What is hyperemesis gravidarum?

Hyperemesis gravidarum is a complication of pregnancy in which sufferers experience severe nausea and vomiting. It makes eating and drinking difficult and leads to weight loss, malnutrition and dehydration if it is not treated.

How is hyperemesis gravidarum different to morning sickness?

Morning sickness refers to nausea and vomiting in pregnancy, even though it doesn't only occur in the morning. The majority of people who are pregnant have some level of morning sickness.

Hyperemesis gravidarum is more severe, affecting about 1 in 100 people who are pregnant. There isn’t a clear definition as to when morning sickness becomes severe enough to be called hyperemesis gravidarum.

In general, people with morning sickness may feel put off by certain foods, but they can eat and drink and don’t lose much weight. Symptoms come and go and usually improve with dietary changes. Sometimes it may affect your mood and your ability to do your usual daily activities.

People with hyperemesis gravidarum have symptoms that are severe and constant. They have difficulty eating and drinking anything and usually need medicines and intravenous fluids. It often involves having to take time off work and needing help with your daily activities. It may affect your mood and in some cases could cause post-traumatic stress after your baby is born.

Both morning sickness and hyperemesis gravidarum usually start between 4 and 10 weeks of pregnancy and improve by 20 weeks. Some people continue to have symptoms throughout pregnancy.

What symptoms or problems could I have with hyperemesis gravidarum?

The main symptoms of hyperemesis gravidarum are severe nausea and vomiting, difficulty eating and drinking and weight loss. Some people have excessive saliva production.

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

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

Other possible effects of hyperemesis gravidarum include:

• depression, anxiety and post-traumatic stress
• breastfeeding difficulties
• relationship problems
• financial problems
• difficulty with daily activities
• reluctance to have more children

How is hyperemesis gravidarum treated?

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. These are worth trying, but more intensive treatment is usually needed if you suffer from hyperemesis gravidarum.

What treatment will I need?

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

Some people find that multivitamins make them feel sick. It’s fine to stop pregnancy multivitamins if this helps, if possible, try to continue taking folate.

If you’ve had hyperemesis gravidarum, in future pregnancies it can help to start taking medicine for nausea and vomiting as early as possible — even before you conceive.

Hydration

Try to drink fluids so you don’t get dehydrated. It can help to sip on a drink containing sugar or electrolytes every 15 minutes, or suck on ice blocks or icypoles.

If you can’t keep food or fluids down, go to your local emergency department. You will need intravenous (IV) fluids, which may help improve nausea and vomiting, and can help keep up your levels of electrolytes.

Nutrition

Try to eat small amounts regularly. Eat any food that you can keep down, as long as it’s safe in pregnancy — don’t worry about eating healthy foods right now.

You might need to see a dietitian. If you have low vitamin levels, you may need supplements.

In extreme cases, if you’re unable to eat, you may need to be fed through a tube. This can cause complications and requires careful monitoring.

Treatment of related conditions

Other treatments may include:

• antacids or other medicines to treat reflux
• laxatives for constipation
• medicines to reduce saliva production

Rinse your mouth out with water after vomiting, to protect your teeth from damage. If you can, add some baking soda to the water you rinse with.

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 you have a higher risk of stillbirth.

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

Where can I get support?

If you experience hyperemesis gravidarum, contact Hyperemesis Australia for information and support.

You can also call Pregnancy, Birth and Baby on 1800 882 436 to speak to a maternal child health nurse.

Other sources of support include:

• relatives or friends who may be able to help you with day-to-day tasks or prepare meals for your family
• services such as cleaners and supermarket delivery
• a social worker
• a psychologist or counsellor for help with depression and anxiety
• Perinatal Anxiety & Depression Australia (PANDA)

If you suffer from hyperemesis gravidarum, it’s likely that working will be difficult, talk to your employer about changing to another role, or about taking special parental leave if you need extended time off to take care of yourself.