We’ve talked about morning sickness, which affects more than half of women during pregnancy, a couple of times on Mother. For a majority of women who experience the pesky nausea and vomiting that comes with morning sickness (which can actually occur at anytime, day or night) our tips on How to Battle Morning Sickness and Natural Remedies for Morning Sickness will probably provide some relief and help them manage mild symptoms, which usually go away by the second trimester.

However, somewhere between 2% and 5% of pregnant women experience more severe nausea and vomiting, called Hyperemesis Gravidarum, which can result in weight loss, severe dehydration, and even miscarriage if left untreated. Sure, if this is you, you can say you have something in common with Kate Middleton, who was diagnosed with HG during both of her pregnancies. But if you’ve lived through HG yourself, you would never wish it upon anyone else. In order to learn a little bit more about extreme morning sickness and how to treat it, we sought the advice of the OB/GYN team at California Pacific Medical Center in San Francisco.

Can you tell us a little bit more about the symptoms of Hyperemesis Gravidarum and what causes it?
“HG, or severe nausea and vomiting during pregnancy, is characterized by persistent sickness that cannot be managed by most of the conventional remedies that we recommend to patients, such as making sure you’re staying hydrated, eating small bland meals, and taking vitamin B12. Vomiting may occur several times a day or more, or anytime after food or drink is ingested. The inability to keep anything down can lead to weight loss, malnutrition for mom and baby, dehydration, and electrolyte imbalance. Once dehydration kicks in, the symptoms will only get only get worse and it can be hard for a woman to replenish the fluids in her system on her own, so it becomes a vicious cycle. At this point, medical attention should be sought. While there are many theories on what causes morning sickness, there is no medically proven reason a woman does or does not experience morning sickness or more severe sickness like HG. Genetics can definitely play a role though, so if you can, ask your mother about her pregnancies. Women whose mother’s experience morning sickness are much more likely to experience it themselves.”

When would recommend a woman who thinks she has severe morning sickness seek medical attention?
“It never hurts to call your doctor if you aren’t feeling well and you need some advice or you think you may need medical treatment. We are here to help you. After speaking with your doctor or a nurse, they may advise you to come into the office or hospital. If you are unable to keep little or any fluids or food down for more than one day, we would recommend coming in to the hospital.”

What treatment is typically provided in the hospital?
“When a patient arrives, the first thing we would do is try to get a urine sample to determine the level of dehydration. We’ll take the patient’s weight and blood pressure and ask them a series of questions to learn more about their symptoms. We’ll give fluids intravenously (through an IV) immediately. Depending on the level of dehydration and discomfort of the patient, we may also give them an anti-nausea medication through an IV. Usually after a couple of hours the woman is able to go home.”

How do you recommend she manages or treats her morning sickness when back home?
“Unfortunately, the IV fluids and meds we provide are only going to provide short-term relief for most patients with extreme morning sickness. Luckily, there are a few different medications and treatment options that can really help. There are a couple of different anti-nausea medications that are deemed safe for pregnant women that we may prescribe. These meds might make symptoms disappear completely for some patients, but for others they may just lessen the symptoms. In the most severe cases a woman may need a central venous catheter, essentially an IV that stays with them at all times and administers fluids and/or medications. If a woman feels comfortable taking the prescription medications we advise, it is highly unlikely they would ever need a central venous catheter. It is pretty rare we need to use that form of treatment. The most important thing is trying to stay hydrated. We definitely see women coming into triage multiple times during their first trimester if they have severe morning sickness and can’t stay ahead of the dehydration.”

You said medications may not make symptoms disappear completely. What else can a woman do, in addition to these medications?
“We offer the same advice we do for patients with less severe morning sickness. Try to drink small sips of water, tea, ginger ale, whatever works for them, throughout the day. Small, bland meals, like toast, saltine crackers, and soup or broth. Kind of like if you had the flu. If they can stomach something with a little protein like yogurt, that is great. Vomiting and nausea may still occur, but as long as the input is more than the output, they should be okay. The most important thing is to stay hydrated and keeping even the smallest amount of food in the stomach.”

How does Hyperemesis Gravidarum affect the baby?
“Usually women experience morning sickness, no matter the severity, during the first trimester, while the fetus is extremely tiny and requires a lot less nourishment than you may think. As long as you are able to keep a little something down, your baby will be okay. I always remind my patients that babies are extremely resilient and if they aren’t able to eat or drink much, they are likely staying away from some of the riskier foods/drinks/activities that have been shown to lead to miscarriage in the first trimester. While nausea and vomiting may continue past the first trimester, if you work with your doctor you can definitely come up with a treatment plan to make sure you and the baby are getting the right amount of nutrients. Before modern medicine, severe morning sickness could have certainly lead to death of the mother and baby, but today we can easily manage it. HG can lead to malnutrition and severe dehydration, which are the biggest risks, but as long as a woman seeks medical attention early on, she and the baby will be just fine. Morning sickness is actually a sign of a healthy pregnancy.”

What would you recommend to a woman that works outside of the home and has severe morning sickness?
“It really depends on the type of work she does, but if she is sick enough, it may be hard to get out of bed and get to any job. While you may not want to disclose your pregnancy before the second trimester, I would recommend you at least tell someone in your HR department. This way you know what options are available. I can’t speak to states outside of California, but here we would definitely sign off on disability for a woman that is so sick she can’t continue to work while symptoms persist. If you need it, request documentation from your doctor so that your employer understands the severity of your sickness. If you take care of yourself early on, you are likely to get better faster and then you’ll be able to return to work sooner.”

Any other words of advice for women diagnosed with Hyperemesis Gravidarum?
“We always tell our patients, ‘If you can get through this, the rest of the pregnancy should be a cinch. No promises, but you may even think labor is easy!’”

One final thought from a woman who has experienced HG herself.
“Morning sickness that is this extreme and severe can come out of no where and take over your life. It can be debilitating and leave you in bed or next to the toilet for weeks or even months. Your old life disappears completely. Being so early in your pregnancy, you may not have shared your news with many family or friends and now you are extremely ill. This can be isolating and take a toll on your emotional well being. It can also make you resent your growing baby or question your ability to make it through this time and your pregnancy. I felt all of these things and when my doctor told me at 7 weeks pregnant that it may last until at least 12-14 weeks I thought it was impossible that I would make it through. I mourned my pre-pregnancy life and felt depressed being in bed all day, but wasn’t capable of doing anything else. However, once I made it to the other side, I felt amazing. I think going from feeling so awful to feeling relatively normal again really made me appreciate my body, my health, and this miracle growing inside of me, which survived on ice chips and saltines for two months! It will pass, you will want to eat again (I seriously thought I may never like food again) and you will resume a normal (new-normal of pregnancy) life.”