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But what happens when the nausea never lets up? When it persists into the afternoon, the evening, and the night? When you start losing weight, can’t hold down water, and feel like you’re barely functioning? For a small group of pregnant women, these are not just symptoms of a tough first trimester. They’re signs of something more serious: hyperemesis gravidarum (HG).
Recognising the Difference
Morning sickness usually means mild nausea resolved with diet adjustments and rest. It peaks around nine to eleven weeks and fades by week fourteen. You might find relief by eating small, frequent meals or drinking ginger tea. Typically, you don’t lose weight and can remain hydrated.In contrast, HG involves persistent vomiting, often more than three times a day, lasting all day and sometimes into later trimesters. You may lose five per cent or more of your pre-pregnancy weight, show signs of dehydration (like dark urine or dizziness), and require IV therapy.
HG is not psychological or a form of weakness; it is a medically recognised condition requiring intervention.
Why Hyperemesis Gravidarum Occurs
The exact cause of HG isn’t known, but several factors have been identified:- Hormonal shifts: Elevated hCG and estrogen are strongly associated with HG.
- Genetic predisposition: Research reveals that HG runs in families.
- Multiple foetuses or high-risk pregnancies: Carrying twins or having thyroid or gastrointestinal conditions can increase HG risk.
- First pregnancy: HG is more common for first-timers, though it can recur.
Diagnosis: What to Expect
A healthcare provider diagnoses HG using well-established criteria:- Persistent vomiting (three or more times daily)
- Weight loss of at least five per cent of pre-pregnancy weight
- Dehydration, low urine output, dizziness, dry mucous membranes
- Laboratory tests revealing electrolyte imbalance, ketones in urine
- Ultrasound to confirm pregnancy viability and rule out other conditions
Treatment: Restoring Balance
Management of HG requires a layered approach:- Hydration and electrolytes: Intravenous fluids with electrolytes and thiamine help treat dehydration and prevent complications such as Wernicke’s encephalopathy.
- Antiemetic medications: The first-line treatment is vitamin B6 with doxylamine (Diclectin). Other options include metoclopramide, ondansetron, and promethazine, used carefully under supervision.
- Nutrition support: If you can't hold anything down, doctors may recommend enteral feeding via a nasogastric tube or parenteral nutrition.
- Hospital care: Admission is necessary when dehydration, weight loss, or electrolyte issues are severe.
- Complementary therapies: Some women find relief via acupuncture wristbands or ginger, though evidence remains limited.
- Preventive strategies: Early intervention, starting anti-nausea therapy at the first sign of symptoms, can reduce progression to HG.
Emotional Health and Daily Life
HG can isolate you physically and emotionally. Women with HG have higher rates of anxiety, depression, PTSD, and even suicidal ideation if untreated.To combat this:
- Acknowledge that HG is not your fault
- Open up to loved ones and ask for help
- Seek professional mental health support
- Adjust your work schedule if needed
- Join support communities like the HER Foundation or the HG subreddits
FAQs on Hyperemesis Gravidarum vs. Morning Sickness: When Nausea Goes Beyond Normal
- How do I know if my nausea is still normal?
If you’re vomiting several times daily, losing weight, or can’t keep fluids down, call your provider; prompt treatment can prevent complications. - Will HG hurt my baby?
With early and consistent treatment, fetal outcomes are usually good. Severe, untreated HG can increase the risk of low birth weight or preterm birth. - Is HG likely to return in future pregnancies?
Yes, especially after a severe case, recurrence rates vary from 15% to 80%. Knowing your history helps your healthcare team prepare early.
