Sickness in pregnancy (sometimes called morning sickness) is common. Around 8 out of every 10 pregnant women feel sick (nausea), are sick (vomiting) or both during pregnancy. This does not just happen in the morning.

For most women, this improves or stops completely by around weeks 12 to 20, although for some women it can last longer.

Some pregnant women experience very bad nausea and vomiting. They might be sick many times a day and be unable to keep food or drink down, which can impact their daily life.

This excessive nausea and vomiting is known as hyperemesis gravidarum (HG) and often needs hospital treatment.

Exactly how many pregnant women get HG is not known as some cases may go unreported, but it's thought to be around 1 to 3 in every 100.

If you are being sick frequently and cannot keep food down, tell your doctor, or contact the hospital as soon as possible. There is a risk you may become dehydrated, and your midwife or doctor can make sure you get the right treatment.

Symptoms of hyperemesis gravidarum

HG is much worse than the normal nausea and vomiting of pregnancy.

Signs and symptoms of HG include:

• prolonged and severe nausea and vomiting
• dehydration– symptoms include feeling thirsty, tired, dizzy or lightheaded, not peeing very much, and having dark yellow and strong-smelling pee
• weight loss

Unlike regular pregnancy sickness, HG may not get better by 16 to 20 weeks. It may not clear up completely until the baby is born, although some symptoms may improve at around 20 weeks.

See your family doctor if you have severe nausea and vomiting. Getting help early can help you avoid dehydration and weight loss.

Other conditions can cause nausea and vomiting, and your doctor will need to rule these out first.

What causes hyperemesis gravidarum?

It's not known exactly what causes HG, or why some women get it and others do not. There is evidence that it is linked to the changing hormones in your body that occur during pregnancy.

There is some evidence that it runs in families, so if you have a mother or sister who has had HG during pregnancy, you may be more likely to get it yourself.

If you have had HG in a previous pregnancy, you are more likely to get it in your next pregnancy than women who have never had it before, so it's worth planning.

Treating hyperemesis gravidarum

Some medicines can be used in pregnancy, including the first 12 weeks, to help improve the symptoms of HG. These include anti-sickness (anti-emetic) drugs, steroids, or a combination of these.

You may need to try different types of medicine until you find what works best for you.

If your nausea and vomiting cannot be controlled, you may need to be admitted to hospital. This is so doctors can assess your condition and give you the right treatment to protect the health of you and your baby.

Treatment can include intravenous fluids, which are given directly into a vein through a drip. If you have severe vomiting, the anti-sickness drugs may also need to be given into a vein or a muscle.

Will hyperemesis gravidarum harm my baby?

HG can make you feel very unwell, but it's unlikely to harm your baby if treated effectively.

However, if it causes you to lose weight during pregnancy, there is an increased risk that your baby may be born smaller than expected (have a low birth weight).

How you might feel

The nausea and vomiting of HG can impact your life at a time when you were expecting to be enjoying pregnancy and looking forward to the birth of your baby.

It can affect you both emotionally and physically. The symptoms can be hard to cope with. Without treatment, HG may also lead to further health complications, such as depression or tears in your oesophagus.

Severe sickness can be exhausting and stop you from doing everyday tasks, such as going to work or even getting out of bed.

In addition to feeling very unwell and tired, you might also feel:

• anxious about going out or being too far from home in case you need to vomit
• isolated because you do not know anyone who understands what it's like to have HG
• confused as to why this is happening to you
• unsure about how to cope with the rest of the pregnancy if you continue to feel very ill

If you feel any of these, do not keep it to yourself. Talk to your midwife or doctor, and explain the impact HG is having on your life and how it is making you feel. You could also talk to a partner, family members and friends if you want to.

Bear in mind that HG is much worse than regular pregnancy sickness. It is not the result of anything you have or have not done, and you do need treatment and support.

Another pregnancy

If you have had HG before, you will likely get it again in another pregnancy.

If you decide on another pregnancy, it can help to plan, such as arranging child care so you can get plenty of rest.

You could try doing things that helped last time.

Talk to your doctor about starting medicine early.

Blood clots and hyperemesis gravidarum

Because HG can cause dehydration, there's also an increased risk of having a blood clot (deep vein thrombosis), although this is rare

If you are dehydrated and immobile, there is a treatment that you can be given to prevent blood clots.

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