Hyperemesis Gravidarum (severe nausea and vomiting)

What is Hyperemesis Gravidarum, or HG?

Hyperemesis gravidarum (HG) is characterised by severe and persistent nausea and vomiting that significantly impacts daily life. It affects around one to three per cent of pregnancies and can be both physically and emotionally challenging.  For some women, symptoms resolve during the second trimester. Others, however, experience HG up until delivery.

What might cause Hyperemesis Gravidarum?

While there have been numerous theories regarding the cause of HG - including HcG levels, nutrient deficiencies and increased sensitivities to taste and smell - it is only in the last few years that researchers have been able to point directly to a likely culprit. 

GDF15, or Growth Differentiation Factor 15, has been identified as a potential biomarker for hyperemesis gravidarum (HG). GDF15 is a protein that is naturally produced in the body, particularly in response to tissue injury, inflammation, or stress. Recent studies have found that GDF15 levels are significantly elevated in women with HG compared to those with normal pregnancies or mild pregnancy-related nausea and vomiting.

Impacts of HG

HG in pregnancy is real and can have a significant impact on a woman’s quality of life.

As well as coping with the physical effects of HG in pregnancy, women are often unable to work or care for older children and can require hospitalisation for treatment of severe dehydration. For some women, hyperemesis gravidarum can be so severe they choose to terminate their pregnancy.

Hyperemesis Gravidarum and perinatal mental health

Research has found that having severe morning sickness increases the risk of depression both during and after pregnancy. In fact, one study found that nearly half of women with HG in pregnancy suffered antenatal depression (depression during pregnancy). Nearly 30 per cent had postnatal depression. Some women also reported thoughts of self-harm.

It’s important to know that if you find yourself struggling emotionally as you battle hyperemesis gravidarum, you’re not alone. Many women describe feeling miserable that their pregnancy hasn’t been the way they expected it to be and worried about how they’ll cope with a new baby after nine months of ill-health and exhaustion.

The need for greater awareness of HG in pregnancy

Research undertaken by COPE highlighted the debilitating impacts of HG in pregnancy, which were often not well understood by others.  This included family and friends of women themselves who experienced HG, as well as workplaces who were unaware of how to support a colleague or team member suffering with HG in the workplace.  This need for greater awareness and understanding of hyperemesis gravidarum also extended to health professionals.

These findings prompted the inclusion of the emotional and mental health impacts of HG in pregnancy as part of COPE’s #thetruth campaign.  Further information about the key research findings, people’s stories, and information for workplaces and health professionals looking to provide support for others can be found on #thetruth webpage.

How to cope with Hyperemesis Gravidarum

Tips and advice from those who’ve been there

• "Find a doctor who will take your concerns seriously – and keep trying until you do. It’s not “just in your head!” and you are not “just lazy.” Discuss treatment options including medications that can help you manage the symptoms."
• "Join a support group on Facebook or an online forum. These can help you feel less alone and are useful for suggestions on how to manage the symptoms. (No ginger biscuits!)"
• "It’s okay to feel both awful AND happy to be pregnant. If you haven’t experienced hyperemesis gravidarum it’s hard to understand how miserable it can be."
• "HG during pregnancy can have a significant impact on your partner as they can often feel helpless and are required to take on more work around the house/childcare. Make sure they have support too, and accept all offers of help from family and friends."
• "Try to be kind to yourself, take each day at a time, and know that this too shall pass! Holding your baby makes it all worthwhile."
• "Take one day at a time. Do not think about the entire pregnancy or it will be too overwhelming."
• "If you have an older child, get others to help take care of that child so you can rest. It might be hard for women to ask for help but it's so important that they do ask and that they realise they have a right/need to ask for help. Seeing a psychologist was great for me."
• "My OB organised my mental health care. Trying to find support and practitioners and schedule appointments was beyond my capabilities. Having someone act on my behalf and advocate for me was very helpful. I felt listened too without having to use the little energy I had to explain myself time and time again."
• "Focus on small things, let others take care of everything else they can. It's ok to feel helpless. It's ok to feel that you don't want to be pregnant - that is separate to your love and want for your baby."

Finding support for Hyperemesis Gravidarum

Sign up to receive the Ready to COPE guide for support and reassurance throughout your pregnancy.  This contains a special edition series for those suffering with hyperemesis. Developed in partnership with HG Australia, you will receive timely supportive advice to help you cope with the physical and emotional impacts of HG

While some women find chatting to other mums who have experienced HG in pregnancy helpful (no one will tell you to try eating crackers!) others find that professional support during pregnancy is invaluable too. Support can also be useful for managing anxiety around subsequent pregnancies.

There are supports available for Hyperemesis Gravidarum.  This includes clinical support to help you manage with the symptoms and impacts of living with HG, as well as peer support from others who have been there, truly empathise and share tips and strategies to help you cope.  

You can find help on the COPE Directory.