Hyperemesis gravidarum, however, is an extreme form of morning sickness which causes a pregnant person to experience excessive nausea and vomiting multiple times throughout the day. Hyperemesis is thought to effect 1 in 100 people. Hyperemesis is often diagnosed by your LMC or Obstetric team using a variety of observations including, but not limited to; 

• Weight loss 
• Frequent Ketones in urine (Scale of 0-3+ indicating body in state of Ketosis due to lack glucose) 
• Dehydration 
• Severe Fatigue 
• Decreasing frequency of urination 
• Nausea and vomiting affecting ability to work and general day to day life 

Unlike typical morning sickness symptoms, HG generally continues past the 12/14 week mark when we would expect typical morning sickness to subside. Some people find their symptoms will settle between 20–28weeks however for some people HG symptoms continue till birth and in some cases after birth. 

Recently a study published in Nature reveals abnormally high levels of the hormone GDF15, and increased sensitivity to it, are the major factors contributing to HG. 

The majority of the time HG will not affect baby. In cases where the maternal weight loss has been very significant it can cause low birth weight. Most people with HG will be offered extra growth scans to ensure baby is growing well. If you are put on long term steroids to help control the nausea and vomiting, these can affect the way your body processes insulin which can lead to an increased risk of developing Gestational Diabetes. 

Focus on fluids. Aim to drink small amounts frequently throughout the day as dehydration can often exacerbate symptoms. If you find swallowing challenging then you can try freezing water, electrolytes, smoothies etc into ice cubes/ice blocks as these can be easier to swallow. Some people find ice cold fluids easier to tolerate while for some room temperate will work better 

• Choose easy to consume foods. A lot of people who have experienced HG find that plain carbs are the best (Hot chips, pasta, mashed potato). Over time you will find ‘safe foods’, these are foods you find easy to eat and that stay down, these may change during your pregnancy 
• Identify your triggers and communicate them to your family to ensure they are managed as best possible. For some, this can include certain foods, smells, noises, times of day, or tiredness 
• Seeing a specialist pregnancy dietician can be beneficial for specific nutrition advice to your circumstances 
• HG can be mentally debilitating as you manage the mental load of frequent nausea and vomiting. Communicate this with people close to you and your LMC. It is really hard for people who haven’t experienced HG to understand 

If your nausea and vomiting begin to affect your ability to continue your day to day life then it might be time to discuss medication options with your LMC or GP. 

There are many antiemetics including: 

• Cyclazine 
• Metoclopramide 
• Ondansetron 
• Prochlorperazine 

Other treatment options can include receiving regular IV fluids, steroids and in some cases IV nutrition and/ or a NG tube may need to be provided to ensure your wellbeing and the wellbeing of baby. 

• Due to the increased vomiting a lot of people find they require dental work after baby is born 
• HG can take you to a mentally dark place, and it’s really normal to feel that termination, suicide, or early induction of labour would be easier options than enduring the debilitating nausea and vomiting. It doesn’t make you love or want your baby any less. It’s important to discuss these feelings with your LMC 
• For some people it can be a case of adjusting the medications and the times they are taken to achieve the best results for you 
• A lot of people who experience HG have increased saliva production. This is called Hypersalivation 

Call your LMC immediately if you do not pass urine for more than 8 hours or have very dark-coloured urine, are unable to keep food or fluids down for 24 hours, feel severely weak, dizzy or faint when standing up, have abdominal pain, have a high temperature of 38°c or above, are vomiting blood, or have pain when passing urine or any blood in your urine.