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70% to 85% of women have morning sickness, a feeling of nausea and vomiting during pregnancy, however, around 1% to 2% of the women have an extreme form of morning sickness that is associated with severe nausea and vomiting. TIt is called hyperemesis gravidarum.

Hyperemesis gravidarum can complicate pregnancy by causing dehydration, metabolic disturbances (abnormal levels of electrolytes and ketones), as well as rapid weight loss.

It may eventually lead to kidney, liver or nervous system damage.


The cause is elusive; however, it may be due to the interaction of the hormones, human chorionic gonadotropin (hCG) and estrogen, with the body.

Risk factors may include the younger age of the mother, obesity, first pregnancy, having no history of previously completed pregnancies, and history of hyperemesis gravidarum in prior pregnancies.

Biological, psychological and social factors may play a huge role.


On average, symptoms begin between the 4th and 8th week of pregnancy and last until 16 weeks or more.

Most women vomit throughout the day, with few, if any symptom-free periods.

Other symptoms include severe nausea, weight loss, reduced urination, headaches, confusion, fainting, and jaundice.

The presence of low blood pressure, increased heart rate, and ketones in urine indicate dehydration.


We make the diagnosis when severe nausea and vomiting lead to dehydration, weight loss, or disturbances in the body’s chemistry. Blood and urine tests, as well as ultrasonography, may be done to rule other causes of nausea and vomiting.


The goal of treatment is to reduce symptoms through changes in diet or environment and by medication, correct complications of nausea and vomiting, and minimize its effects on the fetus.

Becoming aware of, and avoiding, environmental triggers and foods that might provoke nausea and vomiting can help. Ginger and dry foods play a vital role in the management of nausea without vomiting per se.

Some women may benefit from acupuncture and acupressure wristbands. 

Read this article: Endometriosis: Let’s manage it.

For pharmacological treatment, pyridoxine-doxylamine succinate combination therapy is the first line wherever possible. If it is not possible, initiate pyridoxine. Only add doxylamine succinate if pyridoxine (vitamin B6) fails to work.

When vomiting persists, but there’s no hypovolemia, add diphenhydramine or meclizine. If these don’t work, add a dopamine antagonist like prochlorperazine or metoclopramide.

If vomiting persists without hypovolemia, add ondansetron on a case by case basis. It is so especially in women with pregnancies less than ten weeks.

When there’s hypovolemia but no deranged chemistry panels, admit the woman. Administer intravenous fluids and antiemetic therapies. 

Admission is necessary when there are electrolyte imbalances amidst persistent vomiting and hypovolemia.

During the correction of dehydration by intravenous fluids, thiamine can be added to the intravenous fluids to prevent brain damage called Wernicke’s encephalopathy.

In extremes of cases, you may administer parenteral nutrition to prevent further weight loss until the woman can tolerate oral intake.

All that said, women can hyperemesis gravidarum can be prevented by taking prenatal vitamins folic acid inclusive.

DOs and DON’Ts in Managing hyperemesis gravidarum

  • DO get treatment from a health care provider experienced with hyperemesis gravidarum
  • DO eat small, frequent meals.
  • DO have high-protein snacks.
  • DO have crackers, dry toast, or dry cereal when you first get up in the morning.
  • DO call your health care provider if your symptoms worsen or you’re losing weight.
  • DO avoid food and smells that trigger nausea.
  • DON’T eat large or spicy meals or high-fat foods.
  • DON’T eat just before you go to bed or lie down.
  • DON’T take medicines or try home remedies without asking your health care provider.

We are indebted to UpToDate for the part about the treatment section, and Ferri’s Netter Patient Advisor for the initial aspects of this article.

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Dr A. M. Ssekandi is a medical officer, researcher, content creator, author, and founder of He does private practice with a public touch. He is a certified digital marketer. He has earned certificates in Understanding Clinical Research and Writing in Sciences from the University of Cape Town and Stanford University respectively. He also has a certificate of Good Clinical Practice from

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