FAQs for Mothers
Below is a list of frequently asked questions for mothers:
- What causes HG?
- Will HG happen every time I'm pregnant?
- How long will HG last?
- My doctor says there is nothing available to treat HG. Is that true?
- My husband, family and friends think I’m making this up, but I’m really sick. What can I do?
- I think I have HG. How do I know if this is more than morning sickness?
- I can't stop vomiting. Should I call my health professional?
- I had HG in my last pregnancy. Can I prevent it from happening again?
- I can't eat, can't take my vitamins, and have lost a lot of weight. Will this hurt my baby?
- My health professional offered a prescription medication, but will it hurt my baby?
1. What causes HG?
The exact cause of HG is still unknown and many theories exist. Too little research is 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 your fault, and you cannot control whether or not you vomit or are nauseous when pregnant. 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 hormones. 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 you may be 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 I'm 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 you reach 20 weeks gestation, or around halfway. However, about 10-20% of mothers will find nausea and vomiting last until delivery, though it is usually less severe. If you have had HG in previous pregnancies, it will often follow a similar pattern of duration and severity.
4. My 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 if you have moderate or severe HG. Newer medications are not necessarily unsafe, they just don't have as many studies to demonstrate their safety. The risk of treating you with drugs that are most effective is often less risky than not treating her. Chronic dehydration and malnutrition worsen your 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 you have 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 you need. Your spouse or a significant other may need to advocate for you if you are very sick. If you lose more than 8-10% of your pre-pregnancy weight and your doctor is unwilling to give you 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. My husband, family and friends think I’m making this up, but I’m really sick. What can I do?
First of all, understand that no one except those who have had HG will truly understand how you feel. You may have some success by suggesting that it is like 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 if you become isolated due to HG, you may become depressed and/or anxious, especially if HG lasts beyond mid-pregnancy or is very severe. This is not uncommon and not your fault. If you feel you are depressed (PDF), talk to your doctor about medication or try natural homeopathic remedies. Some prescription medications have been researched for use during pregnancy after the first trimester.
- Support Groups
Find others who have had HG and read their stories. It can be very helpful to know you are not alone.
- Survival Guide
Print out or refer them to our Survival Guide pages with information on what it is like to experience HG and how they can help. Remind yourself that they will never completely understand, then find those who do.
- Coping Day to Day
Read our tips on coping day to day.
6. I think I have HG. How do I know if this is more than morning sickness?
If you are vomiting more than a few times a day and losing weight, you might have HG. If you cannot keep enough water down to stay hydrated, are vomiting bile or blood, and have lost more than 1-2 pounds (0.45-0.9 kg) in a week, you likely have HG. You may have great difficulty taking care of your normal responsibilities and/or going to work for weeks or months. If your HG is severe, you may have trouble even caring for yourself, such as showering and preparing food. Immediate medical intervention is critical if your HG is moderate to severe.
|Morning Sickness||Hyperemesis Gravidarum|
|You lose little
if any weight.
||You lose 5-20
pounds or more. (> 5% of prepregnancy weight)
vomiting do not interfere with your ability to
eat or drink enough each day.
vomiting cause you to eat very little and get dehydrated
from vomiting if not treated.
infrequently and the nausea is episodic but not
severe. It may cause discomfort and misery.
often and may vomit bile or blood if not treated.
Nausea is usually moderate to severe and constant.
lifestyle changes are enough to help you feel better
most of the time.
||You will probably
require fluid hydration through a vein and/or medications
to stop the vomiting.
will improve gradually after the first trimester,
but may be a little queasy at times during the
remainder of your pregnancy.
feel somewhat better by mid-pregnancy, but you
may continue to be nauseous and/or vomit until
|You will be able to work most days and care for your family.||You will likely be unable to work for weeks or months, and may need help caring for yourself.|
7. I can't stop vomiting. Should I call my health professional?
If you cannot keep more than a few bites of food or a few sips of water down for 24 hours or more, lose 2 or more pounds (0.9 kg) in one week, vomit blood, faint, or generally feel very unwell, call your practitioner. If you have several of these symptoms and it is after working hours, you may need someone to take you to the ER or an urgent care center.
You can buy Ketostix at a local pharmacy without a prescription. These test your level of dehydration and starvation. If you have ketones in your urine (the test is positive), you 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 you have been vomiting for several weeks and eating very little, you will also need vitamins in your 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 your nausea and vomiting and need to be monitored closely.
Call your health professional if you experience 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. I had HG in my last pregnancy. Can I 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 HG is less severe if you plan ahead and prepare for pregnancy. This includes eating very healthy, taking antioxidants and prenatal vitamins for several months, and making sure you are 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 your history is crucial. Make a plan based on what worked for your last pregnancy and find a health professional willing to help you get the care you need.
9. I can't eat, can't take my vitamins, and have lost a lot of weight. Will this hurt my baby?
In most cases, women who lose weight during their first trimester have normal babies. Adequate nutrition is important for the baby, but his/her requirements are very minimal during the first few months. Your 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 intolerable until around this time, just do your best to take them as long as you can. You 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 you are admitted for IV fluids, make sure a multivitamin is added to your fluids, especially if you have 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. My health professional offered a prescription medication, but will it hurt my 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.
Do not be alarmed if the medication insert says something such as "Not for use during pregnancy." This is commonly written to minimize liability for pharmaceutical companies. Discuss any concerns with your physician.
Updated on: Apr. 18, 2013