Translated, the term means "excessive vomiting during pregnancy". The prefix "hyper" distinguishes it from the classic and harmless pregnancy vomiting, "emesis gravidarum". This type of discomfort occurs in well over half of all pregnant women and is therefore quite normal.
However, between 0.2 and 2 percent of pregnant women from the 4th to 9th week of pregnancy have significantly more severe symptoms.
Without countermeasures, severe disturbances in the fluid and electrolyte balance can occur. This can result in serious deficiencies (minerals, sugar, vitamins, fats).
The diagnosis of hyperemesis gravidarum is assigned the international ICD code O21, depending on severity
- O21.0 with a feeling of illness but without derailment, or
- O21.1 with metabolic disorder.
"Normal morning sickness" with vomiting often begins as early as the 2nd to 4th week. In 80 percent of those affected, it subsides between the 12th and 16th week and disappears without any after-effects.
Those affected mainly vomit in the morning and recover well. Sometimes heartburn and possibly slight weight loss are also experienced.
In the case of hyperemesis gravidarum, pregnant women suffer from more severe and prolonged symptoms. The typical symptoms and signs of hyperemesis include
- persistent nausea,
- vomiting more than five times within 24 hours,
- fasting vomiting,
- severe weight loss (over 5% of body weight),
- Circulatory weakness(dizziness, rapid pulse),
- External signs of dehydration: red, dry mucous membranes, dry tongue, skin folds that remain standing, sunken eyes, thirst and reduced urine,
- Ketosis: ketone bodies in the urine, fruit-like breath odor,
- increased temperature.
In hyperemensis gravidarum, pregnant women vomit much more frequently than normal © nenetus | AdobeStock
If the course of the disease is prolonged and severe, other symptoms may also occur, such as
Why some pregnant women develop excessive morning sickness is not yet fully understood. The possible causes may be existing pre-existing conditions, unfavorable accompanying circumstances of the pregnancy or fluctuations in the hormonal system.
The following points are possible causes of severe morning sickness:
- Stress and tension,
- particular sensitivity to odors,
- psychosomatic disorders,
- elevated hormone levels: hCG (human chorionic gonadotropin), oestrogen, prostaglandin, thyroid hormones (T4, TSH),
- vitamin B deficiency,
- Sluggishness of the esophagus and stomach,
- insufficient lower esophageal closure,
- Infection with the gastric ulcer pathogen Helicobacter pylori,
- genetic disposition.
Pregnancy demands maximum physical performance from the pregnant woman. Risk factors such as
can favor the development of hyperemesis.
If hyperemesis gravidarum has already occurred during a previous pregnancy, it may occur again.
With prior knowledge, precautionary measures and close monitoring of the pregnancy, it can also proceed completely "normally".
Pronounced deficiencies (water, salts, vitamins, nutrients) due to continuous vomiting are particularly unfavorable during pregnancy. Early treatment is all the more important to prevent excessive risk to mother and child.
Consult your doctor immediately if
- you are constantly nauseous within the first 14 weeks of pregnancy,
- you are hardly eating as a result,
- vomit frequently during the day and
- feel increasingly weak.
Vomiting more than five times a day is only a "clinical rule of thumb". Much more important is your personal perception of your condition and the fact that you are losing weight and strength noticeably and feel ill.
Specialists in the fields of gynecology, obstetrics and perinatal medicine are the right contacts for affected women. They will carry out the examinations and prescribe the appropriate treatment.
The diagnosis is made by the doctor using a process of elimination. This is primarily based on
- the clinical symptoms,
- the physical examination and
- laboratory tests of the blood.
The blood test produces a blood count, with which
- the inflammation markers CRP,
- electrolyte,
- liver,
- kidney and
- thyroid values
are recorded and checked. A urine sample provides information on possible ketone bodies in the urine: substances that are produced in the body when fatty acids are broken down. The urine status also includes the density and acidity of the urine.
An ultrasound examination (sonography) shows how the unborn baby or babies are developing. This also allows the doctor to check the development of the pregnancy.
If the condition with constant vomiting and severe nausea has been going on for some time, the doctor will look for other possible causes. Hyperemesis gravidarum can occur at the same time as various illnesses:
The treatment depends on the severity of the symptoms and the deficiency status. To achieve this, the doctor will use several or many different approaches. The primary aim is to stop nausea and vomiting and replenish the stores.
The gynaecologist will provide you with targeted help and give you tips on what you can do yourself - also for prevention.
Optimize eating habits for hyperemesis gravidarum
You can alleviate the mild version yourself by changing your eating habits a little. Avoid triggers such as fatty, spicy, sour, sweet and strong odors.
Eat six to eight small portions throughout the day. Do not starve yourself. Prepare tasty meals with plenty of protein and carbohydrates. Drink plenty between meals, but in small sips, preferably cold, clear and not too sweet: lemonade, isotonic drinks, peppermint tea.
Make sure you rest and avoid heat or high humidity.
Complementary medicine and alternative therapy supplements
For normal morning sickness and mild forms of hyperemesis gravidarum, 1 to 4 g of ginger root a day works very well.
Some people also find acupressure on the wrist (pericardium 6), acupuncture or psychotherapy helpful.
Drug therapy for hyperemesis gravidarum
A gynecologist will also take care of drug therapy.
- Antihistamines,
- anticholinergics and
- antiemetics
calm and relieve nausea; some are prescribed by the doctor in combination with vitamin B6.
Serotonin receptor antagonists such as metoclopramide (MCP) or ondansetron together with B vitamins, on the other hand, have certain risks. They are therefore only considered in cases of severe symptoms.
A drug with the active ingredient meclozine acts directly on the vomiting center and is intended to reduce nausea. Its marketing has been discontinued in Germany, but it is still available from pharmacies abroad under the product name Agyrax.
H2 receptor blockers such as ranitidine help against
- Heartburn,
- reflux (acid regurgitation) or
- Helicobacter infection.
The doctor carefully weighs up the benefits and risks of medication for hyperemesis gravidarum so as not to put additional strain on mother and child.
Clinical admission and treatment
After severe weight loss, inpatient clinical treatment is necessary in parallel with medication. During the stay, the pregnant woman receives infusions for several days to compensate for the deficiencies. It may also be necessary to
- artificial nutrition,
- short-term glucocorticoids (methylprednisolone) or
- an antidepressant (mirtazapine)
may be necessary.
The aim of treatment is to maintain the pregnancy for as long as possible. The child should continue to develop as far as possible and premature birth should be avoided if possible.
A birth, spontaneous or induced, from the 37th week of pregnancy or at least 260 days is no longer considered premature. At the same time, it is very important to pay attention to the well-being and health of the expectant mother.
With early treatment, the multi-pronged measures are very effective. Patients recover quickly and the pregnancy progresses normally. You can prevent it with the simple remedies mentioned above - eating and drinking lightly in small bites. If you are prone to nausea, take ginger and vitamin B6. Your gynecologist can give you further advice.
The severe nausea leads to the following in the pregnant woman
- severe deficiencies,
- physical weakness and
- severe psychological stress.
Depending on the severity, there is an increased risk of
- damage to the oesophagus,
- pre-eclampsia (high blood pressure during or after pregnancy) and
- delayed development of the child with premature birth.
It is very rare for the mother to develop vitamin B deficiency damage to the brain (Wernicke's encephalopathy) or nerves.
There is an increased risk of premature birth for the unborn child. It may also be slightly smaller due to the mother's deficiency and have a lower birth weight of less than 2500 grams.