Hyperemesis gravidarum is the most severe form of nausea and vomiting in pregnancy (NVP)  and is diagnosed in about 1 in 30-300 pregnancies. 

    Nausea and vomiting in pregnancy is common and happens in about 70-80% of pregnant women.  NVP occurs usually before 9 weeks of the pregnancy and fades away as the first trimester leads into the second trimester. The nausea and vomiting can feel severe, but there is a difference between having one bad day of nausea and vomiting and having the more serious and life-threatening condition of hyperemesis gravidarum.

    Hyperemesis gravidarum is often a medical emergency and requires hospital admission and treatment.  There is no single accepted definition of hyperemesis gravidarum. It is a diagnosis of exclusion, which means you need to exclude other medical conditions that may be associated with hyperemesis first before you make this diagnosis. Women are diagnosed as having hyperemesis gravidarum with the following symptoms:

    • significant weight loss (usually around 5% or more of total body weight),
    • dehydration (sometimes severe),
    • ketones in the urine
    • trouble completing normal, daily tasks.

    Hyperemesis gravidarum typically lasts until the second trimester of pregnancy, but there are cases where pregnant women suffer throughout the pregnancy.

    Medical Considerations and Treatment of Severe Morning Sickness

    If severe nausea and vomiting in pregnancy is a problem that lasts longer than a few weeks, your doctor should be notified of the symptoms and issues. You are usually evaluated for other medical conditions which may be associated with nausea and vomiting. Keep track of the foods and drinks you consume during the day and how many times you vomit. Also note how many times you use the bathroom or have a bowel movement each day. Diarrhea is common during pregnancy and can increase the effect of severe NVP leading to hyperemesis gravidarum.

    Medical professionals can offer advice on a proper pregnancy diet for severe morning sickness and prescribe medication to stop nausea. The cause of hyperemesis gravidarum is not known nor is the condition well understood. There are different theories of the etiology of nausea and vomiting in pregnancy which include:

    • Hormone stimulus
    • Psychologic disposition
    • Evolutionary adaptation

    In certain cases, treatment will require hospitalization for dehydration and malnutrition.

    Therapy For Severe Nausea and Vomiting

    Treatment of NVP begins with preventing it in the first place. Studies have shown that women who took a multivitamin at the time of conception were less likely to need medical treatment. The general recommendation is to start taking a prenatl vitamin at least 3 months prior to conception.

    Frequent small meals evry 1-2 hours to avoid a full stomach are recommended. Avoding spicy or fatty food, eating bland or dry food is recommended. A small study showed that eating protein instead of fat or carbohydrate may help.

    Another study showed that taking ginger capsules may improve nausea and vomiting.

    Pregnant women should keep crackers and water next to their bedside to consume before getting out of bed. It is also important not to drink when eating as this can increase nausea. Gentle foods like chicken broth or vegetable broth offer a good source of nutrition and tend to minimize nausea.

    Medications that may help include taking regularly up to 3-times a day  10 mg Vitamine B6 (pyridoxine) and 10 mg doxylamine and are considered to be safe.

    Treatment Recommendations for Nausea and Vomiting in Pregnancy

    1. Take a prenatal vitamin for 3 months before conception
    2. Treat nausea and vomiting of pregnancy with vitamin B6 or a combination of vitamin B6 plus doxylamine
    3. Ginger can help with decreasing the NVP symptoms
    4. Nausea and vomiting of pregnancy should be treated effectively to prevent progression to hyperemesis gravidarum
    5. Admission to the hospital and intravenous hydration may be necessary in dehydrated pregnant women who cannot tolerate oral liquids.