Hyperemesis gravidarum: essential facts to know

Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy that is much worse than normal morning sickness. It only affects one per cent of pregnancies and is diagnosed by the presence of three features:

1. Nausea and vomiting that do not resolve

2. A significant weight loss (5% of body weight)

3. Dehydration (blood abnormalities).

It usually improves by 16 to 20 weeks, but can unfortunately last throughout the whole pregnancy for some people. This is why it is so important to see the doctor and get it under control as best as you are able.

The symptoms are thought to correlate with raised levels of the pregnancy hormone (BHCG). It is therefore more common in multiple pregnancies (for example, twins) where pregnancy hormones reach higher levels. It is also more common in women who have had a prior history of the condition in earlier pregnancies.

As long as hyperemesis gravidarum is managed appropriately and is well-controlled, it is not thought to have a big impact on the health of your baby.

Most women with hyperemesis are able to be managed at home with the use of anti-sickness medication, rest and a change in lifestyle measures. Medications commonly used include promethazine, cyclizine, metocholopramide and prochlorperazine.

Sometimes hospital admission may be required. Usually this is because you are not keeping down fluids or anti-sickness medication and need a bit of extra help. In hospital, you may be given intravenous fluids and anti-sickness medication by injection too. They will also keep a close eye on your blood tests to see what other treatment you need. Sometimes, you need this time in hospital to get back on top of your symptoms.

Ongoing sickness and nausea can have a big impact on whether you enjoy the pregnancy and your mood in general. Do keep an eye on your mood, especially if the hyperemesis is prolonged. This is so important. If you feel you are struggling, or you are getting low or depressed, please do ask for help.

When to consult your doctor:

  • If the sickness is unrelenting
  • If you cannot keep fluids down (a minimum of 500 ml a day) and are getting dehydrated
  • If you have lost a lot of weight
  • Or you are worried for any other reason.
Hyperemesis is a very hard condition to have during pregnancy, and can really impact on your quality of life and those around you in the short term. The important thing is to get help early to manage it. This will make the pregnancy that little bit more comfortable.

RCOG - Green-top Guideline 69 - Nausea, Vomiting and Hyperemesis in Pregnancy

Dr Jennifer Kelly is a GP and founder of the Grace Kelly Ladybird Trust (for awareness and research into childhood cancers).


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