As many as 80 percent of pregnant women experience nausea, vomiting and gastrointestinal symptoms, according to Silvia Degli Esposti, MD, director of the Center for Women’s Gastrointestinal Medicine at the Women’s Medicine Collaborative. But a small number, about one to three percent of pregnant women, experience more than run-of-the-mill morning sickness. Instead, they experience Hyperemesis Gravidarum (HG).

“Hyperemesis Gravidarum can be debilitating. Symptoms of severe nausea and vomiting can last throughout the day and can continue until about the 20 ^th week of pregnancy,” says Degli Esposti. “In some cases, it lasts throughout the entire pregnancy. The good news is that help is available and there are ways to treat this condition.”

How is HG different from “morning sickness”?

According to Degli Esposti, the principal difference between morning sickness and HG lies in the severity, frequency and persistence of vomiting and the ability to keep food and fluids down. Women with morning sickness have mild nausea that’s sometimes accompanied by vomiting that subsides during the day. Women with HG experience nausea that doesn’t subside, severe vomiting, and often dehydration and the inability to sustain adequate nutrition. Hyperemesis Gravidarum can be a life-threatening condition and, untreated, can result in serious ramifications for mother and baby.

How do women get HG and can it hurt a baby?

Causes and triggers of HG are still largely unknown, Degli Esposti says. “What we do know is that women who had HG in a prior pregnancy, are expecting twins or triplets, or whose mother or sister had HG, are more likely to have HG,” she adds. Other contributing factors include pre-existing gastrointestinal trouble and women who get migraines or become ill during travel.

“It’s natural for women to worry when they feel so ill,” Degli Esposti says, “but it’s unlikely that their baby will be adversely affected by this condition if treated.” If the mother loses a significant amount of weight during pregnancy, however, there’s an increased risk that the baby may be born smaller than average size or before 37 weeks gestation. Severe HG that leads to dehydration and not being as active also poses the risk of developing a blood clot called a deep vein thrombosis. Women may be given leg compression stockings or blood-thinning medication to reduce that risk. "But as long as HG is treated,” Degli Esposti assures, “complications are very unlikely.”

Are there emotional implications to having HG?

All women hope for a worry-free, healthy pregnancy and frequent nausea and vomiting can have a negative impact. Women can become fatigued, depressed, withdrawn or misunderstood when ill. “If you have been nauseated for a few hours you can understand how disrupting it would be to be so for weeks and weeks,” notes Degli Esposti. Caring for themselves, a spouse and perhaps children is also made more difficult by illness. Frustration is understandable and some may vow never to be pregnant again. “Women need support and reassurance that this condition isn’t the result of having done, or not done, anything in particular,” says Degli Esposti.

When should I see my health care provider?

Degli Esposti encourages women to speak with their provider as soon as symptoms become concerning or there’s difficulty keeping fluids down. Signs of dehydration include:

• Decreased amount and frequency of urine output and a dark appearance to urine;
• Not urinating for more than eight hours;
• Dizziness, feeling faint, headaches or a rapid heart rate.

How can HG be treated?

Seeking treatment early may help women prevent or minimize HG symptoms. Women should talk with their obstetrician or midwife about how they feel and about treatment options. Mild cases are often treated with dietary changes, rest, antacids and hydration. More severe cases often require anti-nausea medication, intravenous (IV) fluid replacement and occasionally hospital admission.

Other ways to minimize symptoms

• Small frequent meals of dry, bland or cold foods such as salad or sandwiches;
• Moderate bed rest to minimize risk of blood clots and muscle wasting;
• Natural remedies such as ginger or peppermint;
• Acupressure using acupressure wrist bands that apply mild pressure to wrist pressure points to reduce nausea (found over the counter at a local drug stores);
• Medications that don’t pose harm to baby such as antihistamines or anti-nausea medication. (Women should consult their provider before taking medications.)

Replenishing lost fluids, vitamins and electrolytes through IV fluids often offer relief. This can be done in an office setting, at the hospital or even at home. Some women become very dehydrated, lose weight, or find that medication or outpatient fluid replacement doesn’t offer adequate relief, and must be admitted to the hospital for care. Women with severe HG or who have a chronic medical condition, such as diabetes, or require nutritional support may also be admitted to the hospital early in their pregnancy.

How can a woman get help for HG at the Women’s Medicine Collaborative?

The Gastrointestinal Disorders in Pregnancy Program at the Women’s Medicine Collaborative specializes in treating hyperemesis, inflammatory bowel disease, hepatitis, and other gastrointestinal disorders in pregnancy. Several HG treatment options are available and women can receive IV fluid replacement therapy in the office, often saving a visit to the emergency room. Home IV therapy is also an option. In the case of a severe patient condition, women will most often be admitted to the new women’s medicine inpatient unit at Rhode Island Hospital, the only comprehensive women’s health program in the state to be part of a full-service academic hospital.