How it differs from morning sickness
Up to 80 percent of mothers experience some nausea and vomiting in early pregnancy. It is unpleasant, usually peaks around week nine and eases by the second trimester, and does not stop you eating and drinking altogether. Hyperemesis is a different order of illness: vomiting many times a day, inability to keep down food or fluid, weight loss, dehydration, and in many cases an inability to work or care for other children. It commonly persists past week 20 and sometimes to delivery.
What causes it
The mechanism is still being mapped, but several factors are established. High and rapidly rising hCG is implicated, which is why it is more common with twins and molar pregnancy. Oestrogen sensitivity plays a part. Recent research points strongly to the hormone GDF15 and to genetic susceptibility, which explains why it recurs in families and in subsequent pregnancies. Thyroid changes and Helicobacter pylori infection can worsen it.
What does not cause it: anxiety, an unwanted pregnancy, or not trying hard enough. Mothers are still told these things, and it delays treatment.
Symptoms to recognise
- Vomiting more than three or four times a day, or continuous retching.
- Inability to keep fluids down for 12 to 24 hours.
- Weight loss of more than 5 percent of pre-pregnancy weight.
- Very little urine, dark in colour; dry mouth; no tears.
- Dizziness or fainting on standing; racing heart.
- Extreme fatigue, confusion, or a smell of acetone on the breath.
- Excessive saliva, and aversion so strong that the thought of water triggers vomiting.
How it is treated
Treatment is medical and stepped. Anti-emetics such as doxylamine with vitamin B6, ondansetron, metoclopramide or promethazine are prescribed and are used in pregnancy. Intravenous fluids correct dehydration and electrolytes. Thiamine is given to prevent a serious neurological complication of prolonged vomiting. Severe cases need hospital admission, and a small number need nutritional support. Do not wait it out at home hoping it passes — the earlier anti-emetics start, the better they work.
What helps alongside treatment
Sip small amounts constantly rather than drinking a glass at once; ice chips, coconut water, nimbu pani and oral rehydration solution are often tolerated when water is not. Eat dry, bland, cold food — khakhra, toast, plain rice — in tiny amounts, and keep something by the bed to eat before sitting up. Avoid cooking smells: ask someone else to cook, or eat food at room temperature. Ginger and B6 help mild cases and are worth trying, but they will not control hyperemesis on their own.
Looking after yourself through it
Hyperemesis is isolating and is strongly associated with depression and anxiety. Tell your doctor how you are coping, not only how much you are vomiting. Babies of treated mothers do well; the priority is getting you hydrated, nourished and supported.