FAQs for Family & Friends
Below is a list of Frequently Asked Questions for family and friends who know a mother with hyperemesis gravidarum:
- What causes HG?
- Will HG happen every time she is pregnant?
- How long will HG last?
- The doctor says there is nothing available to treat HG. Is that true?
- She says she is really sick, but I don't see other pregnant women this sick? Is she exaggerating?
- I think she has HG. How do I know if this is more than morning sickness?
- She can't stop vomiting. Should I call her doctor?
- She had HG in her last pregnancy. Can we prevent it from happening again?
- She can't eat or take her vitamins, and has lost a lot of weight. Will this hurt the baby?
- Her health professional offered a prescription medication, but will it hurt the baby?
1. What causes HG?
The exact cause of HG is still unknown and many theories exist. It is, however, a real disease. Too little research has been done, and that which is done is often inconclusive or only identifies commonality among half of research participants. What is known is that hormonal changes, dehydration, nutritional deficiencies, and the overall stress on the body’s chemistry and functioning contribute to nausea and vomiting in pregnancy.
The cause is likely due to several factors that may differ for each woman. Some women may be more likely to vomit due to genetic differences. It is not a woman's fault, and she cannot control whether or not she vomits when pregnant, nor can she control the severity of her nausea. Vomiting is almost always stimulated by a place in the brain known as the vomiting center. It may also be stimulated by changes in the stomach and intestines that are caused by pregnancy. Emotional distress may worsen vomiting, but is not the cause. Many causes of hyperemesis are related to the various hormonal changes of pregnancy to which some women are more sensitive. Some known causes include the following:
- Altered sense of taste
- Sensitivity of the brain to motion
- Food leaving the stomach more slowly
- Increased sense of smell
- Insufficient fluids or nutrition
- Rapidly changing hormone levels during pregnancy
- Stomach contents moving back up from the stomach
- Physical and emotional stress of pregnancy on the body
- Vitamin deficiencies
2. Will HG happen every time she is pregnant?
Studies vary, but most find that women have a good chance of experiencing HG in future pregnancies. Statistics suggest over 50% will have it with each pregnancy, and those with more than one experience of HG have a greater risk of experiencing HG in future pregnancies. It also seems to occur in similar patterns and severity, though it is not always consistent. Those who have mothers, grandmothers, or sisters who have had HG will often have at least some nausea and vomiting during pregnancy.
3. How long will HG last?
In most women, it will begin within 2-5 weeks after conception. The nausea/vomiting will generally ease after the first trimester and typically stops before a woman reaches 20 weeks gestation, or around halfway. However, about 10-20% of these women will find nausea and vomiting last until delivery, though it is usually less severe. If a woman has had HG in previous pregnancies, it will often follow a similar pattern of duration and severity.
4. The doctor says there is nothing available to treat HG. Is that true?
Due to the risk of stating a medication is safe for use during pregnancy, few if any drug manufacturers will say their drugs are intended for use during pregnancy or for a pregnancy condition such as HG. However, due to the misery and debility women with HG face, physicians will often treat it with medications deemed safe due to their history of being used for pregnancy nausea and vomiting for decades (e.g. Compazine, Phenergan, Unisom).
It is unfortunate that many health professionals will only consider the older medications, as they are often found to be less effective than newer medications (Zofran, Kytril, Reglan). This is especially true for those with moderate and severe HG. Newer medications are not necessarily unsafe, they just don't have as many studies to demonstrate their safety. The risk of treating a mother with drugs that are most effective is often less risky than not treating her. Chronic dehydration and malnutrition worsen her symptoms and can adversely affect the baby.
Above all, know that effectively treating symptoms early in pregnancy can make a woman less sick and decrease the time it takes to recover. Delaying treatment until she has been vomiting for several weeks makes it harder to gain control over the vomiting cycle. You have the right to adequate health care. Consult with another health professional if needed to get the care she needs. She may need someone to advocate for her if she is very sick. If she loses more than 10% of her pre-pregnancy weight and her doctor is unwilling to give her effective medications or other treatments, it is a good idea to seek a second opinion from a high-risk obstetrician or perinatologist.
Our Referral Network lists health professionals other women with HG have recommended or those who have requested to be added. You will also find information on how to find a practitioner experienced in treating HG if one is not listed in your area.
5. She says she is really sick, but I don't see other pregnant women this sick? Is she exaggerating?
First of all, understand that she is really sick and no one except those who have had HG will truly understand what she is experiencing. You may have a better idea if you imagine having food poisoning for weeks (or months). Most people know how miserable and exhausting just a day or two of that is. Also, keep in mind that women become isolated due to being so ill, and may become depressed (PDF) and/or anxious, especially if HG lasts beyond mid—pregnancy or is very severe. This is not uncommon and not her fault. If she feels depressed, talk to her and her doctor about medication or try natural homeopathic remedies. Some medications have been researched for use during pregnancy after the first trimester.
- Support Groups
Find others who have experienced HG and read their stories. It can be very helpful to read how others have coped and better understand the reality of HG.
- Survival Tips
Print out or refer to our Survival Guide pages for information on what it is like to experience HG and how you can help. Remember, you will never completely understand, but you can be supportive anyway.
Read the pages on coping for tips on how you can cope with the added stress and responsibility.
- How You Can Help Her
Review information specifically for family members and friends on how you can best help a mother with HG cope and survive.
6. I think she has HG. How do I know if this is more than morning sickness?
If she is vomiting more than a few times a day and losing weight, she might have HG. If she cannot keep enough water down to stay hydrated, is vomiting bile or blood, and has lost more than 1-2 pounds (0.45-0.9 kg) in a week, she likely has HG. Women with HG often have great difficulty taking care of their normal responsibilities and/or going to work for weeks or months. In more severe cases, they may have trouble even caring for themselves, such as showering and preparing food. Medical intervention is critical for these women.
|Morning Sickness||Hyperemesis Gravidarum|
|Weight loss is typically less than 5 pounds (2.3 kg).||Weight loss
is often 5-20 pounds (2.3-9.0 kg) or more. (> 5%
of prepregnancy weight)
|Nausea and vomiting do not significantly limit eating and drinking most days.
vomiting greatly reduce food intake and cause dehydration
if not treated.
infrequent and the nausea is episodic and not severe,
but may cause discomfort and misery.
frequent and may contain bile or blood if not treated.
Nausea is usually moderate to severe and constant.
lifestyle changes result in improvement most of
through a vein and/or medications to stop the vomiting
are typically required.
is typically gradual after the first trimester,
although occasional queasiness may occur.
usually occurs by mid-pregnancy, but nausea and/or
vomiting may last until late pregnancy.
|Work and household tasks may be difficult at times, but usually can be completed when nausea is less severe.||Outside employment and home responsibilities may be impossible for weeks or months. Self-care may also be very difficult.|
7. She can't stop vomiting. Should I call her doctor?
If she cannot keep more than a very small amount of food or water down for 24 hours or more, loses 2 or more pounds (0.9 kg) in one week, vomits blood, faints, or generally feels very unwell, call her practitioner. If she has several of these symptoms and it is after working hours, you may need to take her to the ER or an urgent care center.
You can buy Ketostix at a local pharmacy without a prescription. These test her level of dehydration and starvation. If she has ketones in her urine (the test is positive), she will need to get fluids through an intravenous (IV) line at the doctor's office, ER, hospital, or an urgent care center. Ketones may be harmful to the baby and mom if not treated. If she has been vomiting for several weeks and eating very little, she will also need vitamins in her IV. Sometimes this is forgotten, so make sure you ask about it, it is very important. B-vitamins are most critical as they are depleted rapidly by vomiting and lack of eating. Remember, dehydration and ketones worsen nausea and vomiting and need to be monitored closely.
Call her health professional if she experiences any of the following:
- Abdominal pain, bleeding, or cramping
- Difficulty thinking or focusing
- Difficulty walking or talking
- Extreme fatigue and very low energy
- Little if any food or fluids stay down for over 24 hours
- Little saliva and a dry mouth
- Moderate or severe headache and/or fever
- Muscular weakness or severe cramping
- Repeated vomiting or retching daily
- Severe nausea that keeps you from eating/drinking
- Shortness of breath or dizziness
- Urination is infrequent (over 8 hours) and minimal amount
- Urine is dark yellow and concentrated
- Visual disturbances, or fainting
- Vomit is red with blood or yellow with bile
- Weight loss of 2 pounds (0.9 kg) or more in a week
8. She had HG in her last pregnancy. Can we prevent it from happening again?
Since the exact cause is not known and is likely due to more than one factor, it is not preventable. However, the symptoms are often more manageable and less severe if adequate treatment is given early in pregnancy. Sometimes women find HG may be less severe if they plan ahead and prepare for pregnancy. This includes eating very healthy, taking antioxidants and prenatal vitamins for several months, and making sure she is in the best health possible. Underlying conditions such as gall bladder disease can worsen HG. Finding a health professional experienced in treating HG and who knows her history is crucial. Make a plan based on what worked for her last pregnancy and find a health professional willing to give her get the care she needs.
9. She can't eat or take any vitamins, and she has lost a lot of weight. Will this hurt the baby?
In most cases, women who lose weight during their first trimester have normal babies. Adequate nutrition is important for the baby, but fetal requirements are minimal during the first few months. Her body should have sufficient stores for the baby during this time. High-quality vitamins can be helpful for most women, but those with HG often cannot tolerate them, especially if they contain iron. Studies show vitamins seem to be most critical during the few months prior to pregnancy and up to about 6 weeks gestation. This is when the risk of miscarriage is great and the spine is forming. Folic acid and antioxidant requirements are greatest at this point according to these studies. Since HG often does not make vitamins completely intolerable until around this time, just encourage her to take them as long as you can. She can try sublingual (under the tongue) forms of vitamins (especially B and folic acid) that can be ordered online or found at some health food stores. If she is admitted for IV fluids, make sure a multivitamin is added to her fluids, especially if she has been vomiting frequently for more than 2 weeks. This is not routinely done, unfortunately.
The risk to the baby is greatest if the mother is dehydrated for extended periods of time, loses 10% or more of her pre-pregnancy weight and does not receive vitamins or other nutritional support, or fails to gain weight for 2 consecutive trimesters. Obviously, if the mother develops other complications, they also present an increased risk. Most studies, however, show that women with hyperemesis have normal babies unless they are severely ill and receive little treatment.
10. Her health professional offered a prescription medication, but will it hurt the baby?
There is always a risk with any medication taken during pregnancy. However, medications most often prescribed typically present less risk to the mother and child than chronic dehydration and lack of nutrition. The risk decreases after the first trimester or around 10 weeks, but if vomiting is left uncontrolled until then, the stress on the body is great and it is much more difficult to stop the vomiting. These women are then at greater risk for complications and a prolonged recovery. They often will have great difficulty caring for themselves and their family for months. Medications are often more effective if started early because there are fewer nutritional deficiencies and the mother is in better overall health. It can be compared to pain control. Most health professionals know that when pain medicine is given early for pain, rather than later, the pain is easier to control. The same holds true with vomiting. The consequences and complications are typically less if the nausea and vomiting are controlled earlier than later.
Updated on: Apr. 18, 2013