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About Hyperemesis Gravidarum

Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy. It is generally described as unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids. If severe and/or inadequately treated, it is typically associated with:

  • loss of greater than 5% of pre-pregnancy body weight (usually over 10%)
  • dehydration and production of ketones
  • nutritional deficiencies
  • metabolic imbalances
  • difficulty with daily activities

HG usually extends beyond the first trimester and may resolve by 21 weeks; however, it can last the entire pregnancy in less than half of these women. Complications of vomiting (e.g. gastric ulcers, esophageal bleeding, malnutrition, etc.) may also contribute to and worsen ongoing nausea.

There are numerous theories regarding the etiology of hyperemesis gravidarum. Unfortunately, HG is not fully understood and conclusive research on its potential cause is rare. New theories and findings emerge every year, substantiating that it is a complex physiological disease likely caused by multiple factors.

Diagnosis is usually made by measuring weight loss, checking for ketones, and assessing the overall condition of the mother. If she meets the standard criteria and is having difficulty performing her daily activities, medications and/or other treatments are typically offered.

Treating HG is very challenging and early intervention is critical. HG is a multifaceted disease that should be approached with a broad view of possible etiologies and complications. When treating mothers with HG, preventing and correcting nutritional deficiencies is a high priority to promote a healthy outcome for mother and child.

Most studies examining the risks and outcomes for a pregnant woman with nausea and vomiting in pregnancy find no detrimental effects long-term for milder cases. Those with more severe symptoms that lead to complications, severe weight loss, and/or prolonged nausea and vomiting are at greatest risk of adverse outcomes for both mother and child. The risk increases if medical intervention is inadequate or delayed.

The list of potential complications due to repeated vomiting or severe nausea is extensive, all of which may worsen symptoms. Common complications from nausea and vomiting include debilitating fatigue, gastric irritation, ketosis, and malnutrition. Aggressive care early in pregnancy is very important to prevent these and more life-threatening complications such as central pontine myolinolysis or Wernicke's encephalopathy. After pregnancy and in preparation of future ones, it is important to address any resulting physical and psychological complications.

Hyperemesis Gravidarum impacts societies, families and individuals. Recent, conservative estimations suggest HG costs nearly $200 million annually just for inpatient hospitalization. Considering many women are treated outside the hospital to save costs, the actual cost is likely many times greater. Beyond financial impact, many family relationships dissolve and future family plans are almost always limited. Women often lose their employment because of HG, and women are frequently undertreated and left feeling stigmatized by a disease erroneously presumed to be psychological.

Updated on: Apr. 18, 2013

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