During the first trimester of pregnancy, many women have the bouts of nausea and vomiting known as morning sickness.
Despite its name, morning sickness can happen day or night. It usually starts around the 6th week of pregnancy, is at its worst around week 9, and stops by weeks 16 to 18. Although unpleasant, morning sickness is considered a normal part of a healthy pregnancy.
What’s Severe Morning Sickness?
Severe morning sickness is when nausea and vomiting get so serious that a pregnant woman vomits several times a day, loses weight, and gets dehydrated or is at risk for dehydration.
If this rare pregnancy-related condition isn’t treated, it can affect a woman's health and her baby's ability to thrive.
The medical term for severe morning sickness is "hyperemesis gravidarum" (hi-per-EM-eh-sis grav-ih-DARE-um), which means "excessive vomiting during pregnancy." It usually follows a similar timeline to normal morning sickness. But it can go longer, sometimes lasting for the whole pregnancy. Often, the symptoms get less severe as the pregnancy continues.
Most cases of hyperemesis gravidarum affect a woman's first pregnancy. But women who have it in one pregnancy are more likely to have it in future pregnancies.
What Causes Severe Morning Sickness?
The cause of severe morning sickness isn’t known. But it might be related to the hormone changes of pregnancy. A hormone called human chorionic gonadotropin, or HCG, might be to blame because severe morning sickness most often happens when HCG levels are at their highest in a pregnant woman's body.
Severe morning sickness also might run in families. It’s more common in women whose close family members (such as mothers and sisters) have had it.
Other things that can increase a woman's chances of having severe morning sickness include:
- carrying multiples (twins, triplets, etc.)
- history of motion sickness
- migraine headaches with nausea or vomiting
What Problems Can Happen?
The nausea and vomiting that happen in severe morning sickness are so extreme that they can harm the mother and the baby. Not being able to keep down food makes it hard for the mom to meet her nutritional needs. So she might lose weight. And a loss of fluids, combined with the loss of stomach acid from vomiting, can cause dehydration and electrolyte imbalances.
If severe morning sickness isn’t treated, it can cause many problems, including organ failure and the early birth of her baby.
When Should I Call the Doctor?
Call the doctor right away if you’re pregnant and have any of these symptoms:
- nausea that lasts throughout the day, making it impossible to eat or drink
- vomiting three to four times per day or not being to keep anything in the stomach
- brownish vomit or vomit with blood or streaks of blood in it
- weight loss
- fainting or dizziness
- peeing less than usual
- a fast heart rate
- a lot of headaches
- unpleasant, fruity mouth or body odor
- extreme tiredness
- confusion
How Is Severe Morning Sickness Treated?
Treatments used for morning sickness, such as eating dry crackers in the morning or a bland diet, may be recommended for women with extreme morning sickness. But these might not help with severe symptoms.
Medical treatment can include:
- a short period of not eating to rest the gastrointestinal system
- intravenous (IV) fluids
- vitamin and nutritional supplements
Some women might get medicine to stop the vomiting, either by mouth or through an IV. The doctor might recommend eating foods with ginger or taking vitamin B6 supplements to help ease nausea. It can also help to:
- Eat a bland diet.
- Eat frequent small meals.
- Drink plenty of liquids when not feeling nauseated.
- Avoid spicy and fatty foods.
- Eat high-protein snacks.
- Avoid sensory stimuli that can act as triggers (like specific smells or noises).
If a woman feels anxious or depressed about her condition, talking to a therapist or counselor might help her cope with her feelings.
What Else Should I Know?
With treatment, women with severe morning sickness can feel better and get the nourishment they need so they and their babies thrive. And lifestyle changes can help ease nausea and vomiting and make the pregnancy more enjoyable.
With time, symptoms usually do improve. And, of course, they stop by the time a woman's next journey starts: parenthood.
- Around half to two-thirds of all pregnant women will experience morning sickness.
- Possible causes include high levels of hormones, blood pressure fluctuations and changes in carbohydrate metabolism.
- Severe morning sickness, called hyperemesis gravidarum, may require hospitalisation.
- Symptoms of morning sickness may be relieved by eating a few dry crackers before you get up in the morning, avoiding foods and smells that make you nauseous, drinking plenty of fluids and choosing high-carbohydrate and high-protein foods.
Symptoms of morning sickness
Symptoms of morning sickness can include:
- nausea
- loss of appetite
- vomiting
- psychological effects, such as depression and anxiety.
The myth of hysteria and morning sickness
Unrelenting morning sickness can have a profound effect on your quality of life, preventing you from working, socialising and looking after your other children.
Pregnant women enduring morning sickness report higher levels of psychological stress, including anxiety and depression. This prompted the false belief that morning sickness is purely psychosomatic, which means that the woman’s fears and anxieties trigger her physical discomfort. However, there is no research to support these claims.
Possible causes of morning sickness
The cause of morning sickness remains a mystery, but it is thought a combination of physical and metabolic factors play a significant role, including:
- high levels of hormones, including oestrogen
- fluctuations in blood pressure, particularly lowered blood pressure
- altered metabolism of carbohydrates
- the enormous physical and chemical changes that pregnancy triggers.
Morning sickness and your baby
Some women are concerned that the action of vomiting may threaten their unborn baby. Vomiting and retching may strain the abdominal muscles and cause localised aching and soreness, but the physical mechanics of vomiting won’t harm the baby. The fetus is perfectly cushioned inside its sac of amniotic fluid.
Numerous studies have discovered that moderate morning sickness is associated with a reduced risk of miscarriage. However, prolonged vomiting (that leads to dehydration and weight loss) can deprive your child of proper nutrition and increase the risk of your baby being underweight at birth.
If you have nausea and vomiting that will not stop, contact your GP (doctor) or midwife.
Severe morning sickness (hyperemesis gravidarum)
Severe morning sickness is known as hyperemesis gravidarum (HG), and can affect around one in 1000 pregnant women. The symptoms of HG include repeated vomiting, weight loss and dehydration. Treatment usually involves hospitalisation, and the administering of intravenous liquids and nutrition.
The possible complications of untreated hyperemesis gravidarum include:
- electrolyte imbalances
- extreme depression and anxiety
- malnourishment of the fetus
- excessive strain on vital organs, including the liver, heart, kidneys and brain.
Managing morning sickness
Suggestions for coping with morning sickness include:
- Don’t take drugs of any kind, unless your doctor knows you are pregnant and has prescribed specific medications.
- Eat a few dry crackers or plain sweet biscuits before getting out of bed in the morning.
- Don’t eat anything that you suspect will make you nauseous. In general high-carbohydrate meals are well tolerated.
- Eat small meals regularly, as an empty stomach tends to trigger nausea.
- It may help to avoid cooking or preparing foods.
- Drink as much as you can manage. Sometimes sips of flat lemonade, diluted fruit juice, cordial, weak tea, ginger tea, clear soup or beef extract drinks are helpful. If none of these are bearable, try sucking on ice cubes.
- Vitamin B6 supplements can be useful, but doses above 200 mg per day can actually be harmful. Follow your doctor’s advice.
- Consider acupressure or acupuncture on the wrist.
- Wear loose clothes that don’t constrict your abdomen.
- Moving around may aggravate morning sickness. Rest whenever possible.
Seeing your doctor about morning sickness
Always seek medical advice if your morning sickness is severe, if you have lost a lot of weight quickly, or if you feel depressed or anxious. Treatment options can include medication that won’t harm your developing baby.
Where to get help
- Nausea and vomiting in pregnancy , The Royal Women’s Hospital.
- Chan RL, Olshan AF, Savitz DA, et al., 2010, ‘Severity and duration of nausea and vomiting symptoms in pregnancy and spontaneous abortion ’, Human Reproduction, vol. 25, no. 11, pp. 2907–2912.
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