“Morning Sickness” vs. Hyperemesis Gravidarum

Photo by Mikaela Wapman

Photo by Mikaela Wapman

Pregnancy-related Nausea or “Morning Sickness”

Pregnancy-related nausea is a common enough concept for most of us: nausea and vomiting during the first trimester, food aversions, and beyond.

Morning sickness – a misnomer, as it’s symptoms strike throughout the day for most women –  usually begins around the 6th week of pregnancy and tends to last for the duration of the first trimester (or until around the 14th week), but many women don’t experience relief from the symptoms for another month or so. And some women don’t feel a lessening of symptoms until they give birth, or somewhere around 40 weeks.

Pregnancy-related nausea affects over 70% of all pregnant womenAccording to Baby Center, more than half of pregnant women experience both nausea and vomiting, a quarter experience only nausea, and the remaining quarter are don’t experience any form of “morning sickness”.

Hyperemesis Gravidarum

Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting during pregnancy that is characterized by “unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids”. If HG is severe enough, or untreated, it can be 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

While the majority of women experience some form of morning sickness, around 1-3% of women are hospitalized for HG. That may seem pretty low, but these statistics offer very limited information, as many of the women who suffer from HG are treated as outpatients with mild to severe symptoms. Helpher.org – a website devoted to raising awareness about HG – goes on to say,

There are reports from hundreds, if not thousands, of women who terminated out of desperation when given the diagnosis of morning sickness and given inadequate treatment. One study by Zhang, et al of 1867 women found a 10.8% incidence of severe vomiting. Many women are not represented in current statistics which only report the number of women hospitalized as inpatients. HG is not a rare disorder.

Like more moderate forms of pregnancy-related nausea and vomiting, symptoms from HG can resolve around 21 weeks, though – for less than half of these women – can last for the duration of the pregnancy. The effects of all forms of HG are severe: considering the cost of additional doctor’s visits, outpatient care, consultations, and treatments for consultations, the annual cost could reach to one billion dollars.

Beyond the financial effects of HG are the emotional and psychological impacts: family relationships are disrupted, women could be “misdiagnosed by a disease erroneously presumed to be psychological”, and women could lose their jobs because of the debility. 

While there is no known prevention of HG, there are many ways to alleviate and manage the symptoms. These include: bed rest, acupressure, herbs (ginger or peppermint), IV fluids to restore lost hydration, electrolytes, vitamins and nutrients, tube feeding, and medications.

Distinguishing between Pregnancy-Related Nausea and HG:

Pregnancy-related nausea is what is commonly referred to as morning sickness. Symptoms of those suffering from Hyperemesis Gravidarum are generally more severe, as is depicted in the chart below (source: www.helpher.orgAmerican Pregnancy).

Why do we have pregnancy-related nausea, anyways?

Theories regarding the etiology of pregnancy-related nausea and HG are inconclusive. This is partially because pregnancy-related nausea and HG are influenced by a number of factors, and may vary among women depending on their biological makeup (genetics), body chemistry, and general health.

Theories regarding the cause of  pregnancy-related nausea and HG center on hormonal changes (increase in estrogen during pregnancy) and physical changes (relaxed esophageal sphincter) during pregnancy, since the time period is restricted to pregnancy.

Other half-witted theories include: one’s psychological state may be related to the development of pregnancy-related nausea and HG. In this vein, women who are frustrated, depressed, isolated, and / or have feelings of helplessness are more likely to experience pregnancy-related nausea or HG. Understandably, others respond by pointing to the fact that most, if not all women experience psychological effects (frustration, anger, depression, isolation, and feelings of helplessness) secondarily to  pregnancy-related nausea and HG.

At present moment, there are no conclusive theories as to the etiology of pregnancy-related nausea and HG. Click here to learn more about the many theories of pregnancy-related nausea and HG’s etiology.

Narratives from HG

To get a sense of what Hyperemesis Gravidarum (HG) can look like, check out Huffington Post ‘s post What It Really Feels Like to Have Hyperemesis Gravidarum”. An account of a third time mom who experienced HG so severe that she was hospitalized for 11 days, and spent the remaining duration of her pregnancy receiving IV fluids and medications for HG through a PICC line and stomach pump. Alexa continues,

One of the worst things about HG is how isolating it is. I cannot go out, cannot even talk on the phone for a long time because it makes me feel sick. I cannot cook, everything smells terrible to me, and even walking to the bathroom makes me vomit most days. I also have ptyalism, which is hyper-salivation, and swallowing it makes me vomit too, so I am constantly spitting into a cup. I feel disgusting.

Her account ends happily, with her giving birth to a 9 pound, 11 oz son (described by her OB as “the world’s most effective parasite”). For her, her HG improved after about 22 weeks of pregnancy, though she is the first to remind us that “far too many sufferers are severely ill until they give birth”. Read the whole thing here

For more information on Hyperemesis Gravidarum, visit www.helpher.org and beyondmorningsickness.com.

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