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This severe condition affects about 0.3 to 2 per cent of pregnancies. It is defined as persistent and excessive vomiting occurring before the end of the 22nd week of gestation. Hyperemesis Gravidarum is among the most frequent reasons women are admitted to the hospital during the first trimester of pregnancy. It impacts your physical health and also takes a toll on your mental well-being. Identifying and managing the condition early is important to avoid issues such as malnutrition or preterm birth.
Indications of Hyperemesis Gravidarum
Hyperemesis Gravidarum is characterised by the following signs:- Occurs between 6 and 22 weeks of gestation.
- Vomiting more than three times a day.
- Weight loss of more than 3 kilograms or over 5 per cent of body weight.
- Presence of ketonuria. It refers to the presence of ketones in the urine. Ketones are produced when the body doesn't have enough carbohydrates for energy. In this case, the body begins to break down fats and proteins for fuel.
Morning Sickness Vs Hyperemesis Gravidarum
Hyperemesis gravidarum is often confused with morning sickness since both involve nausea and vomiting during pregnancy. But HG is much more serious and comes with greater health risks compared to the milder morning sickness. It's important to tell the difference between the two.| Morning Sickness | Hyperemesis Gravidarum |
| Mild to moderate nausea and vomiting | Severe, persistent nausea and vomiting |
| Affects 80 per cent of pregnant women | Affects 0.3-2 per cent of pregnant women |
| Begins at 6 weeks, peaks between 8 to 10 weeks, and resolves by 13 weeks | Begins 5-6 weeks, may persist beyond 20 weeks or throughout pregnancy |
| Minimal weight loss | Weight loss of more than 5 per cent of body weight |
| Rarely needs medical intervention | Often requires hospitalisation |
Symptoms of Hyperemesis Gravidarum
Hyperemesis Gravidarum is more than just normal pregnancy nausea. It can make daily life hard and affect your health. Knowing the symptoms early can help you get the right care.- Severe nausea and vomiting
- Weight loss
- Dehydration
- Ketosis
- Extreme fatigue
- Headaches
- Strong reactions to certain smells or foods
- Inability to perform routine tasks due to symptoms
Causes of Hyperemesis Gravidarum
Experts are still not fully sure what causes Hyperemesis Gravidarum. But there are a few factors that may play a role.- High levels of hormones like human chorionic gonadotropin (hCG), estrogen, and progesterone in early pregnancy may lead to excessive nausea and vomiting.
- Having HG in a past pregnancy or a family member who had it can raise your risk. This points to a possible genetic link.
- Some women with HG may also have temporarily high thyroid levels in early pregnancy.
- Being pregnant with twins or more can raise hCG levels. This might make nausea and vomiting worse.
- Molar pregnancy is a rare condition where the placenta grows abnormally. It can lead to very high hCG levels and excessive vomiting.
Role of H. pylori Infection in Hyperemesis Gravidarum
Helicobacter pylori infection has recently been identified as a potential contributing factor in the development of Hyperemesis. It spreads through food or water that has been contaminated with faeces. The bacteria of this infection can survive in environments with low oxygen concentrations. This helps them stay alive longer and makes it easier for the infection to spread.The bacterium settles in the outer mucus layer of the stomach. It produces large amounts of ammonia, which can damage the stomach's lining cells. Some case reports have also indicated that treating H. pylori infection can help improve symptoms of Hyperemesis Gravidarum.Risk Factors for Hyperemesis Gravidarum
Hyperemesis Gravidarum has been linked to a higher risk of negative pregnancy outcomes. Some of the commonly reported risk factors include:- First-time pregnancy
- Lower socioeconomic status
- Smoking
- Family history of Hyperemesis Gravidarum
- Young maternal age
- Multiple pregnancies
Complications of Hyperemesis Gravidarum
Hyperemesis Gravidarum complications are a result of prolonged vomiting, dehydration, and poor nutritional intake. Complications that are commonly associated with this condition include:- Fluid loss from persistent vomiting
- Electrolyte imbalances causing weakness
- Malnutrition
- Low birth weight
- Preterm birth
- Small-for-gestational-age infants
- Higher risk of Thrombosis (blood clots) due to dehydration
- Neurological issues like Wernicke’s encephalopathy
- Depression
- Oesophageal tears
- Kidney damage
- Constipation
Diagnosing Hyperemesis Gravidarum
HG is diagnosed only after other potential causes have been ruled out. This includes conditions like hyperthyroidism, chronic medical issues, psychiatric disorders and gastrointestinal diseases.Exams and Tests
- Complete blood count
- Electrolyte panel
- Urine ketones
- Weight monitoring
- Ultrasound
- Helicobacter pylori testing
Treatment Options for Hyperemesis Gravidarum
Below are some treatment options to help manage and alleviate symptoms of Hyperemesis Gravidarum:Hydration
Severe vomiting can lead to dehydration. Try sipping fluids with sugar or electrolytes every 15 minutes. Fizzy drinks or sucking on ice may also help during milder phases. If you can’t keep fluids down, you may need intravenous (IV) fluids at the hospital to restore lost fluids and electrolytes.Nutrition
Eating in small amounts regularly is better than eating nothing at all. Eat pregnancy-safe foods you can tolerate, like bland, dry options such as crackers, toast, or rice, every 2 hours. A dietitian can suggest supplements if you’re low on vitamins. If you are not able to eat enough, then tube feeding might help. This involves delivering nutrients directly to your stomach through a nasogastric tube. It requires regular medical supervision. In extreme cases, total parenteral nutrition (TPN) is used.Medications
You may be given medicines to manage nausea. Vitamin B6 and doxylamine (Unisom) are common first-line options. If multivitamins make you feel sick, you may pause them but try to continue folate supplements.Lifestyle Changes
Consider wearing acupressure wristbands and consuming ginger in forms like tea or supplements. Try to avoid triggers such as strong odours, bright lights, loud sounds, tight clothing, or car journeys. It is advisable to avoid high-fat, greasy, or spicy foods to reduce nausea.Other Treatments
Your doctor may prescribe antacids or laxatives if reflux or constipation is also present.Dental Care
Rinse your mouth with water after vomiting. Use baking soda in the rinse to reduce the effect of stomach acid on your teeth.Can Hyperemesis Gravidarum Be Prevented?
Currently, there are no definitive preventive measures for Hyperemesis Gravidarum. But certain strategies may mitigate its onset or severity. If you've experienced HG in a previous pregnancy and are planning another, consider starting anti-nausea medication early. This could help reduce the severity of symptoms. Prevention isn't always possible, but knowing your risk factors can help you prepare better. Make sure to talk to your doctor about the best approach for your situation.When to Seek Medical Help
You may need medical care if you're pregnant and dealing with severe nausea or vomiting. Get immediate help if you experience:- Signs of dehydration such as dark urine, infrequent urination, or extreme thirst.
- Inability to keep any food or fluids down for 12 hours or more.
- Frequent vomiting, occurring three or more times daily for several days.
- Lightheadedness, dizziness, or confusion.
- Blood in your vomit.
- Abdominal pain.
- Significant weight loss.
- Nausea that prevents you from eating or disrupts daily functioning.
FAQs
- What is Hyperemesis Gravidarum?It is a severe form of nausea and vomiting during pregnancy that can lead to dehydration, weight loss, and malnutrition. It usually occurs during the first trimester.
- Can Hyperemesis Gravidarum be prevented?There are no guaranteed ways to prevent it, but starting anti-nausea medication early in future pregnancies may reduce its severity.
- How do I know if I have HG or just morning sickness?HG is more severe and persistent than morning sickness. It can cause weight loss of over 5% of body weight and lead to dehydration.