Severe Nausea and Vomiting During Pregnancy: How to Manage Hyperemesis Gravidarum

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A little nausea—and maybe some vomiting—is a normal, expected symptom of pregnancy. Though these symptoms are often called “morning sickness,” they can occur any and all times of day. When the nausea and vomiting become severe, it is called hyperemesis gravidarum (HG), and it can cause complications for mother and baby. Check out this The Pulse post for a comprehensive overview of HG and its causes, symptoms, and treatments. Keep reading for some more tips on what you (and even your family and friends) can do to help manage your HG.

What it is

Simply, HG is nausea and vomiting that is so severe it leads to weight loss, dehydration, and electrolyte imbalances. It can also cause headaches, confusion, fainting, extreme fatigue, low blood pressure, rapid heart rate, and anxiety and/or depression. HG is believed to be caused by increases in hormone levels (especially human chorionic gonadotropin) during pregnancy, but the exact cause is not known. Thankfully, most symptoms of HG subside about halfway through pregnancy. (Some women will experience symptoms for the entire duration of pregnancy.)

What it is not

If you experience nausea that is only sometimes accompanied by vomiting, you likely have regular morning sickness and not HG. Similarly, if you experience vomiting but do not experience dehydration and you are still able to keep some food down, you likely do not have HG. If you aren’t sure if your nausea and vomiting are abnormal and to confirm that the symptoms aren’t due to another illness, contact your healthcare provider.

How to help

There are simple, self-help measures that you can try for HG that are usually not harmful to your baby and may provide some relief.

In general, diet modifications can help relieve symptoms. Simply, eat and drink when you are able to tolerate it. Usually, small, frequent meals are better, and bland foods are easier to tolerate than spicy foods or those with strong flavors.2 Your meals should contain more carbohydrates than fats and acids, and protein-rich foods can reduce the symptoms of HG. When you don’t feel nauseated, try to increase your fluid intake so you can stay hydrated if a bout of vomiting strikes. Consuming ginger or peppermint have also been shown to decrease HG symptoms.

Women with HG should get as much rest and avoid stress as much as possible, and bed rest is a simple step that may provide some relief from HG.4 (Be careful not to self-impose too much rest, as this can cause muscle and weight loss over time.) Family and friends can be especially helpful during this time, since many women with HG require emotional support in addition to physical support. If you are suffering from HG, ask your friends and family to run simple errands for you, help you around the house, or care for other children in your house so you can rest.

Acupressure may alleviate some of the symptoms of nausea and vomiting. Pressure applied to the inside of the wrist has been especially helpful for decreasing symptoms of nausea and vomiting. Wrist bands sold for seasickness are easy-to-find, inexpensive acupressure tools that some women find helpful for HG.

Hypnosis has also been effective for some women with HG.1 It has been shown to provide deep relaxation and provide symptom relief, and it has no known negative effects.

When self-help steps are not effective and the nausea and vomiting don’t go away, there are medications to help control symptoms of HG, but you will need to discuss these options with your healthcare provider and weigh all the risks and benefits of any option you choose. Often, drugs that reduce nausea and vomiting can be used during pregnancy: metoclopramide, promethazine, diphenhydramine (known as Benadryl), ondansetron (Zofran), and steroids. Additionally, vitamin supplementation may be recommended for HG. Vitamins B6, C, and thiamine can help prevent certain complications of malnutrition related to excessive vomiting.

You may need to receive fluids through an IV if you become severely dehydrated.

The best thing you can do for HG is to try and identify any triggers that can make the nausea and vomiting worse. For example, some women are sensitive to certain sounds, bright or blinking lights, strong smells, pressure on your stomach (like from wearing clothes that are too tight), riding in a car, or even taking a shower. If you are able to avoid any of these triggers, it may help to lessen your symptoms.

You aren’t alone

Your healthcare provider can help you answer questions about your pregnancy, including what’s normal nausea and vomiting and what’s HG. He or she can help you decide on some diet modifications, self-help activities, or medications that may be right for you. Make sure you contact your healthcare provider if you are unable to tolerate fluids for more than 12 hours or if you are vomiting blood, as this may be the sign of a serious complication.

Finding a community to support you through HG is one of the best things you can do for yourself. There are in-person and online support groups and resources that can provide the encouragement, help, and care you need. This The Pulse guest post provides links to resources for mom, friends, and family to help manage HG. You are not alone in this struggle, and, as bad as you may feel, the nausea and vomiting will end once your baby arrives.

Jennifer Gibson
Dr. Jennifer Gibson earned a Bachelor of Science degree in Biochemistry from Clemson University and a Doctor of Pharmacy degree from the Medical College of Virginia School of Pharmacy at Virginia Commonwealth University. She trained as a hospital pharmacist and is the author of clinical textbooks, peer-reviewed journal articles, and continuing education programs for the medical community, as well as a contributor to award-winning healthcare blogs and websites. In her free time, she enjoys running, reading, traveling, and spending time with her family.

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