Overview

Feeling sick (nausea) or being sick (vomiting) are common in pregnancy, with around 7 out of 10 pregnant women experiencing this. You might have heard of 'morning sickness' but nausea and vomiting can happen at any time. Usually, these symptoms improve or stop by around week 12 but sometimes they can last longer.

Very rarely, vomiting is so severe that it leads to dehydration (excessive loss of water and salts from the body) and weight loss. This is known as hyperemesis gravidarum (HG), and often needs hospital treatment. HG is thought to affect 3 in 100 pregnant women. HG typically improves by 20 weeks of pregnancy but in some women with severe disease the symptoms will last the whole pregnancy.

Is not known what causes HG, or why some people get it and others don’t. Some experts believe it's linked to the changing hormones in your body that happen during pregnancy.

Symptoms of hyperemesis gravidarum (HG)

Symptoms include:

• prolonged and severe nausea
• persistent and excessive daily vomiting
• not being able to keep down fluids and food
• tiredness
• light-headedness
• weight loss
• producing too much saliva (ptyalism)
• low blood pressure
• rapid heart beat (tachycardia)

The symptoms of HG are severe and can result in the disease affecting your mood and even suicidal thoughts, services are available to support you if you have any of these symptoms. 

You might also feel:

• anxious about going out or being too far from home, in case you need to be sick
• isolated, because you don’t know anyone who understands what it’s like to have HG
• confused as to why this is happening to you
• unsure whether you can cope with the rest of the pregnancy if you continue to feel very ill

If you have any of these concerns please do not hesitate to talk to a healthcare professional.

When should I go to hospital?

Come sooner rather than later and don’t wait until the evening if you’re unwell. If your treatment starts later and you are unwell there may be delays in completing the treatment and you might need to stay in hospital overnight. 

Treatment at the EPAGU

When you arrive, we'll ask you for a urine sample (as urine infections can also cause nausea and vomiting). We might also take blood tests to check your kidney and liver function, which can be affected in severe cases of HG.

How HG affects your baby

Nausea and vomiting are unpleasant symptoms, but they are unlikely to harm your baby if treated effectively. If it causes you to lose weight during pregnancy, there is an increased risk that your baby may be born smaller than expected and might not get all the nutrients that it needs. This is why is important to get help early so that you can be prescribed anti-sickness medicines and be treated if you become dehydrated.

If you are unable to keep any foods or fluids down and begin to lose a lot of weight, you must see your GP or contact the early pregnancy and acute gynaecology unit (EPAGU) for assessment.

Treating HG

Depending on how severe your symptoms are and the test results, you may be given:

• dietary advice
• anti-sickness medicines to take home
• anti-sickness medicines by injection
• intravenous fluids (given through a drip) to correct your dehydration until the vomiting is controlled in the EPAGU hyperemesis outpatient clinic

In extreme cases you may need to stay in hospital overnight (usually on the gynaecology ward) so we can monitor you and treat or prevent dehydration.

The hospital has an @home service where we give you care at home, rather than in hospital. This service is for patients living within Lambeth and Southwark. A member of staff will discuss this with you if it’s appropriate for you.

If you do not get treatment

If you do not get treatment your condition may get better on its own if the symptoms are mild. However, if the vomiting does not stop or it becomes more frequent and you are not able to eat or drink anything, it is important to get medical advice so that you do not become too dehydrated.

Blood clots and HG

Because HG can cause dehydration, there is also an increased risk of having deep vein thrombosis (a blood clot), although this is rare. If you are dehydrated and immobile, there is treatment that you can be given to prevent blood clots.

Lifestyle changes to help with HG

Although there is no evidence that nausea and vomiting in pregnancy can be prevented, in mild cases vomiting during pregnancy sometimes may be reduced by lifestyle changes.

• Avoid foods or smells that trigger your symptoms.
• Rest, especially after meals, as tiredness may increase nausea.
• Always drink plenty of water, but little and often to help avoid dehydration.
• Have a snack as often as every hour or two during the day if possible.
• While nauseated, eat low-fat, bland foods. For example, crackers, English muffins, toast, baked chicken and fish, potatoes, noodles, rice and low-fat dairy products.
• Keep a light snack such as a savoury biscuit or cracker by your bed and eat it within 20 minutes of getting up in the morning, or if you wake in the night, to help prevent sickness in the morning.
• Eat foods with a lot of water in them. Try clear soups, ice lollies and fruit jelly.

Useful information

Pregnancy Sickness Support is a registered UK charity working to improve care, treatment and support with nausea and vomiting in pregnancy and HG:

Visit www.pregnancysicknesssupport.org.uk or call 024 7638 2020