Severe vomiting in pregnancy
Medical treatment can include:
Severe Morning Sickness (Hyperemesis Gravidarum)
During the first trimester of pregnancy, many women have the bouts of nausea and vomiting known as morning sickness.
Despite its name, morning sickness can happen day or night. It usually starts around the 6th week of pregnancy, is at its worst around week 9, and stops by weeks 16 to 18. Although unpleasant, morning sickness is considered a normal part of a healthy pregnancy.
What’s Severe Morning Sickness?
Severe morning sickness is when nausea and vomiting get so serious that a pregnant woman vomits several times a day, loses weight, and gets dehydrated or is at risk for dehydration.
If this rare pregnancy-related condition isn’t treated, it can affect a woman’s health and her baby’s ability to thrive.
The medical term for severe morning sickness is “hyperemesis gravidarum” (hi-per-EM-eh-sis grav-ih-DARE-um), which means “excessive vomiting during pregnancy.” It usually follows a similar timeline to normal morning sickness. But it can go longer, sometimes lasting for the whole pregnancy. Often, the symptoms get less severe as the pregnancy continues.
Most cases of hyperemesis gravidarum affect a woman’s first pregnancy. But women who have it in one pregnancy are more likely to have it in future pregnancies.
What Causes Severe Morning Sickness?
The cause of severe morning sickness isn’t known. But it might be related to the hormone changes of pregnancy. A hormone called human chorionic gonadotropin, or HCG, might be to blame because severe morning sickness most often happens when HCG levels are at their highest in a pregnant woman’s body.
Severe morning sickness also might run in families. It’s more common in women whose close family members (such as mothers and sisters) have had it.
Other things that can increase a woman’s chances of having severe morning sickness include:
- carrying multiples (twins, triplets, etc.)
- history of motion sickness
- migraine headaches with nausea or vomiting
What Problems Can Happen?
The nausea and vomiting that happen in severe morning sickness are so extreme that they can harm the mother and the baby. Not being able to keep down food makes it hard for the mom to meet her nutritional needs. So she might lose weight. And a loss of fluids, combined with the loss of stomach acid from vomiting, can cause dehydration and electrolyte imbalances.
If severe morning sickness isn’t treated, it can cause many problems, including organ failure and the early birth of her baby.
When Should I Call the Doctor?
Call the doctor right away if you’re pregnant and have any of these symptoms:
- nausea that lasts throughout the day, making it impossible to eat or drink
- vomiting three to four times per day or not being to keep anything in the stomach
- brownish vomit or vomit with blood or streaks of blood in it
- weight loss
- fainting or dizziness
- peeing less than usual
- a fast heart rate
- a lot of headaches
- unpleasant, fruity mouth or body odor
- extreme tiredness
- confusion
How Is Severe Morning Sickness Treated?
Treatments used for morning sickness, such as eating dry crackers in the morning or a bland diet, may be recommended for women with extreme morning sickness. But these might not help with severe symptoms.
Medical treatment can include:
- a short period of not eating to rest the gastrointestinal system
- intravenous (IV) fluids
- vitamin and nutritional supplements
Some women might get medicine to stop the vomiting, either by mouth or through an IV. The doctor might recommend eating foods with ginger or taking vitamin B6 supplements to help ease nausea. It can also help to:
- Eat a bland diet.
- Eat frequent small meals.
- Drink plenty of liquids when not feeling nauseated.
- Avoid spicy and fatty foods.
- Eat high-protein snacks.
- Avoid sensory stimuli that can act as triggers (like specific smells or noises).
If a woman feels anxious or depressed about her condition, talking to a therapist or counselor might help her cope with her feelings.
What Else Should I Know?
With treatment, women with severe morning sickness can feel better and get the nourishment they need so they and their babies thrive. And lifestyle changes can help ease nausea and vomiting and make the pregnancy more enjoyable.
With time, symptoms usually do improve. And, of course, they stop by the time a woman’s next journey starts: parenthood.
Severe vomiting in pregnancy
Sickness in pregnancy (sometimes called morning sickness) is common. Around 8 out of every 10 pregnant women feel sick (nausea), are sick (vomiting) or both during pregnancy. This does not just happen in the morning.
For most women, this improves or stops completely by around weeks 12 to 20, although for some women it can last longer.
Some pregnant women experience very bad nausea and vomiting. They might be sick many times a day and be unable to keep food or drink down, which can impact on their daily life.
This excessive nausea and vomiting is known as hyperemesis gravidarum (HG), and often needs hospital treatment.
Exactly how many pregnant women get HG is not known as some cases may go unreported, but it’s thought to be around 1 to 3 in every 100.
If you are being sick frequently and cannot keep food down, tell your midwife or doctor, or contact the hospital as soon as possible. There is a risk you may become dehydrated, and your midwife or doctor can make sure you get the right treatment.
Symptoms of hyperemesis gravidarum
HG is much worse than the normal nausea and vomiting of pregnancy.
Signs and symptoms of HG include:
- prolonged and severe nausea and vomiting
- dehydration – symptoms include feeling thirsty, tired, dizzy or lightheaded, not peeing very much, and having dark yellow and strong-smelling pee
- weight loss
Unlike regular pregnancy sickness, HG may not get better by 16 to 20 weeks. It may not clear up completely until the baby is born, although some symptoms may improve at around 20 weeks.
See your GP or midwife if you have severe nausea and vomiting. Getting help early can help you avoid dehydration and weight loss.
There are other conditions that can cause nausea and vomiting, and your doctor will need to rule these out first.
What causes hyperemesis gravidarum?
It’s not known exactly what causes HG, or why some women get it and others do not. There is evidence that it is linked to the changing hormones in your body that occur during pregnancy.
There is some evidence that it runs in families, so if you have a mother or sister who has had HG in a pregnancy, you may be more likely to get it yourself.
If you have had HG in a previous pregnancy, you are more likely to get it in your next pregnancy than women who have never had it before, so it’s worth planning in advance.
Treating hyperemesis gravidarum
There are medicines that can be used in pregnancy, including the first 12 weeks, to help improve the symptoms of HG. These include anti-sickness (anti-emetic) drugs, steroids, or a combination of these.
You may need to try different types of medicine until you find what works best for you.
You can visit the Bumps website to find out which medicines are safe to use in pregnancy.
If your nausea and vomiting cannot be controlled, you may need to be admitted to hospital. This is so doctors can assess your condition and give you the right treatment to protect the health of you and your baby.
Treatment can include intravenous fluids, which are given directly into a vein through a drip. If you have severe vomiting, the anti-sickness drugs may also need to be given into a vein or a muscle.
The charity Pregnancy Sickness Support has information and tips on coping with nausea and vomiting, including HG.
Will hyperemesis gravidarum harm my baby?
HG can make you feel very unwell, but it’s unlikely to harm your baby if treated effectively.
However, if it causes you to lose weight during pregnancy, there is an increased risk that your baby may be born smaller than expected (have a low birthweight).
How you might feel
The nausea and vomiting of HG can impact your life at a time when you were expecting to be enjoying pregnancy and looking forward to the birth of your baby.
It can affect you both emotionally and physically. The symptoms can be hard to cope with. Without treatment HG may also lead to further health complications, such as depression or tears in your oesophagus.
Severe sickness can be exhausting and stop you doing everyday tasks, such as going to work or even getting out of bed.
In addition to feeling very unwell and tired, you might also feel:
- anxious about going out or being too far from home in case you need to vomit
- isolated because you do not know anyone who understands what it’s like to have HG
- confused as to why this is happening to you
- unsure about how to cope with the rest of the pregnancy if you continue to feel very ill
If you feel any of these, do not keep it to yourself. Talk to your midwife or doctor, and explain the impact HG is having on your life and how it is making you feel. You could also talk to a partner, family members and friends if you want to.
If you want to talk to someone who has been through HG, you can contact Pregnancy Sickness Support’s help section. They have a support network across the UK and can put you in touch with someone who has had HG.
Bear in mind that HG is much worse than regular pregnancy sickness. It is not the result of anything you have or have not done, and you do need treatment and support.
Another pregnancy
If you have had HG before, it’s likely you will get it again in another pregnancy.
If you decide on another pregnancy, it can help to plan ahead, such as arranging child care so you can get plenty of rest.
You could try doing things that helped last time.
Talk to your doctor about starting medicine early.
Blood clots and hyperemesis gravidarum
Because HG can cause dehydration, there’s also an increased risk of having a blood clot (deep vein thrombosis), although this is rare.
If you are dehydrated and immobile, there is treatment that you can be given to prevent blood clots.
