Severe vomiting during pregnancy (hyperemesis gravidarum)

Hyperemesis gravidarum (HD) refers to severe nausea and vomiting experienced during pregnancy. It more severe than morning sickness and makes it difficult to eat and drink enough. Untreated, it can lead to weight loss, malnutrition (Opens in new tab) and dehydration (Opens in new tab) can significantly affect your quality of life.

The main symptoms of HG are severe, persistent nausea (Opens in new tab) and vomiting (Opens in new tab). It may not improve with simple remedies used for morning sickness, such as over-the-counter medicines.

Some people may also have excessive saliva production.

The cause of hyperemesis gravidarum isn't clear, but factors that may increase your risk include:

• younger age
• being pregnant with a female baby
• twin or higher order multiple pregnancy
• a family history of HG
• high levels of hCG
• high levels of thyroid hormones
• Helicobacter pylori (Opens in new tab) infection

Contact your midwife or doctor if you:

• experience frequent or uncontrollable vomiting
• have ongoing nausea that makes it difficult to eat and drink enough
• you are losing weight

Hyperemesis gravidarum is diagnosed based on your symptoms such as ongoing vomiting and weight loss. Your doctor will ask about your symptoms, perform a physical examination and may refer you for tests to assess your and your baby's wellbeing.

You should receive treatment from a doctor with special expertise in this area. You'll be monitored closely and may need to go to hospital for ongoing care.

There are many dietary and lifestyle measures that can reduce nausea and vomiting. More intensive treatment is usually needed if you suffer from severe vomiting during pregnancy.

Medicines

There are medicines available to treat nausea and vomiting. Your symptoms may not disappear completely, but the aim is for you to manage some food and water during the day without vomiting.

If taking multivitamins make you feel sick, talk to your doctor about stopping pregnancy multivitamins to see if this helps. If possible, try to continue taking a folate supplement.

Hydration

It's important to drink enough fluids to prevent dehydration, though this can be difficult with HG. You can try to sip on a drink containing sugar or electrolytes every 15 minutes. You can also suck on ice blocks or try drinking fizzy water. Some people find very cold or frozen drinks easier to tolerate.

Go to your local emergency department if you can't keep fluids down at all. In the hospital, the staff can give you intravenous (IV) fluids to treat dehydration and replace electrolytes (Opens in new tab) lost during vomiting. It may also help improve nausea and vomiting.

Nutrition

Try to eat small amounts regularly. Eat any food that you can tolerate as long as it's safe in pregnancy. If you have HG, any food you can tolerate is better than no food, even if it's not 'healthy'.

It may be helpful to see a dietitian (Opens in new tab) for specific nutrition advice. If you have low vitamin levels, they may recommend supplements.

If your symptoms are very severe, your doctor may offer to place a feeding tube, if you're unable to eat enough due to HG. This can cause complications and needs careful monitoring.

Treatment of related conditions

Other treatments may include:

• antacids or other medicines to treat reflux
• laxatives (Opens in new tab) for constipation
• medicines to reduce saliva production

Rinse your mouth out with water after vomiting to protect your teeth from damage from stomach acid. If you can tolerate it, add some baking soda to the water you rinse with to reduce the acidity of your mouth after vomiting.

HG can significantly affect your quality of life and ability to manage daily activities.

Sources of assistance and support may include:

• relatives or friends who may be able to help with day-to-day tasks or prepare meals for your family
• paid services such as cleaners and supermarket delivery
• a social worker
• a psychologist or counsellor for help with depression and anxiety

Hyperemesis gravidarum can lead to other health problems, such as:

• dehydration or malnutrition
• low vitamin levels and an imbalance of salts or acid in your body
• kidney (Opens in new tab) damage
• a tear in your oesophagus
• reflux (Opens in new tab)
• constipation
• dental erosion (Opens in new tab)

Other possible effects of hyperemesis gravidarum include:

• a higher incidence of depression, anxiety and post-traumatic stress disorder
• breastfeeding difficulties
• relationship problems
• financial problems, if you are unable to work due to HG
• difficulty with daily activities
• reluctance to plan future pregnancies

In severe situations, people may choose to have a termination of pregnancy (abortion), if they have tried intensive treatment without relief.

Can hyperemesis gravidarum affect my baby?

If you have hyperemesis gravidarum, your placenta may not be working as it should. This can affect your baby. Your baby may be more likely to be small and to be born early. It's not clear if your baby has a higher risk of stillbirth.

There's no sure way to prevent hyperemesis gravidarum.

If you have a history of HG and are planning another pregnancy, it may help to start taking medicine for nausea and vomiting early in the pregnancy — even before you conceive. Ask your doctor whether this is recommended for you.

Talk to your maternity care provider if you experience severe vomiting during pregnancy.

You can also visit Hyperemesis Australia (Opens in new tab) for more information and support.

Perinatal Anxiety & Depression Australia (PANDA) (Opens in new tab) can give you advice and support if you feel that your mental health is affected by HG.