Kierstin has two daughters and dealt with hyperemesis gravidarum in all of her pregnancies.
Overview of Signs It's Hyperemesis Gravidarum and Not Normal Morning Sickness
- You always feel faint, whether you're walking around, standing up or just in bed.
- You're losing a lot of weight, as in, your pants won't stay on or your bra is no longer the right size.
- You have a lot of spit in your mouth, all of the time.
- You're vomiting so often and so violently that you're losing bladder control.
- You spend more time in the bathroom than you do anywhere else.
- Rather than just dealing with a lack of appetite, you're finding it mentally excruciating to eat a meal.
- Most things cause you dizziness and nausea including watching television or looking at a magazine.
- You are never not nauseous.
- Medications like Zofran and Zantac hardly help you feel better.
- You're too sick to work or care for yourself.
- Riding in the car causes nausea and vomiting.
- Nausea and vomiting keep you up at night.
- You're so sick that you can no longer engage in social activities.
- You're so sick that you're experiencing anxiety and depression.
At exactly six weeks pregnant, only shortly after I'd gotten my positive on the pregnancy test, I woke up to my first bout of morning sickness. I was so relieved! I'd been all over BabyCenter that week and knew that getting sick was a sign of a healthy, progressing pregnancy.
I settled back into bed with a sense of deep pride at the chaos the little growing blastocyst was causing my body and tried to nod back off. But almost immediately, the waves of nausea returned and I was back in the bathroom.
Over the next few days, the sickness didn't dissipate. Instead, it escalated.
What was supposed to be the loveliest, glowiest and most magical time of my life had reduced me to a bag of bones shuffling back and forth to the bathroom for the entire first trimester, into the second. It turns out, I have a possible gene mutation called hyperemesis gravidarum.
Unfortunately, hyperemesis gravidarum is a reoccurring condition that rears it's ugly head with each subsequent pregnancy after it's first experienced.
But what's the difference between HG and plain ol' regular morning sickness?
I may use specific words or phrasing that trigger HG symptoms. If you're feeling especially susceptible, hand this article off to a friend and ask them to read it for you and relay the information to you.
What is Hyperemesis Gravidarum?
If you've never heard of it before, hyperemesis gravidarum sounds like something you'd say right before performing a magic trick, and in a way it feels like one too. One minute you're healthy, happy and expecting a new little babe and the next - abracadabra - you're sick as a dog and living a completely different life than what you'd expected this pregnancy adventure to entail.
Hyperemesis Gravidarum (or HG) is defined as extreme nausea and vomiting in pregnancy. It's a condition that can only occur during pregnancy, and it is accompanied by weight loss and dehydration. It is sometimes called "severe morning sickness."
Symptoms of Morning Sickness vs. HG
|Symptom||Typical Morning Sickness||Hyperemesis Gravidarum|
Doesn't interfere too much with everyday life and can be curbed with a light, bland snack, fresh air, or anti-nausea medications.
Unrelenting and doesn't occur randomly or at one time of day. Instead, it's constant and while medication is helpful in taking the edge off, it will not get rid of it.
May happen fairly consistently in the first trimester but has a likely trigger or only happens once or twice a day with a quick recovery.
Vomiting to the point of dry heaving, loss of bladder control, after consuming most foods and beverages. Can happen several times per day (usually between 5 and 10 for me).
Loss of Appetite
Normal loss of appetite might mean eating less and mostly bland foods but doesn't prevent eating altogether.
Loss of appetite is dramatic, especially if you're afraid of throwing up again.
Food cravings in early pregnancy are normal and can be quite dramatic. Usually these cravings result in a happy tummy.
Food cravings, believe it or not, do happen in HG pregnancies too. You will probably still throw up what you ate though.
Losing a few pounds or not gaining any weight at all in your first trimester is totally normal.
Weight loss is drastic and happens quickly. Losing 1-2 pounds or more a week is typical of HG.
Physical Symptoms and Side Effects of Hyperemesis Gravidarum
The most obvious symptoms of hyperemesis gravidarum are the physical ones which typically start between 4-6 weeks. They often include:
- Nausea that does not subside. This is not like the vague queasiness that you might have during a typical hormonal shift, like right before your period or when taking birth control. This is a constant and heavy nausea that is lessened only with medication or briefly after an episode of getting sick.
- Vomiting several times a day. For each woman this might be a different number. For me it was at least 3-5 times but I had days where I vomited until I couldn't any longer and then dry heaved every 15-20 minutes.
- Loss of appetite. This is pretty obvious, from the nausea. For me, when presented with a small plate of food it took me at least a half an hour to get up the nerve and interest to try it because I knew I'd just throw it up anyway.
- Weight loss. This is a side effect of the loss of appetite and vomiting. I lost a total of 15-20 pounds in both pregnancies before the HG subsided.
- Low blood sugar. When you're not eating enough, you don't have enough sugars to turn to glucose. Thus, low blood sugar.
- Dizziness. Dizziness during pregnancy is not uncommon but can be really extreme with HG. I couldn't walk far without support.
- Exhaustion and weakness. As a side effect of the dehydration and low blood sugar.
- Sleeplessness. Because nausea persists through the night, it can be really hard to sleep.
- Sensitivity to smells, sights and sounds. I was very sensitive to smells, especially perfumes, soaps and of course, food. I also found myself sensitive to sights that I perceived as overwhelming or dizzying. This included bright colors, patterns and movements, computer and phone screens and loud or overwhelming sounds like music and particular television shows. Rather than just experiencing feelings of unpleasantness however, these triggered nausea and vomiting.
- Darkened urine. Because I was unable to hold down liquids much of the time my urine was very concentrated.
- Infrequent bowel movements. Because I was unable to hold down solid food I only had a bowel movement about twice a week.
- Stomach pain. I'm not a doctor but I would imagine this was a combination of typical pregnancy pains alongside stomach inflammation, dehydration and muscle pain from frequent vomiting.
- Throat pain. Constant throwing up made my throat sore and hurt the muscles along it. Sometimes it would also bleed.
- Dental issues. I lucked out on this one but dental issues are a possible side effect of HG since it's nearly impossible to brush your teeth without becoming sick.
- Skin issues. Because I was so thin during this time the skin that rested along my jutting bones, especially my hips, became bruised and sensitive.
Mental and Emotional Side Effects of Hyperemesis Gravidarum
- Fogginess When I was experiencing HG it was hard to think clearly, solve problems or hold a conversation because I just couldn't think straight. This was probably do to a lack of energy or nutrition to power my brain.
- Loss of Focus It became difficult to begin or end anything, even TV shows with plots so I ended up watching episode after episode of Property Brothers. A truly dark time for me.
- Depression and Anxiety Likely due to a mix of factors including not leaving my room much and being sick for a long period of time I found myself crying daily and worrying about the future, especially what kind of mother I would be if I couldn't even handle the gestation period.
- Isolation Along with not being able to leave the house except for doctors appointments, I was also unable to maintain a social life outside of infrequent Facebook logins (because Facebook it turns out, was pretty triggering...) I missed out on many holidays, birthday parties and family gatherings during my pregnancies.
Common Hyperemesis Triggers Include
- Overwhelming television shows or movies. This isn't a great time for a Stranger Things binge.
- Reading or focusing your eyes too much on a phone, tablet or computer screen.
- Riding in a car which might as well feel like getting on a roller coaster.
- Thoughts of triggers. Thinking about foods or activities that induce nausea can actually make the nausea worse. Yay.
- Too much physical activity. While you might have moments that make you feel like you can get up and get a lot done, you'll likely feel worse afterward.
Things That Are Difficult or Impossible to Do With Hyperemesis Gravidarum
- Drive. Thanks to dizziness and lightheadedness it's not only hard, it's pretty dangerous to drive.
- Cook. Cooking involves a lot of triggering sights and smells.
- Clean. Again, the sights and smells of cleaning, along with the physical exertion can be triggering.
- Socialize or hold a conversation. Talking can make it harder to maintain.
- Shop, which can be physically overwhelming.
- Attend classes or do homework.
Questions About Hyperemesis Gravidarum
When does Hyperemesis Gravidarum end?
The timeline for HG's progression is different for everyone, but mine followed the most usual timeline which was:
- Onset 4-6 weeks. I became sick the first time at 5 weeks and at 6 weeks in my second pregnancy.
- Peak at 9-13 weeks. For me, my worst weeks were actually weeks 8-10, hands down. This is when I experienced the most pain, weakness and consistent sickness.
- Relief by 14-20 weeks. By the beginning of my second trimester I was experiencing relief in that I wasn't getting sick as often (I went down to just a couple of times a day then to just a few times a week) and the nausea started to relent with random flare ups. By around week 24 I was bouncing back and able to enjoy my pregnancy and my baby bump.
For some women, they'll experience HG until they give birth, and possibly for a couple of days afterward as the hormones leave their body. Know though, that as uncommon as HG is, having it full-throttle throughout the whole pregnancy is even less common. While I did experience waves of it up until I gave birth, I was through the worst of it by five months.
Are there medications to treat HG?
Yes, there are and while they can't cure it, they help. Here's a comprehensive list by the HER Foundation of treatment options.
Will Hyperemesis Gravidarum kill you?
No, it won't. Because we live in a modern medical age with access to doctors, hospitals and rehydration methods. HG itself won't kill you, not staying hydrated is the issue, but if you can't get by on sports drinks, you can have medical intervention to make sure you don't become severely dehydrated.
Should I call my doctor if I think I have HG?
If you recognize that your "morning sickness" isn't normal, you need to call your doctor and discuss treatment options. Not all care providers recognize HG as a serious concern. If your doctor doesn't take your illness seriously or if you're experiencing symptoms of dehydration then you need to head straight to the emergency room for IV fluids.
Are there resources for hyperemesis gravidarum
Yes, the HER Foundation has compiled excellent resources,
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Questions & Answers
Question: Why do I have Hyperemesis Gravidarum in my second pregnancy when I didn’t have it with my first?
Answer: That’s a really good question and one that I don’t have a finite answer to. Since HG has always seemed to exist, we know it’s not a new thing, but the research on it is and as of yet all we seem to know for certain at this point is that two genes are likely the culprit for “severe morning sickness” in pregnant women. If this is the case, I’m not sure why HG would be present in a second pregnancy but not the one before it.
So here’s a few of my theories (and only mine, I’m not speaking as an expert or a researcher, just as someone who has it):
You had HG with the first pregnancy but it wasn’t as “bad” as this time around. I think this is unlikely, since HG is hard to ignore. But we do forget the bad parts of pregnancy and labor a bit, right? It’s possible you’re glorifying your last pregnancy as “not being that bad” when in reality, if you were vomiting and losing weight beyond the norm for morning sickness, you were probably dealing with HG and since the condition seems to worsen for most women with each pregnancy, this time around is worse than before.
Your pregnancy ended early. If you had a miscarriage before 6-8 weeks, it’s possible that your pregnancy didn’t progress far enough along to experience HG symptoms which typically appear after six weeks.
There’s something about those two genes that probably cause hyperemesis gravidarum that we just don’t understand yet! Perhaps they don’t always “wake up” until some of the other things happen that didn’t happen in your first pregnancy.
You don’t have hyperemesis gravidarum. Hold up - I HATED being told my pregnancies were normal so I know how crappy it is of me to say that. But something I’ve noticed in my friends who have had different gendered pregnancies is that my friends who started off pregnant with boys did just fine with only slight discomfort through their first trimester, but when they carried a girl in their next pregnancy, they felt really awful in comparison. She was usually vomiting in the morning or at least having a hard time getting through breakfast and feeling generally run down, worn out, queasy and sick through their first 14 weeks. I’ve also had friends who carried their girly pregnancies fine but felt really awful with the boys. So, I think that sometimes our bodies react poorly to either the testosterone or estrogen and if your first pregnancy was a different gender than this pregnancy, maybe that’s what’s going on. Again, NOT an expert and my opinion only. No matter what, if you have a hard time keeping up with your daily responsibilities and keeping food down you need to talk to your OB about how to feel better and take good care of yourself through your pregnancy.
Question: Is it safe to take medication to treat Hyperemesis Gravidarum? Will it hurt my baby?
Answer: Deciding whether or not to take medication when you’re pregnant can be daunting, but determining if it’s the right thing to do when you have hyperemesis gravidarum is downright overwhelming on top of how awful you already feel.
The first thing you should do, when you have the energy is to write down your symptoms (or ask someone to help you write them down if you’re having trouble with it). The reason I think this is important is because with my first pregnancy I was so sick that when I would see my midwife I could hardly articulate how sick I was, and often just got out of there as soon as possible so I could get back to my safe bathroom which was the only place I felt truly at home anymore.
I believe this is part of the reason I never received proper care during that pregnancy. I was taking over the counter Unisom tabs to help ease nausea, but all it did was help me sleep most of the day away to give me breaks from the vomiting. Thanks to that I don’t remember much of the first half of that pregnancy! Not knowing the true level of sickness I was dealing with, my midwife didn’t believe there was anything wrong with me other than typical morning sickness combined with anxiety, and she refused to prescribe Zofran. So you need to have your symptoms and the true day-to-day misery at hand to describe to your doctor so they can get a solid feel for what you’re dealing with and how they can best treat you.
With my second pregnancy, with a new care provider, I was prescribed Zofran (and anti-nausea medication) without question. That pregnancy was still difficult but with the help of prescription medication I was able to be more coherent and vomit less (though still often). It didn’t take my hyperemesis gravidarum away, but it did give me the ability to have okay moments where I could get some Gatorade and a cup of yogurt in me and give me enough time to digest that properly before I got sick again.
There are other medications your doctor may want to prescribe you, depending on your circumstances and some of these include anti-nausea, sleep medications, and acid reducers. The thing I will tell you not to do is to medicate yourself. Always talk to your doctor about the right combination of prescription and over the counter medications and how and when you should take them. They’ll know best what is safe for you and your baby.
Which, on an anecdotal side note - both of my daughters are healthy and have no apparent issues with the medications I took while pregnant with them.
Question: Were you able to cook after 5 months? Also did you eat a lot like 8 times a day after 5 months?
Answer: I was able to cook after 5 months. Not all of the time, I still struggled with some lingering nausea and smell sensitivities but I was nowhere near as sick at that point. I found that most of my nausea was happening just in the morning and then at night when it was time for me to get to bed.
As for eating, I don't think I was eating a ton at 5 months but by the time I was about 7-8 months along I was eating CONSTANTLY and kept that up right up until labor (and even begged to eat during labor but at that time, it wasn't allowed though I believe they've recently changed those standards).
I didn't gain until the last two months and within those two months I gained 30 pounds (both pregnancies) so that's a pretty quick gain!
Question: Should I get an abortion if I have hyperemesis gravidarum?
Answer: This is such a tough situation to be in, especially if you have a lot of other responsibilities looming including other kids to care for, work, etc.
Every woman’s experience with Hyperemesis Gravidarum is different and here’s mine - I had a lot of help in both pregnancies from my husband and our mothers. We were in a position at the time where I didn’t have to work and when I was pregnant the second time my husband and our moms all took turns caring for me and our infant. By 14 weeks I was semi-functional and by 20 weeks I was mostly independent to care for myself and my daughter again. Not everyone’s situation is the same as mine and I can say in all honesty that had I not had the help that I did financially and with childcare I couldn’t have kept my second pregnancy because I already had one child to take care of and HG prevented me from doing that efficiently.
This is a decision you have to make based on your own feelings and situation. If you can get through the pregnancy without a serious risk to your own financial situation or your other children and you want to keep the pregnancy then you can work around the illness. Don’t be afraid to feel like a burden to the people who love you - it’s temporary.
If you have a lot on your shoulders and you can’t see shirking your parental and financial responsibilities for the next few months at least and if the medications your doctor has provided aren’t giving you enough of a break to do the bare minimum then you shouldn’t be afraid to explore the option of abortion.
Neither decision should be made by anyone except you and no one else can judge it until they’ve been in it themselves.
Question: How do I tell the difference between hyperemesis gravidarum and a stomach bug?
Answer: If you really want to know what HG feels like, then the closest comparison that I’ve experienced is a stomach bug that feels like it’ll never relent, like norovirus. Unfortunately, the similarities can make it hard to tell the difference between HG and a tummy virus, at first. The thing about tummy bugs is that you recover within 7-10 days (although let’s be real, the effects on your digestive system can linger for a long time after that), and within that time frame symptoms will begin to dissipate gradually. HG isn’t like that.
Here are a few ways to tell the difference between hyperemesis gravidarum and a stomach bug:
The timing of onset is one. If the symptoms start within the first eight weeks of pregnancy, then there’s a better possibility that you’re dealing with HG which doesn’t usually develop later in the pregnancy. Now that we know a gene likely causes the disease this makes sense.
If your symptoms start to taper off after a few days, that’s not HG. HG may fluctuate slightly but within the first trimester, at least, the symptoms never go away, and they really don’t get better. Instead, thanks to prolonged vomiting, you’ll find yourself getting weaker and sicker as the days wear on.
I don’t know about you, but when I get a stomach bug, I’ll get it coming out both ends for the first couple of days. It’s not great, and it feels like satan is trying to leave my body through whichever orifice is most convenient. But with HG, and it does differ from woman to woman, but typically, you’re not going to have excessive, or even any, diarrhea. That’s probably because HG is a disease and stomach bugs are, well, viruses that affect the digestive system and your body needs to rid itself of that virus through whatever means possible. HG, on the other hand, is a disease that causes extreme nausea and what results from extreme nausea? Yeah, the pukes. With HG your body isn’t trying to rid itself of anything; it seems to be reacting to nausea.
To me, and to probably to a lot of other HG moms, I would say the best way to tell the difference between it and a bug is how long it lasts and the severity. If you’re going on a week of non-stop puking, that’s probably not a stomach bug.
Question: Does having hyperemesis gravidarum mean I’m having twins?
Answer: No, having hyperemesis gravidarum doesn’t mean you’re having twins. You could be having twins and still have hyperemesis gravidarum, but you’re not any likelier to have it just because of that.
Just within the past year, HG researchers are learning that the cause of this disease isn’t a particular kind of pregnancy, a particular gendered pregnancy or because of the mother’s diet or prior health leading up to the pregnancy as has been suggested by random sources. Instead, HG is being linked to two genes that control appetite. So HG is in your genes and not determined by single or multiples in a pregnancy.
When I was experiencing hyperemesis, I also thought I must be pregnant with twins or more and if not then I was possessed by an alien life form out to kill me. But so far, this research confirms the cause is much less dramatic. Still gross though.
Question: Can I still work if I have Hyperemesis Gravidarum?
Answer: Probably not and if someone is telling you that you can (or should) they need to straight up check themselves, because life is serious right now. Hyperemesis Gravidarum isn’t like a nasty cold. You don’t catch it, take a few days off and then head back to work pumped up on cold meds. Instead, it’s progressive. You’ll do better if you rest but even if you do, you’re still going to have it, it’s not going away for a while.
If your pregnancy is like many HG pregnancies, you’ll probably be okay to work by the third trimester, however, when you’re in the throes of this condition your priority must be rest, hydration and maintaining until your pregnancy until you’re able to stop vomiting and start gaining weight and strength.
Many women can go on short-term disability with an HG diagnosis, so talk to your OB about what steps to take to do this in your state if need be.
Question: Does Hyperemesis Gravidarum last for the entire pregnancy?
Answer: No, not usually. Some women will experience HG straight through the pregnancy and even through labor, delivery and for a (very) short time after the delivery but that’s just not the norm when it comes to HG.
I had hyperemesis gravidarum two times, and both times I stopped throwing up around 17 weeks with nausea greatly improving by the third trimester. The timeline for hyperemesis that I noticed in my own pregnancies was:
6 weeks: Onset of severe morning sickness (I usually didn’t feel many symptoms when I first would find out that I was pregnant)
8-12 weeks: These were the absolute worst weeks for me with constant sickness, nausea and dramatic weight loss.
13-16 weeks: Vomiting began to lessen, and I would go whole days without getting sick at all and was able to manage my symptoms with medications. Usually, I would go in a pattern of like one good day then two bad days through this period.
16-28 weeks: Still experiencing some nausea that could be controlled through proper diet, exercise and getting enough rest (with several breaks throughout the day). Almost no vomiting except random bouts.
28 weeks - delivery: Only experienced random bouts of nausea but did deal with a lot of acid reflux!
Every woman, every pregnancy, and even every HG pregnancy is different but take solace in that it almost always gets better (and once that baby is out you’ll be cured!)
Question: Will I have hyperemesis gravidarum with every pregnancy?
Answer: The jury’s out, but I think we’ll get more information as the current gene study being conducted fleshes out more information. Often, hyperemesis gravidarum is recurring. So, if you have HG with one pregnancy, you could have it with all subsequent pregnancies. Personally, I did.
© 2018 Kierstin Gunsberg
Kathy on February 04, 2020:
My granddaughter has this. Thank god now we know what it is. In my time I never heard of HG. This was a lot of information and I will be there for her. Thank you.
Ellen Gregory from Connecticut, USA on February 16, 2018:
Very informative and well written.