Hyperemesis: Beyond Morning Sickness

When the Duchess of Cambridge announced recently that she and her husband, Prince William, were expecting their third baby, it was also revealed that she was under a physician’s care for a condition unique only to pregnancy: hyperemesis gravidarum (or hyperemesis for short). When the Duchess was pregnant the last two times, she dealt with this similar situation. Thankfully both of her previous pregnancies were otherwise uncomplicated, but the condition that the Duchess is experiencing is real and can be dangerous to a pregnant woman if not treated properly. Hyperemesis, then, goes beyond “morning sickness”.

Normal Symptoms of Morning Sickness

Many pregnant women will experience some form of morning sickness. Pregnant women notice symptoms around 4 to 6 weeks of pregnancy with symptoms peaking typically between 9 to 13 weeks. Relief, however, often comes by week 14 onward. The cause is unknown but the current belief is that the rising levels of hormones in a woman’s body, coupled with the lack of food intake for the several hours a woman may have been sleeping, leads to feelings of nausea. The nausea is most noticeable, then, upon arising, hence the term “morning sickness”. The nausea of morning sickness is not debilitating: it is not typically accompanied by abdominal pain or fever, and vomiting may or may not happen.  A pregnant woman may simply feel “queasy” but after a few sips of water or tea, or perhaps a light breakfast, the sensation goes away. Other women may have dry heaves or a small amount of vomiting with relief felt immediately after. Hunger usually returns right after vomiting and pregnant women can keep down food for the rest of the day. Morning sickness, then, is self- limiting and typically does not impact a pregnant woman’s day to day life too greatly.

Photo by Anthony Tran


Hyperemesis, in contrast, is unrelenting feelings of nausea with repeated episodes of vomiting throughout the day (often 3 or more times per day). Pregnant women with hyperemesis are unable to keep any liquids or food down. These women, further, have an aversion to food and often the thought of eating can incite another wave of nausea or episode of vomiting. Fatigue, body aches, and headaches may accompany the other symptoms of hyperemesis. Since these women are not eating or drinking, they urinate less and begin to experience weight loss. The cycle of vomiting and lack of eating or drinking causes electrolyte imbalances within her body and could, ultimately jeopardize her pregnancy and baby.

Photo by Imani Clovis

Whereas morning sickness can be managed with simple remedies, hyperemesis often requires medical care and often hospitalization. It is important to stress that hyperemesis is not something a woman should attempt to treat on her own with home remedies or over-the-counter medication. Restoring adequate intake is essential, so intravenous fluids are used to restore a proper fluid and electrolyte balance. Medicines for nausea are administered intravenously also until a woman can swallow pills and food on her own. Laboratory tests are done regularly to gauge a woman’s progress along with monitoring of her weight, urine output, and the status of her baby. It can take several days, then, to get hyperemesis under control.

What You Should Do

No two women are alike and each pregnancy is unique. Symptoms of morning sickness, or hyperemesis, in one pregnancy may not repeat in a future pregnancy, or may be worse. The important message is to listen to your body and not ignore the symptoms you have. It is important to communicate with your health care practitioner if you have prolonged nausea, vomiting, fever, or abdominal pain. Further, if you are not eating or drinking, or you can eat but cannot keep food down, your health care practitioner should be notified. If the diagnosis of hyperemesis is made, proper care and monitoring, like the Duchess, allows a healthy pregnancy to continue without impact to the baby.

Featured photo (top of the page) by Carfax2 (Own work). CC BY-SA 3.0 via Wikimedia Commons

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