If you are suffering from persistent nausea and/or vomiting which is preventing you from eating and/or drinking then you may be suffering from HG. With ordinary nausea and vomiting of pregnancy (NVP), the sickness does not interfere with your ability to eat and drink enough, you should not be losing weight and you should be able to continue to care for yourself and your family although you may not be feeling too great. With HG, sufferers often need help caring for themselves, never mind look after their family. The illness can be completely debilitating for weeks or even months. Because of the name of the condition, some women think they don't have it because they're not actually vomiting a lot. However, severe nausea that prevents you from eating or drinking is also HG because it has the same result as vomiting ie you end up dehydrated and starved. If you're not sure, the Hyperemesis Education and Research (HER) website have a fact sheet to help you determine whether or not you are suffering from HG or NVP. See HER HG or morning sicknessDiagnosis is important as, without effective antiemetics, you will inevitably become dehydrated and you will need to be admitted to hospital for IV rehydration. Starvation is another risk. When your body burns fat for energy, it produces chemicals called ketones which can be detected in your urine. You can monitor your levels of starvation using ketosticks, available from pharmacies. You pee on the stick and it monitors your levels of ketones. If levels are high, you should tell your doctor or midwife. If you are worried about dehydration and ketone levels and you can't see your doctor or midwife, you can go to A&E.
Some women are greatly helped by alternative medicine, particularly homepathy and acupunture. Some women can claim to have had the illness 'stopped in its tracks' by acupunture, but success varies between individual patients and it tends to be expensive. These remedies are worth a try if you can afford it but you should also be pursuing conventional treatments in parallel as, anecdotally, the success rate for alternative remedies is low. See Alternative Remedies for more information. There is also little or no good quality trials data to support these alternatives.
There is conﬂicting evidence as to whether having a boy or a girl makes HG worse, some studies say there is no difference, some say there is an association of more nausea and vomiting of pregnancy with girls. Even though there is may be a slightly higher risk with girls, it is still possible to have HG while carrying a boy. There is no evidence that the severity of HG is worse with girls, and you can't predict the sex of the baby by whether you have HG in any particular pregnancy. See PSS Review Gender Dependence of HG for details of research.
Yes there is evidence that carrying more than one baby makes HG worse.
You will often be told that morning sickness is a good sign and feeling sick means the pregnancy is well established. This is generally the case with normal NVP, however, it is not the case with untreated HG. There is actually a higher risk of pre-term birth and low birth weight. However, continuing to feel sick may be a sign that the pregnancy is still progressing. Some women with HG who miscarried reported that the ﬁrst sign was that they suddenly stopped feeling sick.
For most women, HG peaks in the ﬁrst trimester and tails off or disappears completely later in the pregnancy. The usual advice for morning sickness is that it will improve after 12 weeks but this is not the case for HG. The HER foundation have survey results on the duration of nausea and vomiting on their website. See How long does it last? for more detailed information about duration of NVP and HG. Unfortunately, some women suffer severely for the entire pregnancy. Others ﬁnd that it improves, but they suffer from nausea and occasional vomiting until birth. Relapse is quite common especially if you have tried to return to your normal busy life. There is a great temptation to make up for lost time and become very active once you start to feel better, but this very often leads to the nausea returning. You should be very careful about resuming work and normal household activities even if you feel as though you're up to it. Be careful too about stopping your medication, do it very gradually and resume at the ﬁrst sign of the condition returning. You may have to continue to take it for the entire pregnancy to prevent a relapse.
The good news is that for the vast majority of sufferers the physical symptoms of HG disappear completely as soon as the baby is born. You should be aware though that it is not unknown for the nausea to persist after birth especially if you have been severely ill. If this occurs, speak to your doctor. For women who suffered persistent, long term nausea and vomiting, it may take some time to restore energy levels and nutritional reserves. Moreover, while the physical symptoms may leave, the trauma of HG can leave an emotional legacy for many women, especially when combined with the rigours of caring for a baby. If you have any concerns, speak to your doctor or midwife. Don't feel that you should just be able to pick yourself up and get on with things, if you're having problems you are entitled to seek support.
Unfortunately HG has a strong genetic component of risk and it has been observed to run in families so you are more likely to suffer if your mother or sister has had it. See the following link for more information about relevant research. PSS Review genetic factors
Unfortunately, having HG in one pregnancy puts you at a higher risk of suffering in subsequent pregnancies although it is possible to escape it. Some women ﬁnd that the HG gets better in subsequent pregnancies, whereas others ﬁnd it stays the same or gets worse. There is really no way of knowing how your pregnancies will relate to each other. If you have had HG it is a good idea to prepare for it in subsequent pregnancies. It's better to be prepared and not suffer it, than to cross your fingers and hope you won't get it then get caught out.
The HER website has a page of advice on preparing for your next pregnancy. HER prepare for HG If you had medication which worked for you in your previous pregnancy, make sure that you have it ready to take as soon as you feel ill. Studies show that the quicker you get on top of the sickness, the better the medication works. Because HG can start within days of missing your period, see your GP as soon as you know you're pregnant. Also see Trying Again for more information and to download an action plan to take to your doctor with you.
No, many women in the UK have been prescribed ondansetron. When it was under patent and was sold under the brand name of Zofran it was very expensive and some doctors were reluctant to prescribe for cost reasons. It is still more expensive than other drugs but is no longer prohibitively expensive. According to estimates, a 2 month course of ondansetron costs as much as one typical in-stay in hospital for an HG patient so it is a false economy for a doctor to refuse it on cost grounds.
Ketones are a class of organic chemical which includes acetone. All people have ketones naturally occurring in their bodies as a normal part of the metabolism of fat. They can be detected in urine and breath at very low levels, but when you are starved or dehydrated, the concentration of ketones in urine and breath increases. This is because when the body is starved of glucose, it will break down body fat for energy. The chemical reactions which this causes lead to a greater production of ketones. The levels of acetone on the breath of even healthy people changes during the day depending on how long it has been since they have eaten, and fasting for as little as one day can cause levels of breath acetone to increase tenfold. In diabetics who are undiagnosed or not taking enough insulin, breath acetone levels can rise high enough to give off a characteristic sweet smell. During prolonged fasting, such as happens with HG, ketone concentrations in the blood rise dramatically and can be detected in urine using a simple test called a ketostix. These are available from pharmacies. High ketone levels should not be ignored, if you have a high sample reading, you should seek medical attention. Note that levels can change quickly with time. It is advisable to do your own testing even in hospital as many hospitals use ketone levels as a criterion for admission or discharge after IV fluid treatment.