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Women's Health

Understanding Hyperemesis Gravidarum

Kimber W. MacGibbon RN

Co-founder & Executive Director, HER Foundation

Severe nausea and vomiting of pregnancy, also called Hyperemesis Gravidarum (HG), often causes serious physical and mental health complications in mothers and children with consequences that may persist indefinitely. Unlike morning sickness of a healthy pregnancy, HG means months of bedrest and miserable symptoms that are difficult to control and strains families and finances.

Characterized by malnutrition, dehydration, weight loss, and debility due to severe nausea or vomiting, HG is a potentially life-threatening pregnancy disease associated with preventable maternal and fetal complications. Symptoms end by mid-pregnancy in half of women, but others have symptoms until delivery or later. Imagine enduring months of food poisoning while sustaining a baby — that is HG.

An estimated 6 million women across the globe suffer from HG each year, yet there are no universally accepted assessment and treatment standards nor postpartum screening and management of residual health issues. Over 75 percent of mothers have HG again in subsequent pregnancies, so support for HG recovery and preparation are crucial to improving future pregnancy health.


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HG pregnancies have a fetal loss rate of 34 percent, with at least 6 percent being unwanted terminations. Overall, HG is fatal for tens of thousands of babies each year in the United States. Surviving children have significant risks of restricted growth, neurodevelopmental delays, behavioral issues, autism spectrum disorders, and sensory processing disorder, as well as cardiometabolic disease and mental health issues in adulthood. The risk increases with prolonged sickness or severe weight loss. MRI brain scans of HG children confirm structural changes consistent with these adverse neurological conditions. Treating severe HG symptoms aggressively will protect the health and life of many children.

During HG, a woman may feel as if she’s dying and fear losing her life and her child’s. She feels guilt because she can’t eat and must take medications to survive. The strain of medical bills and income loss might burden her. She worries about her baby’s health and risks of invasive procedures. Cumulative stress negatively affects her and impairs her baby’s brain development and growth. Employment leave is usually necessary to avoid exacerbating HG. Reducing complications and psychosocial stress is important for a healthy mother and child. 

HG treatment options include IV rehydration, medications, and nutritional interventions like a feeding tube or IV nutrition. Standard care should include at least 100 mg per day of thiamin (vitamin B1) orally or through IV. The actual cost of managing HG, from treatment and domestic help to loss of income, is unknown but estimated to exceed $4 billion. 

Ineffective medical care contributes to numerous complications including liver and kidney failure, preterm birth, placental abruption, sepsis, preeclampsia, embolism, hemorrhage, encephalopathy, severe malnutrition, chronic dehydration, gastrointestinal and esophageal damage, trauma, and mood disorders. These threaten or take the lives of too many mothers and babies.


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Women often receive inadequate care because many still believe HG’s cause is hCG or psychological factors. But recent groundbreaking research links HG to the appetite, taste aversion, and cachexia hormone, GDF15. Now there is evidence proving women should not be blamed for being sick, diagnosed with eating disorders, or told termination is their only option. What these vulnerable women need is a compassionate medical advocate; rest in an environment that does not trigger symptoms; and copious support from family, friends, and employers. 

With proactive medical intervention, short and long-term medical costs are reduced, fewer babies die, and both mother and child have a chance at a healthy future. 

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