Excessive Vomitting in Pregnancy (Hyperemesis gravidarum)

What is hyperemesis gravidarum? How is it different from ‘morning sickness’?

This is a condition in pregnancy where there is severe nausea and vomiting that could lead to dehydration, weight loss and electrolyte disturbances due to inability to keep any food down. In some women, they may also experience inability to swallow their own saliva.  On the other hand, ‘morning sickness’ is to describe milder form of nausea which may or may not be accompanied by vomiting. About 70-80% of women will experience morning sickness and only 0.3 – 2% 1 of pregnant women will have hyperemesis gravidarum. Unfortunately, hyperemesis gravidarum tends to recur in the subsequent pregnancies.
What is the cause of hyperemesis gravidarum?
The actual cause of hyperemesis gravidarum is unknown. It could be due to the hormonal changes associated pregnancy. Hence, hyperemesis gravidarum is much more common in pregnant women with multiples (i.e carrying twin or more) or molar pregnancies.
Is it true that if you suffer from hyperemesis gravidarum you are carrying a baby girl?
Interestingly, there are studies that have shown that women who experience hyperemesis gravidarum tend to be carrying baby girls.2,3 However, if you really want to know the sex of your baby ask your doctor to do a scan for you!
What investigations will my doctor do for me?
Your doctor will order some blood investigations such as your full blood count and renal function. In addition, a pelvic scan will be done to rule out any multiples or molar pregnancies which is associated with hyperemesis gravidarum. If you have symptoms or signs to suggest underlying a hyperactive thyroid, a blood test i.e thyroid function test will also be ordered.
What is the treatment for hyperemesis gravidarum?
If you are unable to tolerate any food or drink at all, you doctor will advise you to be admitted to hospital for fluid rehydration through the intravenous (i.v) line to prevent further dehydration and electrolyte imbalance. In addition, some anti-nausea medications which is safe in pregnancy will be prescribed. Majority of women will need to stay in hospital only for a few days.
When should I see my doctor?
  • You are unable to tolerate any food at all.
  • You have lost more than 5 pounds (2.3kg)
  • You notice any symptoms or signs of dehydration such as you are going to toilet to urinate less frequently, your urine colour is tea colour or dark and dizziness on standing.
  • You are vomiting throughout the day or if there is blood in your vomitus.
  • You have abdominal pain or cramping
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1. Bailit, JL. Hyperemesis Gravidarum: Epidemiological findings from a cohort study.  Am J Obstet Gynecol 2005 Sep; 193: 811 – 4.
2. Shift MA, Reed SD, Daling JR. The sex ratio of pregnancies complicated by hospitalization for hyperemesis gravidarum. BJOG 2004 Jan; 111(1):27-30.
3. del Mar Melero-Montes M, Jick H. Epidemiology 2001 Jan; 12(1):123-4.


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