Hyperemesis Gravidarum

Hyperemesis Gravidarum (HG) is a serious form of morning sickness that affects up to 2% of pregnant women. HG often occurs starting the 4th and 6th week of pregnancy and can worsen around weeks 9 and 13. Women with HG endure persistent nausea and vomiting, dehydration, weight loss, and electrolyte imbalances that can last weeks, or even months, throughout the pregnancy. The constant symptoms of this sickness can lead to a debilitating and fatigued feeling. The condition can cause a weight loss of more than 5% body weight, and the low levels of vital electrolytes, such as sodium and potassium, contribute to the feeling of dizziness, muscle weakness, and a significant drop in blood pressure. The severe vomiting may cause, although rare, bleeding in the esophagus as well as other serious health complications. HG can make self-care and focus on oneself during pregnancy challenging, and cause anxiety and depression that lingers even after the pregnancy.


One likely cause of HG is due to the increasing level of Human Chorionic Gonadotropin (hCG) that naturally occurs during pregnancy. HCG, a pregnancy hormone made by the cells of the placenta, facilitates the production of other pregnancy hormones such as progesterone and estrogen. This thickens the lining of the uterus and increases its blood supply to nourish the embryo after implantation. Studies indicate that on the 11th week of pregnancy, however, there’s a correlation between peak levels of hCG levels and the presence of ‘normal’ nausea and vomiting symptoms. These findings are not definitive. There may also be a genetic component as to why women experience morning sickness. If your mother, or another family member, has had morning sickness during their pregnancy, outsmart your genes by consulting your doctor and educating yourself about the condition to follow necessary prevention.


Women have a higher risk of HG if they have the following:

  • A family history of HG
  • Pregnancy with more than one baby, such as twins
  • Being overweight
  • Being a first-time mother
  • Hydatidiform mole, a condition that causes the growth of an abnormally fertilized egg or an overgrowth of tissue from the placenta.


In terms of diagnosis, a physician will first look to see if you have any common signs of HG, such as abnormally low blood pressure or a fast pulse. Tests may also be done to check your hydration status by assessing your complete blood count, electrolytes, urine ketones, and weight loss. As there’s an increased risk of HG for carrying more than one child or having a Hydatidiform mole, an ultrasound is usually done to check for both.


There are several natural ways to prevent nausea, one method that doctors may recommend is ginger. Taking 1 to 1.5 grams daily in several small doses may help some women manage their symptoms. Pyridoxine (Vitamin B6) and Thiamine (Vitamin B1) supplements are also known to help alleviate nausea. However, please consult your doctor before taking any supplements, as large doses of either can cause side effects. There are anti-nausea medications patients may take such as Doxylamine, Promethazine, Metoclopramide, and Ondansetron. If a woman cannot take medicines by mouth, the drugs can be administered through an IV or a suppository.


Since an empty stomach can contribute to nausea, it’s beneficial to eat small, frequent meals. Try dry, bland foods such as crackers, rice, or bread that sit well with your stomach. Avoid things that trigger nausea and vomiting, such as certain noises and sounds, bright and blinking lights, riding in a car, or any form of pressure on your stomach.


With proper identification and close monitoring of symptoms, serious complications from HG for the mother and child are rare. In the most severe cases, there are often a few visits to urgent care or emergency departments for IV fluid hydration and rarely a few days stay in the hospital to get the severe vomiting under control.


Fortunately, for most women, HG resolves in the late 2nd trimester and they can enjoy the last half of pregnancy.   Having HG in pregnancy and knowing it is likely to recur can often affect future childbearing plans.  These are important discussions to have with your physician.


El Camino Women’s Medical Group offers the latest Minimally Invasive Solutions for gynecologic problems.   Drs. Amy TengErika Balassiano, and Pooja Gupta, all members of AAGL (American Association of Gynecologic Laparoscopy) are highly trained and experienced in the field of Minimally Invasive Gynecologic Surgery.   Dr. Erika Balassiano has also completed a Minimally Invasive Gynecologic Surgery Fellowship, under the supervision of world-renowned Dr. Camran Nezhat.


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