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Hyperemesis gravidarum

Definition

Hyperemesis gravidarum is extreme, persistent nausea and vomiting during pregnancy. It can lead to dehydration, weight loss, and electrolyte imbalances.

Alternative Names

Nausea - persistent - in pregnancy; Vomiting - persistent - in pregnancy

Causes

Most women have some nausea or vomiting (morning sickness), particularly during the first 3 months of pregnancy. The cause of nausea and vomiting during pregnancy is believed to be a rapidly rising blood level of a hormone called human chorionic gonadotropin (HCG). HCG is released by the placenta.

Women with hyperemesis gravidarum have extreme nausea and vomiting during pregnancy. It can cause a weight loss of more than 5% of body weight. The condition can happen in any pregnancy, but is a little more likely if you are pregnant with twins (or more babies), or if you have a hydatidiform mole.

Symptoms

Symptoms of hyperemesis gravidarum are:

  • Severe, persistent nausea during pregnancy
  • Salivating a lot more than normal
  • Weight loss
  • Dehydration
  • Light-headedness, weakness, headaches, or fainting
  • Constipation

Exams and Tests

Your health care provider will do a physical exam. Your blood pressure may be low. Your pulse may be high.

The following laboratory tests will be done to check for signs of dehydration:

Your provider may need to run tests to make sure you do not have liver and gastrointestinal problems.

A pregnancy ultrasound will be done to see if you are carrying twins or more babies. Ultrasound also checks for a hydatidiform mole.

Treatment

If your nausea and vomiting causes you to become dehydrated, you will receive fluids through an IV. You also may be given anti-nausea medicine. If nausea and vomiting is so severe that you and your baby might be in danger, you will be admitted to the hospital for treatment. If you can't eat enough to get the nutrients you and your baby need, you may get extra nutrients either through an IV or a tube placed into your stomach.

To help manage symptoms at home, try these tips.

Avoid triggers. You may notice that certain things can trigger nausea and vomiting. These may include:

  • Certain noises and sounds, even the radio or TV
  • Bright or blinking lights
  • Toothpaste
  • Smells such as perfume and scented bathing and grooming products
  • Pressure on your stomach (wear loose-fitting clothes)
  • Riding in a car
  • Taking showers

Eat and drink when you are able. Take advantage of the times you feel better to eat and drink. Eat small, frequent meals. Try dry, bland foods such as crackers or potatoes. Try eating any foods that appeal to you. See if you can tolerate nutritious smoothies with fruits or vegetables.

Increase fluids during times of the day when you feel least nauseated. Seltzer, ginger ale, or other sparkling drinks may help.

Vitamin B6 (no more than 100 mg daily) has been shown to decrease nausea in early pregnancy. Ask your health care provider if this vitamin might help you. Another medicine called doxylamine (Unisom) has been shown to be very effective and safe when combined with Vitamin B6 for nausea in pregnancy. You can buy this medicine without a prescription.

Outlook (Prognosis)

Severe nausea and vomiting may start between 4 and 8 weeks of pregnancy and often goes away by weeks 14 to 16. Some women will continue to have nausea and vomiting for their entire pregnancy. With proper identification of symptoms and careful follow-up, serious complications for the baby or mother are rare.

Possible Complications

Severe vomiting is harmful because it leads to dehydration and poor weight gain during pregnancy. Rarely, a woman may have bleeding in her esophagus or other serious problems from constant vomiting.

The condition can make it difficult to continue to work or take care of yourself. It can cause anxiety and depression in some women that lingers after the pregnancy.

When to Contact a Medical Professional

Call your health care provider if you are pregnant and have severe nausea and vomiting.

References

Cappell MS. Hepatic and gastrointestinal diseases. In: Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 45.

Gordon A, Platt J. Nausea and vomiting in pregnancy. In: Rakel D, ed. Integrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 52.

Ferri F. Hyperemesis gravidarum. In: Ferri FF, ed. Ferri's Clinical Advisor 2015. Philadelphia, PA: Elsevier Mosby; 2014:section I.

Kelly TF, Savides TJ.  Gastrointestinal disease in pregnancy. In: Creasy RK, RResnik R, Iams JD, Lockwood CJ, Moore TR, Greene MF. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 7th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 62.

Review Date:12/30/2015
Reviewed By:Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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