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Hyperemesis gravidarum (HG) begins between the fourth and sixth week of pregnancy. Symptoms usually improve somewhat by the 15th to 20th week of gestation, although some women continue to have frequent relapses throughout pregnancy. Most affected women have numerous episodes of vomiting throughout the day with few if any symptom-free periods, especially during the first three months. This leads to rapid and significant weight loss, dehydration, electrolyte disturbances, ketosis and acetonuria often requiring hospitalization. If these derangements are not treated promptly or adequately, they can lead to fetal loss, and irreversible renal, neurologic, and hepatic damage.

Other complications include Mallory-Weiss tears (linear mucosal tears at the cardio-esophageal junction with hematemesis), acid aspiration, and metabolic alkalosis. These women present to their physicians with weight loss of 5 to 20+ pounds (2.25 to 9+ kgs.); however, since some are overweight to begin with, they may not appear malnourished on visual inspection. This is especially true as the pregnancy progresses. Early, aggressive medical care often decreases the severity of a woman's symptoms and leads to quicker recovery.

Recognition of the signs that a woman is transitioning from morning sickness to hyperemesis gravidarum is critical. The initial signs include:

  • Rapid weight loss (1.5+ lbs [or .68+ kgs.] per week)
  • Recurrent ketosis
  • Frequent and/or severe nausea/vomiting
  • Dehydration

If these are seen early in pregnancy, hydration with vitamins, antiemetics, and close monitoring is imperative. For more on management, see our Suggested Protocol.

Updated on: Feb. 10, 2016

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