Morning Sickness

It’s common to experience nausea and vomiting in your first trimester of pregnancy. Known as morning sickness, these unpleasant side effects usually stop after three months. But when nausea and vomiting are more severe, you have what’s known as hyperemesis gravidarum.

What is Hyperemesis Gravidarum?

According to the American College of Obstetricians and Gynecologists, hyperemesis gravidarum — or extreme morning sickness — is a condition that causes severe nausea, vomiting, and weight loss. Less severe cases can be treated at home. Some women may need to be hospitalized. While morning sickness is common, hyperemesis gravidarum occurs in only 0.5 to 2% of women during pregnancy.

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Causes of Hyperemesis Gravidarum

Women in their first trimester — the first three months of pregnancy — are at risk for developing hyperemesis gravidarum. There currently is no way to prevent this condition.

Doctors are working to uncover what causes some women to develop the condition. In the last few years, studies found that genes may play a role.

Some doctors think estrogen levels may contribute to nausea and vomiting during pregnancy. Estrogen levels are highest during the first trimester, when many women experience morning sickness. Those levels decline during the second trimester, which is when morning sickness goes away for most women. It’s not known why a small percentage of women develop more severe nausea and vomiting.

You may also experience it if you have a family member who has had it.


The most common hyperemesis gravidarum symptoms are severe, relentless nausea, and vomiting. You may become dehydrated because you aren’t able to keep fluids down. Weight loss exceeding 5% of pre-pregnancy weight is another sign that you are experiencing more than typical morning sickness.

Other symptoms of hyperemesis gravidarum include:

  • Fatigue
  • Low blood pressure
  • Fast heart rate
  • Electrolyte imbalance
  • Vitamin deficiency

Unlike morning sickness, hyperemesis gravidarum can last a short period of time or throughout your pregnancy. And symptoms change throughout your pregnancy, becoming more or less severe at different times.

How Can You Treat It?

Treatment depends on your symptoms. You may find relief through at-home remedies, such as bed rest, herbal supplements (such as ginger or peppermint), and acupressure. Motion sickness wrist bands that apply continuous pressure to your wrists also help. If nausea and vomiting continue, your doctor may prescribe an anti-reflux medicine to help control your symptoms.

What happens if symptoms continue despite these interventions? A hospital stay is necessary if you become severely dehydrated, can’t absorb the nutrients you and your baby need, or continue to lose weight. Intravenous therapy can help your body rest and re-hydrate by providing key nutrients to your system.

Complications of Hyperemesis Gravidarum

If you experience hyperemesis gravidarum during pregnancy, you may be at risk for complications. Vomiting and dehydration can cause small tears in the wall of your esophagus and low blood potassium levels. You also may experience increased levels of anxiety and depression.

While these complications do not directly impact your pregnancy, they can cause lasting harm to you and your child if left untreated. Women who suffer depression throughout pregnancy and do not receive treatment are more likely to have babies who are born too early and have long-term developmental and behavioral issues. And while very rare, some women with the condition develop Wernicke encephalopathy, a rare and life-threatening neurological condition.

The National Organization for Rare Disorders notes that children of women who experience hyperemesis gravidarum are more likely to be born premature or underweight, especially if the mother needs to be hospitalized more than once or experiences symptoms throughout the pregnancy.

If you have more questions about hyperemesis gravidarum or would like to schedule an appointment with a doctor, visit the Obstetrics and Gynecology Services at UPMC Magee-Womens Hospital website or call 1-866-MyMagee (696-2433).

Hyperemesis Gravidarum: Signs, Symptoms, and Treatment, Pregnancy Complications. American Pregnancy Association. Link

Rare Disease Database, Hyperemesis Gravidarum. National Organization for Rare Disorders. Link

Understanding Hyperemesis. HER Foundation: Pioneers in HG Education and Research. Link

Jennings, Lyndsey K. and Diann M. Krywko. Hyperemesis Gravidarum. NCBI. Link

About UPMC Magee-Womens

Built upon our flagship, UPMC Magee-Womens Hospital in Pittsburgh, and its century-plus history of providing high-quality medical care for people at all stages of life, UPMC Magee-Womens is nationally renowned for its outstanding care for women and their families.

Our Magee-Womens network – from women’s imaging centers and specialty care to outpatient and hospital-based services – provides care throughout Pennsylvania, so the help you need is always close to home. More than 25,000 babies are born at our network hospitals each year, with 10,000 of those babies born at UPMC Magee in Pittsburgh, home to one of the largest NICUs in the country. The Department of Health and Human Services recognizes Magee in Pittsburgh as a National Center of Excellence in Women’s Health; U.S. News & World Report ranks Magee nationally in gynecology. The Magee-Womens Research Institute was the first and is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology, with locations in Pittsburgh and Erie.