Hyperemesis gravidarum • Extreme vomiting during pregnancy

Many women are familiar with nausea during pregnancy, but a small percentage suffer from a particularly severe form, known as hyperemesis gravidarum. Constant vomiting can make pregnancy an extreme feat. How dangerous the disease is and what helps with severe vomiting in pregnancy.

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Around 25 percent of all women suffer from nausea during early pregnancy, and around 50 percent also suffer from vomiting (emesis gravidarum). In most cases, the symptoms subside towards the end of the first third of pregnancy (trimester). In 0.2 to 2 percent of pregnancies, however, vomiting is excessively pronounced – this is hyperemesis gravidarum.

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Home remedies for nausea: This calms the queasy stomach

Home remedies for nausea: This calms the queasy stomach

What is hyperemesis gravidarum?

Experts understand hyperemesis gravidarum to be a pregnancy complication characterized by particularly severe nausea and frequent vomiting (more than five times a day). Other criteria of the disease are:

  • weight loss of more than five percent of body weight,
  • Disorders in metabolism as well
  • lack of fluids (dehydration).

The extreme nausea usually starts in the 4th to 9th week of pregnancy. In about half of the patients, the symptoms improve again from the 14th week of pregnancy (GW). Only in exceptional cases does the uncontrollable pregnancy vomiting last beyond the 20th week. Due to the poor general condition, a hospital stay is necessary in many cases.

Degrees of severity of hyperemesis gravidarum

Experts distinguish two degrees of severity:

  • Hyperemesis gravidarum Grad 1 Nausea, vomiting and a pronounced feeling of illness occur. The metabolic values ​​are in the normal range.

  • Hyperemesis gravidarum Grad 2 In addition to the symptoms of grade 1, pregnant women suffer from a disturbed metabolism, water and mineral balance.

Symptoms: hyperemesis gravidarum or normal morning sickness?

Nausea during pregnancy is not uncommon and usually places a heavy burden on those affected. In most cases, however, it is a normal side effect of pregnancy and not a serious illness.

Hyperemesis gravidarum, on the other hand, is an extreme form of morning sickness. Typical signs include:

  • Persistent nausea and vomiting (at least five times in 24 hours)
  • Food and liquid cannot be retained in the body
  • Weight loss (more than five percent of body weight)
  • Dehydration (dry mucous membranes and tongue, tight skin folds, sunken eyes, reduced urge to urinate and feeling thirsty)
  • Circulatory weakness (dizziness, rapid pulse)
  • High temperature
  • Sweet breath odor (indicative of ketosis)
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Other symptoms are possible with continued dehydration. Frequent consequences are nutrient deficiencies and disturbances in the water balance such as electrolyte imbalances.

If the disease persists beyond the 16th to 18th week of pregnancy, serious damage to the liver can occur, which can be seen in jaundice, for example. In the case of severe liver damage or lack of fluids, clouding of consciousness up to and including delirium may occur. Blood clotting disorders as well as nerve and muscle pain are also possible.

How dangerous is hyperemesis gravidarum?

The constant vomiting not only represents a strong psychological burden for pregnant women, it also often leads to physical weakness and deficiency states, which increase the risk of further complications such as preeclampsia (high blood pressure during pregnancy with kidney problems) or damage to the esophagus.

Left untreated, hyperemesis gravidarum can affect the metabolism of pregnant women. Vitamin B deficiency damage to the brain (Wernicke encephalopathy) or nerve damage can occur. However, such complications are rare.

For the unborn child there is a risk of being born prematurely (i.e. before the 37th week of pregnancy). The baby may have a reduced weight (less than 2.5 kilograms) at birth.

Causes: how does hyperemesis gravidarum occur?

The exact causes of the disease are not yet clear. It was long thought to be purely psychological and stemmed from stress during pregnancy. This assumption is now considered outdated and has not been scientifically proven. Instead, experts suspect that several different factors play a role.

These include hormonal changes. In particular, the pregnancy hormone hCG (human chorionic gonadotropin) seems to play a role, since nausea and vomiting are triggered by a high hCG level. In addition, the disease occurs more frequently in multiple pregnancies, in which the hCG level is generally higher. But other hormones such as estrogen, progesterone and thyroid hormones also appear to be involved.

Women whose mothers also had the condition are about three to four times more at risk. Therefore, experts assume that the predisposition also has an influence. In addition, sluggishness of the esophagus and stomach could be causing the constant nausea. Studies have also found that the gastric germ Helicobacter pylori is significantly more common in pregnant women with hyperemesis gravidarum. However, it has not been proven whether this is the cause or consequence of the disease.

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Risk factors that favor hyperemesis gravidarum:

  • Young age
  • overweight
  • Metabolic diseases (e.g. diabetes mellitus)
  • Mehrlingsschwangerschaften
  • African or Asian descent

How is hyperemesis gravidarum diagnosed?

Pregnant women who are constantly nauseous and who vomit frequently should definitely seek medical help. As a rule, the first point of contact is the gynecological practice. There, those affected are first asked about the frequency of vomiting and other symptoms. This is followed by a physical examination, during which a possible weight reduction and general condition are checked. Attention is also paid to signs of dehydration or a metabolic disorder.

This is followed by a laboratory diagnostic test. Blood counts are checked for inflammation, electrolytes, liver, kidney, and thyroid levels. A urine sample provides information on possible ketone bodies in the urine. The substances are formed during the breakdown of fatty acids in the body and are an important indication of a possible metabolic imbalance. The diagnosis also includes an ultrasound examination (sonography) to check the development of the unborn child.

Under certain circumstances, further examinations are used to rule out diseases such as gastroenteritis or pancreatitis. In addition, other diseases can occur at the same time as hyperemesis gravidarum, such as:

  • Preeclampsia
  • Pregnancy obese liver
  • Inflammation in the digestive tract or urogenital area
  • neurological diseases
  • metabolic diseases

A poor general condition (signs of dehydration or severe weight loss) requires admission to a hospital.

Therapy: How is hyperemesis gravidarum treated?

The aim of treatment for hyperemesis gravidarum is to stop the urge to vomit and to replenish fluid, vitamin and electrolyte stores. Depending on the severity of the symptoms, different treatments are possible:

Diet and conservative measures

In milder cases, a change in diet and measures recommended for normal morning sickness can often help. These include, among others:

  • Avoiding triggers (e.g. certain smells)
  • Low-fat and high-carbohydrate diet
  • Lots of small meals
  • Drink enough (especially chamomile or herbal teas are good for the stomach and intestines)
  • Lots of rest and enough sleep
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Ginger, acupuncture, wrist acupressure, and vitamin B supplementation can also help relieve nausea. However, the measures cannot reduce vomiting.


Various medications can help with hyperemesis gravidarum. Antihistamines, anticholinergics, and antiemetics are often prescribed to relieve nausea. The drug of choice is the antihistamine meclozine, which in Germany is only available from pharmacies abroad. Alternatively, medical professionals often prescribe a combination of doxylamine and pyridoxine (vitamin B6) to reduce nausea.

In severe cases, the administration of metoclopramide (from the group of antiemetics), cortisone-containing drugs or ondansetron is also possible. The latter is normally used for nausea attacks during cancer therapy, but has also shown success with extreme morning sickness. When prescribing medication during pregnancy, the benefits and risks must be carefully weighed.

Inpatient treatment

In severe cases of vomiting during pregnancy, an inpatient stay is necessary. Pregnant women receive electrolyte solutions and medication for nausea and vomiting here. In the case of malnutrition, vitamin intake (especially thiamine) may also be indicated. In the hospital, the condition of those affected and the baby can be better monitored.

Duration and prognosis of hyperemesis gravidarum

Severe complications and life-threatening conditions are rare in hyperemesis gravidarum. The symptoms usually subside from the 14th week of pregnancy, but they persist in around 15 to 20 percent of those affected in the third trimester, and in around 5 percent even until birth.

Severe vomiting during pregnancy is very exhausting and stressful. Private and professional activities are impaired and pregnant women can develop pregnancy depression. Medical, family and, under certain circumstances, psychological care is therefore very important.

Can hyperemesis gravidarum be prevented?

So far, hyperemesis gravidarum cannot be prevented. The risk that women will develop hyperemesis gravidarum if they become pregnant again is 15 to 20 percent.

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