Hyperemesis gravidarum (HG) is an uncommon condition characterized by frequent, persistent, and severe vomiting and nausea during pregnancy. As a result, you may be unable to take in a sufficient amount of food and fluids. It can cause a weight loss of more than 5% of your pre-pregnancy body weight. This can also cause dehydration and vitamin and mineral deficiencies. Treatment may require hospitalization.
HG is a more severe form of nausea and vomiting of pregnancy (NVP), also called morning sickness. Morning sickness affects anywhere between 50% to 90% of pregnant women. HG is estimated to occur in 0.5%-2% of pregnancies.
There are many theories about the causes of HG, but none have been confirmed. HG is a complex disease that is likely caused by many factors. Some of these include:
The Brain May Be Cause of Nausea
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Some researchers have found that the following factors increase your chance of developing HG. If you have any of these risk factors, tell your doctor:
The following list of symptoms are general and may be caused by other, less serious health conditions. However, if you experience any one of them, call your physician to discuss your condition. Symptoms may include:
Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include the following:
Treating HG symptoms early in pregnancy can make you less sick in the long run and can decrease recovery time. Because HG is caused by many factors that vary among women, it is difficult to find a treatment that works for everyone. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Try to eat frequent, small meals, bland or dry foods, high-protein choices.
Reducing nausea, and thus allowing eating and drinking, will hasten recovery. Due to the risk of stating that a drug is safe for use during pregnancy, very few pharmaceutical manufacturers will say that their drugs are intended for a pregnancy condition like HG (examples: promethazine or prochlorperazine). However, doctors often recommend that women with HG take certain anti-nausea medicines, balancing the potential benefits and risks. Talk to your doctor about the right medicines for you.
A common and safe remedy is to take supplemental vitamin B6 (pyridoxine), to a maximum of 100 mg/day. The American Congress of Obstetricians and Gynecologists recommends that first-line treatment of nausea and vomiting of pregnancy should start with pyridoxine with or without doxylamine. Pyridoxine has been found to be effective in significantly reducing severe vomiting.
In urgent visit situations, HG can be managed by IV fluids and vitamins. This can sometimes be done without hospitalization. Very rarely, some people require IV fluids throughout the entire pregnancy.
If you are unable to tolerate food by mouth, you may need to receive nutrition by vein. This is called parenteral nutrition. A special kind of catheter is placed in a large vein and liquid nutrition is given. This can sometimes be done without hospitalization.
In extreme cases, induced abortion may be considered.
If you are diagnosed with HG, follow your doctor's instructions.
Many of the conditions that lead to HG are not preventable. It is unknown why some women without those conditions develop HG. You can try to reduce your nausea during pregnancy by:
The American Congress of Obstetricians and Gynecologists
Hyperemesis Education and Research Foundation
National Organization for Rare Diseases
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada (SOGC)
ACOG issues guidance on the treatment of morning sickness during pregnancy. American College of Obstetrics and Gynecology website. Available at: http://www.acog.org/About_ACOG/News_Room/News_Releases/2004/ACOG_Issues_Guidance_on_Treatment_of_Morning_Sickness_During_Pregnancy. Accessed August 20, 2011.
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Last reviewed September 2012 by Andrea Chisholm
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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