or two of that is.
Also, keep in mind that women become isolated due to being so ill, and may become depressed and anxious, if not traumatized, especially if HG persists or is very severe. This is not uncommon and not her fault. If she feels depressed, discuss medication or try natural treatments. Some antidepressants have been approved for use during pregnancy, though some need to be discontinued prior to delivery.
- Support Groups
Find others who have experienced HG and read their stories. It can be very helpful to read how others have coped and better understand the reality of HG.
- Survival Tips
Print out or refer to our Survival Guide pages for information on HG and how you can help. Remember, you may never completely understand, but you can be supportive and make a difference.
Read the pages on coping for tips on dealing with the added stress and responsibility.
How You Can Help HER
Review information specifically for family members and friends on how you can best help a mother with HG cope and survive.
If she is vomiting more than a few times a day and losing weight, she might have HG. If she cannot keep enough water down to stay hydrated, is vomiting bile or blood, and has lost more than 1-2 pounds (0.45-0.9 kg) in a week, she likely has HG. Women with HG often have great difficulty taking care of their normal responsibilities and/or going to work for weeks or months. In more severe cases, they may have trouble even caring for themselves, such as showering and preparing any food. Medical intervention is critical for these women.
|Morning Sickness||Hyperemesis Gravidarum|
|You lose little if any weight.||You lose 5-20 pounds or more. (> 5% of prepregnancy weight).|
|Nausea and vomiting rarely interfere with your ability to eat or drink enough each day.||Nausea and vomiting cause you to eat very little and get dehydrated if not treated.|
|You vomit infrequently and the nausea is episodic but not severe. You have significant discomfort and misery.||You vomit, or feel the need to, often and may vomit bile or blood if not treated. Nausea is usually moderate to severe and constant.|
|Traditional remedies like diet or lifestyle changes are enough to help you feel better most of the time.||You will probably require fluid hydration through an IV and/or medications to ease your symptoms.|
|You typically improve after the first trimester, but may be queasy at times throughout pregnancy.||You usually feel some relief by mid-pregnancy, but may be nauseous and/or vomit until late pregnancy.|
|You will be able to work most days and care for your family, though less than usual at times.||You will likely be unable to work for weeks or months, and may need help just caring for yourself.|
|You may feel a bit depressed at times, especially if you have more severe nausea, but are able to be your usual self most of the time. You will likely forget most of the unpleasantness after delivery.||You may feel anxious about what lies ahead if you had HG before. You will likely become depressed due to misery and physical depletion. More severe HG often is traumatic and may impact you for years to come.|
If she cannot keep more than a very small amount of food or water down for 24 hours or more, loses 2 or more pounds (0.9 kg) in one week, vomits blood, faints, or generally feels very unwell, call her practitioner. If she has several of these symptoms and it is after working hours, you may need to take her to an emergency or urgent care center.
You can buy Ketostix at a local pharmacy without a prescription. These test her level of starvation. If she has ketones in her urine (the test is positive), she will need to get fluids through an intravenous (IV) line. Ketones may be harmful to the baby and mom if not treated. If she has been vomiting for 2-3+ weeks and eating very little, she will also need vitamins in her IV. Often this is forgotten, so make sure you ask about it! B-vitamins are most critical as they are depleted rapidly by vomiting and lack of eating and depletion can result in life-threatening complications. Remember, dehydration and malnutrition worsen nausea and vomiting and should be monitored closely.
Call a health professional if she experiences any of the following:
- Abdominal pain, bleeding, or cramping
- Difficulty thinking or focusing
- Difficulty walking or talking
- Extreme fatigue and very low energy
- Little if any food or fluids stay down for over 24 hours
- Little saliva and a dry mouth
- Moderate or severe headache and/or fever
- Muscular weakness or severe cramping
- Repeated vomiting or retching daily
- Severe nausea that keeps you from eating/drinking
- Shortness of breath or dizziness
- Urination is infrequent (over 8 hours) and minimal amount
- Urine is dark yellow and concentrated
- Visual disturbances, or fainting
- Vomit is red with blood or yellow with bile
- Weight loss of 2 pounds (0.9 kg) or more in a week
Since the exact cause is not known and is likely due to more than one factor, it is not preventable. However, the symptoms are often more manageable and less severe if adequate treatment is given early in pregnancy. Sometimes women find HG may be less severe if they plan ahead and prepare for pregnancy. This includes eating very healthy, taking quality antioxidants and prenatal vitamins for several months, and making sure she is in the best health possible. Underlying conditions such as gall bladder disease can worsen HG. Finding a health professional experienced in treating HG and who knows her history is crucial. Make a plan based on what worked for her last pregnancy and find a health professional willing to give her whatever care she needs.
Read more about Preparing for HG
In most cases, women who lose weight during their first trimester have normal babies. Adequate nutrition is important for the baby, but fetal requirements are minimal during the first few months. Her body should have sufficient stores for the baby during this time. High-quality vitamins can be helpful, but those with HG often cannot tolerate them, especially if they contain iron. Studies show vitamins are critical during the months prior to pregnancy and up to about 6 weeks gestation. This is when the risk of miscarriage is great and the spine is forming, and often when HG is least severe. Folic acid and antioxidant requirements are high at this point. Encourage her to take high quality vitamins as long as she can. She can try sublingual (under the tongue) forms of vitamins (especially B and folic acid) that can be ordered online or found at some health food stores. If she is admitted for IV fluids, make sure a multivitamin is added to her fluids, especially if she has been vomiting frequently for more than 2 weeks. This is not routinely done, unfortunately.
The risk to the baby is greatest if the mother is dehydrated for extended periods of time, loses 10% or more of her pre-pregnancy weight and does not receive vitamins or other nutritional support, or fails to gain weight for 2 consecutive trimesters. Obviously, if the mother develops other complications, they also present an increased risk. Most studies, however, show that women with hyperemesis have normal babies unless they are severely ill and receive little treatment.
There is always a risk with any medication taken during pregnancy. However, medications most often prescribed typically present less risk to the mother and child than chronic dehydration and lack of nutrition. The risk decreases after the first trimester or around 10 weeks, but if vomiting is left uncontrolled until then, the stress on the body is great and it is much more difficult to stop the vomiting. These women are then at greater risk for complications and a prolonged recovery. They often will have great difficulty caring for themselves and their family for months. Medications are often more effective if started early because there are fewer nutritional deficiencies and the mother is in better overall health. It can be compared to pain control. Most health professionals know that when pain medicine is given early for pain, rather than later, the pain is easier to control. The same holds true with vomiting. The consequences and complications are typically less if the nausea and vomiting are controlled earlier than later.
Read more about Medication Safety