Signs You Have Hyperemesis Gravidarum & Not Just Awful Morning Sickness

Most women know that for many, morning sickness and having a bun in your oven just go together. Morning sickness is categorized as feeling a little nauseous and puking maybe once per day, but some women suffer from a more extreme sickness like hyperemesis gravidarum (HG). So what's the difference? Two experts weigh in on how to know if you have hyperemesis gravidarum, and let me tell you — you definitely don’t want to leave this untreated.

The American Pregnancy Association (APA) noted that even though a whopping 70 to 80 percent of women experience morning sickness, “recent studies show that at least 60,000 cases [of HG] are reported by those who were treated in a hospital, but the numbers are much higher than this since many women are treated at home or by outpatient care with their healthcare provider.”

What causes women to have HG instead of morning sickness? According to the APA, the absolute cause is unknown, but it’s generally caused by rising hormone levels. HG usually shows up around week four or six of pregnancy, but “may peak between nine and 13 weeks,” the organization suggested.

So how can you tell the difference? Dr. Sherry Ross, OB-GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California, says that while morning sickness is normal and expected, your doctor should be able to tell if you have HG at your scheduled exams. “Your doctor should be checking your urine during each prenatal visit to make sure you are not depriving the baby of important nutrients needed during pregnancy — this is the best indicator to know if the vomiting is significant and needs special medical attention,” she tells Romper in an email interview.

As far as how you can tell at home, if you’re vomiting more than three times per day, it’s probably not morning sickness. When is it time to see a doctor? Ross says, “If the nausea and vomiting prevent a pregnant woman from drinking or eating for more than a 24-hour period, it’s time to take next steps and bring it to the attention of your doctor. You know your body the best, and if you are feeling tired or unable to tolerate foods and fluids for prolonged periods of time, you need to bring it to the attention of your doctor."

APA also noted that for regular morning sickness, you’ll be nauseous but won’t always throw up, it will generally end after 12 weeks, and you’ll be able to keep some food down. With HG, you’ll always have severe vomiting when you’re nauseous, and it will last more than 12 weeks. Additionally, if you’re throwing up so much that you’re severely hydrated and cannot keep any food or drink down whatsoever, you should seek medical attention immediately. Other signs and symptoms of HG include “weight loss of 5 percent or more of pre-pregnancy weight, a decrease in urination, headaches, confusion, fainting, jaundice, low blood pressure, rapid heart rate, extreme fatigue, loss of skin elasticity, and secondary anxiety and depression.”

Dr. Yvonne Bohn, OB-GYN at Providence Saint John’s Health Center in Santa Monica, California, says in an email interview with Romper that additional symptoms include ketosis, electrolyte imbalances, tears in your esophagus from repetitive vomiting, and possible preterm birth and low birth weight.

To treat HG, Bohn says, “Treatment involves reducing the daily nausea and vomiting. First-line therapy is now treated with a combination antihistamine and vitamin B6: Doxylamine/pyridoxine called Diclegis. This drug has the safest rating of all drugs in pregnancy. It is taken as two tablets at bedtime because the Doxylamine causes sleepiness. Some women find themselves too sleepy, so cutting the dose in half helps with this.”

If the above is ineffective, Bohn says, “The second most commonly used antiemetic is Zofran, which is given intravenously with IV fluids when a woman is admitted with dehydration.” However, “Zofran has been associated with possible cardiac defects in a few studies, so it is second-line therapy,” she says. “Finally, if vomiting persists after IV fluids, Zofran women may need intravenous feeding. In rare cases, steroids may be given if all the above fails.”

Morning sickness is the worst, but HG is even worse than that. If you’re throwing up more three times per day and cannot keep anything down, you need to make an appointment to get your urine checked by your healthcare provider. And don’t worry, your baby can still be perfectly healthy, as there are several different treatment methods to help you out.

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