More About Severe Morning Sickness and HG (hyperemesis gravidarum)
“Do I have Morning Sickness or HG (hyperemesis gravidarum)?”
Morning sickness, technically known as “nausea and vomiting of pregnancy” is not a sickness and not even always in the morning. According to the American College of Obstetricians and Gynecologists, up to 80% of pregnant patients experience nausea and 50% experience vomiting. Women often ask if they have hyperemesis gravidarum (HG) or severe morning sickness. According to the HER Foundation, “Early in pregnancy, it may be difficult to know because HG may develop gradually.” Use this scientifically validated test to help determine the severity of your symptoms. If you are vomiting long after the first trimester, losing weight, or are having difficulty doing your normal daily routine due to vomiting, you likely have HG.
With so many pregnant people having nausea and vomiting, there is a movement in the world of birth care givers to move away from calling morning sickness an actual “sickness.” It’s not really a sickness, though the suffering it causes can be tremendous. Nausea and vomiting in pregnancy is a normal, though very uncomfortable, experience of pregnancy. Most nausea and vomiting occurs in the morning, but it can happen throughout the day. Most people experience symptoms only during the first trimester, but some can experience it the entire pregnancy. Some people experience mild to moderate nausea and vomiting and some suffer from debilitating nausea and vomiting. When patients suffer due to nausea and vomiting, they likely have HG.
HG, on the other hand, is not morning sickness. It lasts longer, is more debilitating, and has more significant consequences. HG typically continues into the second trimester, and there is usually weight loss more than 5 pounds from the pre-pregnancy weight. People with HG often have consistent and unrelenting nausea despite multiple treatments.
The HER foundation recommends if you are dehydrated (can’t keep food or liquids down for more than 12 hours), or are losing 1-2 pounds a week, that you should find a health care professional who understands HG management. The physician at our clinic has experience treating HG and can work in tandem with your pregnancy health care provider to get you on a treatment plan to get you feeling better.
Delaying treatment or care for severe morning sickness can cause it to progress to HG. Delaying care in severe morning sickness cases increases risk to both yourself and your baby from dehydration and malnutrition. There are many treatments that have been used to treat severe morning sickness and HG in pregnancy, and research finds little if any increased risk to your baby throughout your pregnancy.
If you are suffering from nausea and vomiting of pregnancy, make an appointment to get evaluated at our clinic so that we can answer all your questions and develop a treatment plan to get you feeling better.
Early intervention can prevent severe morning sickness from becoming HG
Following a nausea and vomiting treatment plan reduces the severity, suffering, and stress of hyperemesis gravidarum. Studies show early treatment can prevent progression to severe HG.
Why do people get morning sickness and HG?
“Normal” nausea and vomiting may be related to changing hormones from pregnancy. Some nausea and occasional vomiting is normal, as almost half of pregnant people experience vomiting. But severe nausea and vomiting to the point that it’s effecting your daily life, that’s not normal. Thanks to research by Dr. Marlena Fejzo and The HER Foundation, we now know that there is a genetic component to hyperemesis gravidarum. GDF-15, a protein that helps the placenta mature, is overproduced in patients with HG, and it causes severe nausea and vomiting.
What are the risks of morning sickness and HG for me and our baby?
Patients with HG and severe nausea and vomiting can have physical, social, and psychological effects. Electrolytes such as potassium, sodium, and calcium are lost in vomit and/or are not absorbed when you are not eating well. Same with certain important vitamins, such as folic acid, which is important in early fetal development. Lightheadedness, dark colored urine, general weakness, heart palpitations, and dry mouth are common with dehydration. Pregnant HG patients can develop severe vitamin deficiencies that can result in brain and/or heart damage. There are other risks including kidney injury, injury to the GI tract from prolonged vomiting, and debilitation from prolonged bedrest, to name a few. Socially, many HG patients feel isolated when they are unable to participate in community settings due to vomiting and just feeling terrible. Loss of time at work leads to decreased income, and loss of time with friends leads to decreased happiness. It’s not surprising that pregnant people experiencing severe nausea and vomiting have higher depression and anxiety scores, and many experience PTSD from their illness.
Risk to the baby is directly related to the severity for the mother. For mild to moderate symptoms, risk to the baby is very low, and some scientific evidence shows that women with typical nausea and vomiting of pregnancy actually have lower rates of miscarriage. No evidence exists saying that there are any fetal abnormalities caused by mild to moderate vomiting in pregnancy.
There is growing evidence that hyperemesis gravidarum can lead to low birth weight, premature birth, and other neuro-developmental issues such as autism. Pregnancies with severe HG and weight loss have a 30% chance of miscarriage. For more on complications of HG, visit the HER Foundation’s website.
Signs of severe morning sickness or hyperemesis gravidarium
Use this test to determine the severity of your symptoms
Debilitating, near constant nausea and vomiting
Chronic ketosis and dehydration (we can run lab tests during your appointment at The Morning Sickness clinic that will tell us if you are in ketosis, as well as your level of dehydration)
Muscle weakness
Inability to take care of yourself (such as taking a shower, preparing a meal)
Weight loss or very little weight gain during your pregnancy
If your morning sickness doesn’t subside by roughly 14 weeks of your pregnancy
How is Hyperemesis Gravidarum treated?
HG treatment is complicated and depends on the severity of symptoms. Most suffering from HG require frequent visits to the doctor, ER, hospital, or home health. Infusions of vitamins and IV fluids, and multiple nausea treatments on a set schedule and given in a variety of ways. Some will require total parenteral nutrition, or all of your vitamins, nutrients, and calories through an IV. Some require feeding the intestines through a tube inserted in the nose or in the stomach/jejunum.
How much vomiting is too much when you are pregnant?
There is no accepted guideline for how much vomiting is too much. If you are suffering during your pregnancy from nausea and vomiting, come see us at the Morning Sickness Clinic. Recommendations from the American College of OB/GYNs say that if you have not held down fluids for more than 12 hours, you are becoming dehydrated and should be evaluated. If you experience lightheadedness, dry mouth, decreased urination/dark urine, or generalized weakness in the setting of nausea and vomiting, you are likely dehydrated and need to discuss your symptoms with a qualified healthcare provider.
Besides morning sickness, is there anything else that could be causing my nausea and vomiting?
Yes, many things cause nausea and vomiting, and you should keep a close eye on your symptoms. If you develop any significant abdominal pain, besides mild pain in your upper abdomen after vomiting, you should seek urgent medical attention. Any fever, weakness isolated to any one arm or leg, severe headache, difficulty breathing, or chest pain should warrant urgent evaluation.
I can’t keep anything down because of vomiting. What do I do?
If you have not held down anything in 12 hours, you need to talk to your pregnancy health care provider or come visit The Morning Sickness and HG Clinic. After a few days of severe vomiting, you can start having other serious symptoms from dehydration, and you are not taking in adequate vitamins for your pregnancy. Please contact us and we will try to get you in as soon as we can. Our physician can evaluate you and make a care treatment plan to try and alleviate the nausea and vomiting.
When should I go to the emergency room for HG or morning sickness?
If you have high fever, severe abdominal pain, chest pain, passing out for no reason, heavy bleeding, shortness of breath, weakness in one part of the body, or other sudden symptoms, you should be evaluated in the emergency room at a hospital. The Morning Sickness and HG Clinic is equipped for fluid infusions and management of nausea and vomiting of pregnancy and HG, but not for evaluation for things like appendicitis, gall bladder disease, blood clots, or other possible life threatening illnesses. You can also contact your pregnancy health care provider for their recommendations.
