What is hyperemesis gravidarum?
Hyperemesis gravidarum is an uncommon disorder in which extreme, persistent nausea and vomiting occur during pregnancy. This condition might lead to dehydration.

What causes hyperemesis gravidarum?
The condition might be caused by rapidly rising serum levels of hormones such as HCG (human chorionic gonadotropin) and estrogen. Extreme nausea and vomiting during pregnancy might indicate a multiple pregnancy or hydatidiform mole (abnormal tissue growth that is not a true pregnancy).

What are the risk factors for hyperemesis gravidarum?
A risk factor is something that increases a person’s chance of getting a disease or condition. Risk factors do not necessarily mean that a person will develop a condition. In the case of hyperemesis gravidarum, the following are risk factors:

• Hyperemesis gravidarum during a previous pregnancy
• Being overweight
• Having a multiple pregnancy
• Being a first-time mother
• The presence of trophoblastic disease, which involves the abnormal growth of cells inside a woman's uterus

What are the symptoms of hyperemesis gravidarum?
Hyperemesis gravidarum usually occurs during the first trimester of pregnancy. A woman might have hyperemesis gravidarum if she is pregnant and she vomits:

• More than three to four times per day
• So much that she loses more than 10 pounds
• So much that she feels dizzy and lightheaded
• So much that she is becoming dehydrated

How is hyperemesis gravidarum diagnosed?
A doctor will ask about symptoms, take a medical history, and perform a physical exam. In addition, the doctor might order certain lab tests to help in making a diagnosis.

How is hyperemesis gravidarum treated?
The type of treatment that is required depends on how ill a woman becomes. Possible treatments might include:

• Preventive measures—These might include a pressure-point wristband — similar to those used for motion sickness — vitamin B6, and/or ginger.
• Small frequent meals—Nausea and vomiting might be treated with dry foods (such as crackers), small frequent meals, and emotional support.
• Intravenous fluids—It is important for a pregnant woman to maintain her fluid intake. IV fluids might be needed if a woman continues to vomit throughout pregnancy. In severe cases, the woman might require hospitalization and given IV fluids. IV fluids might be discontinued when a woman is able to take in fluids by mouth.
• Total parenteral nutrition—The most severe cases of hyperemesis gravidarum might require that complex, balanced solutions of nutrients be given through an IV throughout pregnancy. This is called total parenteral nutrition (TPN).
• Medicines—Medicine to prevent nausea is used when vomiting is persistent and poses possible risks to the mother or baby. If a woman cannot take medicines by mouth, the drugs might be administered through an IV or a suppository. Medicines used to prevent nausea include Promethazine, Meclizine, and Droperidol.

Can hyperemesis gravidarum be prevented?
Although there are no known ways to completely prevent hyperemesis gravidarum, the following measures might help keep morning sickness from becoming severe:

• Eating small, frequent meals
• Eating bland foods
• Waiting until nausea has improved before taking iron supplements
• Using a pressure-point wrist band, vitamin B6, and/or ginger, as recommended by a doctor

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/.

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