The truth about morning sickness - aka Hyperemesis Gravidarum

My story and experience with Hyperemesis Gravidarum (HG)

For me, as a first-time mother, I had never heard of HG before, and when the dreaded “morning sickness” began around Week 5, I thought this was normal and it would pass.

The constant nausea and sickness at the back of my throat never ceased. I was being sick constantly, with no warning, whether it be the street, work, toilets, friends’ houses or (if I was lucky) in the privacy of my own home.

Again, I (and others), convinced myself that this was normal, that it would pass when I hit the magical second trimester. Needless to say, it did not. Another month of vomit-filled hell went by. I was barely showing my pregnancy, I had lost weight, was exhausted, and was left wondering when this would stop and the amazing “pregnancy glow” would start. When it finally came to bedtime, the acid reflux and heartburn from the constant throwing up was so painful that I could not sleep, so the nightly Gaviscon started, which later turned into an omeprazole prescription.

Going into the second trimester, I was vomiting after every meal, every drink, constantly. The only thing I could vaguely tolerate were ham sandwiches and cookies (odd, I know). Christmas soon arrived at the 16-week mark, and there I was about to sit down to a delicious Christmas dinner with my family, and I had to run off to the toilet to throw up. Then began the comments, the looks, the “just try a bit more”, or “have you tried this?”

After trying to work through this, pulling the car over to be sick, 10–15 runs to the bathroom every day at work, I went to the doctor. They said I was dehydrated and tried to give me a week’s sick note and told me to drink more. However, I knew something was not right. After further discussion, the doctor diagnosed me with HG and started me on an antiemetic (ondansetron). This did not make any difference; I was still vomiting to the point where I now could not keep anything down at all.

A couple of weeks later, I was admitted to the hospital and put on a 24-hour IV drip and injection antiemetic. I started to feel better for a very short-lived period of time. Once again, I was weak, dehydrated, malnourished, and nothing could stop the sickness. A week later, I was back in the hospital and the whole cycle repeated.

Eventually, I was put on a different antiemetic, and everything slowly started to get better, and by Week 29, I was not vomiting 24/7. I was still being sick, still had awful nausea at the back of my throat, but it was better than before.

I took this antiemetic every day until I gave birth. Once the birth was over, the nausea magically disappeared, it was bliss, the post-birth pain was barely there as I was so relieved that I was no longer being sick.

Although my daughter was worth every hospital trip, every vomiting episode, every tablet, and every embarrassing situation. I was traumatised for months after, still, to this day I get travel sick, I have acid reflux, I am now unsure whether I want to have another child and go through that all over again. How would that work with another child to look after when I could barely look after myself?

People expect you to be happy through your pregnancy, but I was not. Everyone assumes you are “weak” or “exaggerating” about the extent of your sickness. I was lucky to have an incredible support system behind me, others are not so lucky, and it can be very isolating and lonely when you are suffering to such an extreme and being brushed off with some vague sympathy by friends and healthcare professionals.

So, what is the point of this post?

Awareness. Understanding. Acceptance.

What is Hyperemesis Gravidarum?

HG is a debilitating, and potentially life-threatening pregnancy condition. It can cause dehydration, weight loss, malnutrition due to severe nausea and vomiting, and may cause long term health issues for mum and baby[1].

HG affects up to 3% of pregnant women[2] and re-occurs in 80% of subsequent pregnancies[3]. Most women who have suffered with HG (82.8%)[4], have reported that it caused negative psychosocial changes, such as[4]:

Socioeconomic changes, for example, job loss resulting in financial difficulties
Psychiatric sequelae, for example:

Depression (including postpartum)
Anxiety, fear of future pregnancies
Guilt for choosing to terminate the pregnancy, approximately 1,000 women a year choose to terminate because of the extreme effects of HG

HG is widely misunderstood and thought of as “bad morning sickness,” it is in fact, much worse. Pregnancy Sickness affects around 80% of pregnancies and is short-lived, improving at around 12–16 weeks at the end of first trimester[5]. Women suffering from HG find it difficult to function and complete basic daily tasks. They struggle with nourishment and fluid intake and can find themselves vomiting more than 30 times a day with constant severe nausea. HG is characterised by dehydration and weight loss of up to over 20% of pre-pregnancy weight. Other symptoms can include[5]:

Extremely heightened sense of smell
Extreme fatigue
Headaches
Depression
Extreme isolation

Complications that can arise from HG include oesophageal tears, muscle wasting and risk of deep vein thrombosis from bed rest, severe vitamin deficiency from excessive vomiting, and complications from extreme dehydration[6]. Before the introduction of intravenous (IV) fluids, HG was the leading cause of death in early pregnancy[6].

What causes Hyperemesis Gravidarum?

Pregnancy sickness is thought to be caused by the hormones produced in pregnancy which are at their highest in the first trimester[1]. How and why this develops into HG is unknown and difficult to determine. It can vary between women depending on their body chemistry, changes in the gastrointestinal system, genetics, and overall health[1]. Studies have suggested that women with first-degree relatives who have suffered from HG will have a higher risk of suffering from it in pregnancies[1].

What treatment is available for morning sickness?

In addition to changes to diet and lifestyle, medicinal methods can help with the prevention and treatment of HG. There are various treatment options which can include:

Medications

Antiemetics are usually the most common and effective for vomiting, for example, Ondansetron (Zofran) and Metoclopramide. However, they should not be used in the first trimester due to potential damage to the developing foetus[7]
Acid reducing medications or proton pump inhibitors such as cimetidine and omeprazole help with heartburn and esophagitis[8]

Steroids[7]

IV hydrocortisone
Oral methylprednisolone

Nutritional therapies[1]

Parenteral nutrition can be administered centrally or peripherally to address chronic dehydration and malnutrition

Vitamins[7]

Oral thiamine (1.5mg/d) before the onset of nausea/vomiting is recommended
Vitamins and minerals (particularly B1, folic acid, K, Mg, D) within 2 weeks of reduced nourishment and nausea/vomiting to avoid worsening of HG symptoms

Infusion therapy[7]

Scheduled IV to replace lost fluid and electrolytes. Antiemetics can also be injected via a vein or a muscle if the vomiting is severe

Where can I find support and more information?

Pregnancy Sickness Support[5] is a UK charity that participates in ongoing research and aims to raise awareness to both the public and healthcare professionals about HG, they have a vast amount of information and advice on their website, an online support forum, and a helpline for those suffering from hyperemesis gravidarum and severe morning sickness.

The HER foundation[1] is a leading source for information about HG and provide support and education to hundreds of thousands of families across the globe. They have a worldwide Healthcare Professional Referral List, a helpline, and support groups and forums to help those who are suffering.

So many women are unnecessarily suffering in silence. Awareness and understanding of HG will enable mothers-to-be to get early treatment without being judged and help their physical and mental well-being.

If you are personally suffering, or you would like to find out more information about HG, please do not suffer in silence. Follow these links for help, information and support:

https://www.hyperemesis.org/
https://www.pregnancysicknesssupport.org.uk/

References

HER Foundation website. https://www.hyperemesis.org
Jennings LK, Mahdy H. Hyperemesis Gravidarum. 2021 Aug 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.
Fejzo MS, Macgibbon KW, Romero R, et al. Recurrence risk of hyperemesis gravidarum. J Midwifery Womens Health. 2011 Mar-Apr;56(2):132-6
Poursharif, B., Korst, L., Fejzo, M. et al. The psychosocial burden of hyperemesis gravidarum. J Perinatol 28, 176–181 (2008).
Pregnancy Sickness Support website. https://www.pregnancysicknesssupport.org.uk/
Fejzo, M. S., Brecht-Doscher, A., Kimber MacGibbon, R., et al. The impact of and risk factors for HG: treatment, genetics, and epidemiology. Available at: https://www.pregnancysicknesssupport.org.uk/documents/conference_papers/The_impact_of_and_risk_factors_for_HG.pdf
Wegrzyniak LJ, Repke JT, Ural SH. Treatment of hyperemesis gravidarum. Rev Obstet Gynecol. 2012;5(2):78-84.
Jueckstock JK, Kaestner R, Mylonas I. Managing hyperemesis gravidarum: a multimodal challenge. BMC Med. 2010;8:46.

Author

Frances Edwards

Manager, Medical Communications & Medical Marketing, & Principal Medical Writer