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Nemours

Nemours
Providing pediatric care through
the Nemours/Alfred I. duPont Hospital for Children,
Nemours Children's Hospital, and
primary and specialty care practices
in Delaware, Pennsylvania, New Jersey, and Florida


Severe Morning Sickness (Hyperemesis Gravidarum)

What's Morning Sickness?

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.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: November 2020