Severe Morning Sickness: Symptoms, Triggers, and Treatment of Hyperemesis Gravidarum

Reviewed by Marina Savchenko, MD, Pediatric Neurologist, Medical Consultant at Flo

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What is severe morning sickness?

Severe morning sickness is a pregnancy complication which has a negative impact on the health of an expectant mother. While normal morning sickness is experienced by roughly 85 percent of pregnant women, HG is much rarer.

Between 1 and 5 percent of women require hospitalization to manage the accompanying symptoms. Severe morning sickness is capable of producing fetal complications, including low birth weight, prepartum bleeding, preterm delivery, and even undescended testicles in male infants.

Severe morning sickness symptoms

HG is characterized by uncontrollable nausea and vomiting, which tends to peak at around week 9, before subsiding around week 20. (However, some moms-to-be observe HG symptoms until childbirth.) They include:

• Dehydration (leading to thirst, dizziness, fatigue, lightheadedness, confusion, and decreased urination)
• Progressive weight loss
• Orthostatic hypotension (i.e., low blood pressure when standing up)
• Ptyalism (i.e., excessive salivation)

Particularly serious cases of severe morning sickness also produce complications such as:

• Muscle degeneration or rhabdomyolysis (i.e., when muscle fibers break down and dissolve)
• Ketonuria, marked by the presence of ketone bodies in the urine ‒ a byproduct of cells breaking down
• Electrolyte imbalance 
• Low blood urea nitrogen (BUN)
• Hyponatremia or low blood sodium
• Hypokalemia or low blood potassium

Root causes and triggers for severe morning sickness

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The exact reasons for hyperemesis gravidarum are still largely unknown, but it may be attributable to numerous biological and physiological factors.

Some studies show that severe morning sickness could, in part, be hereditary. Pregnant women are three times more likely to struggle with HG themselves when their mothers had it. Similarly, expectant moms who previously experienced it carry a 15 percent chance of developing it again, compared to a 0.7 percent risk for first-timers.

High levels of human chorionic gonadotropin (HCG), which is secreted by the early embryo and placenta, also increase susceptibility. Elevated HCG numbers occur more frequently in multiple pregnancies and molar pregnancies (i.e., gestational trophoblastic disease).

What’s more, women with severe morning sickness demonstrate higher rates of Helicobacter pylori infection. This is a type of bacteria that infects the stomach and causes gastritis, peptic ulcers, and in some instances, stomach cancer.

It’s worth noting that experts once believed emotional problems to be the source of severe morning sickness. We now know that such feelings are a consequence, rather than the root cause of HG.

Contributing factors for severe morning sickness

Although some moms-to-be develop HG in the absence of any known risk factors, the following things could increase your likelihood of severe morning sickness: 

• Being overweight or obese
• A multiple pregnancy
• Previous bouts of hyperemesis gravidarum 
• Gestational trophoblastic disease

Remedies for severe morning sickness

Severe morning sickness is a potentially debilitating condition requiring medical attention or even emergency care. Depending on your symptoms, different strategies may provide relief for severe morning sickness.

HG treatment at home

A few DIY remedies for severe morning sickness can assist in managing symptoms. They include:

Dietary changes

Stay hydrated to maintain both your and your baby’s well-being. Consult your health care provider about electrolyte drinks or supplements for restoring proper electrolyte balance. It’s also crucial to drink small amounts of water throughout the day.

When you’re struggling with severe morning sickness, a well-balanced diet might mean eating multiple, small meals instead of three large ones every day. Opt for more carbohydrates and protein than fats, as well as dry or cold foods. Avoid caffeine and anything fried or acidic, not to mention specific cooking methods that trigger nausea for you.

Lastly, try to have a small meal before going to bed to alleviate severe morning sickness.

Lifestyle modifications

If stress has got you down, consider seeing a therapist to explore and discuss your feelings, including any anxiety directly linked to severe morning sickness. Ask for moral support from your partner and loved ones, especially since HG tends to interfere with daily activities. 

Thiamine and ginger 

Also known as vitamin B1, thiamine is an essential micronutrient involved in numerous metabolic processes, and it might prevent certain HG complications.

For some pregnant women, ginger serves as a natural remedy for severe morning sickness symptoms. Try sipping on ginger tea throughout the day, or ask your health care provider about taking a powdered ginger supplement.

When to see a doctor for severe morning sickness

If severe morning sickness leads to excessive nausea and vomiting, please seek medical attention right away. Your provider can prescribe medications to control many of these symptoms. Hospitalization may be necessary under the following circumstances:

• Prolonged and/or severe nausea and vomiting
• Dehydration
• Inability to tolerate fluids consumed orally 
• Ketonuria or ketosis
• Electrolyte imbalance
• Weight loss equal to 5 percent or more of initial body weight
• Abnormal blood test results
• Pre-existing medical conditions, such as diabetes, or heart or kidney disease 

Fluid intake and urinary output will be closely monitored, along with other vital signs, and you’ll be temporarily placed on an IV. Aside from thiamine, you may receive antiemetics like cyclizine, prochlorperazine, metoclopramide, or ondansetron to tackle nausea and vomiting. 

Should these medications fail to help, corticosteroids pose another option. Most HG patients stop taking anti-nausea drugs between weeks 18 and 20, while others require low doses of corticosteroids for the remainder of the pregnancy.

Expectant mothers are already more vulnerable to thrombosis, and dehydration and immobility only make matters worse during hospitalization. Your provider may suggest wearing graduated elastic compression stockings and taking blood thinners like heparin to prevent blood clots. 

Takeaway

Although early pregnancy signs such as nausea and vomiting often point to a healthy pregnancy, severe morning sickness is a potentially serious problem.

Begin by making simple diet and lifestyle adjustments at home to address severe morning sickness. But if HG symptoms worsen, don’t hesitate to contact your health care provider as hospitalization might be necessary. Remember, early diagnosis and treatment of severe morning sickness will allow you to feel better faster and protect your baby.

History of updates

Current version (20 April 2020)

Reviewed by Marina Savchenko, MD, Pediatric Neurologist, Medical Consultant at Flo

Published (20 April 2020)