As if morning sickness isn't grim enough, there's an extreme and debilitating form called hyperemesis gravidarum.
If the following list describes your symptoms, you need to see your midwife or GP:
- Vomiting repeatedly
- Dark yellow urine (ie you're dehydrated)
- Losing, rather than gaining, weight
Fortunately, hyperemesis isn't very common - it affects between 1% and 3% of pregnant women - but it's potentially harmful to you and needs checking out.
When you're undernourished, your body burns fat for energy and produces chemicals called ketones, which can be detected in your urine. You can monitor your levels using ketosticks, available from pharmacies, and if they're high you should tell your GP or midwife.
The Hyperemesis Education and Research (HER) has a factsheet with a comprehensive list of symptoms to help you work out whether you have hyperemesis or morning sickness.
How is hyperemesis treated?
There are a number of antiemetic (anti-sickness) drugs your GP can prescribe. Initially, you may be advised to use anti-nausea strategies similar to the general advice given to any pregnant woman.
These may help in the initial stages of hyperemesis, but Mumsnetters say they become ineffective once hyperemesis is in full swing.
You may be able to cope at home, but if you can't keep anything down at all, you may be admitted to hospital to be put on a drip, to replace lost fluids and nutrients, and given drugs to minimise the vomiting. If there are ketones in your urine, you may need extra minerals, and these can be added to your drip.
How long does hyperemesis last?
For most women, hyperemesis 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. The majority of women with hyperemesis ﬁnd that it takes longer than this.
Unfortunately, some poor souls suffer severely for their entire pregnancy. Others ﬁnd that it improves but that they suffer from nausea and occasional vomiting until the birth. As many posts on Mumsnet Talk testify, hyperemesis is severely incapacitating for some women and seriously mars their pregnancy.
Relapse is common, especially if you have tried to return to your normal, busy life. Be very careful about resuming work and normal household activities and stopping your medication. Resume activities very gradually and resume medication at the ﬁrst sign of the condition returning.
Possible complications of hyperemesis
- Dehydration, vomiting and malnutrition can have lead to a number of associated symptoms such as:
- Cracked lips
- Mouth sores
- Acid reflux
- Tooth enamel erosion
- Sleep disorder
- Vitamin and mineral deficiency
- Excessive salivation
Repeated vomiting can cause tears in the gullet, called Mallory-Weiss tears, which cause you to bring up fresh, red blood. But if you bring up vomit that looks like coffee grounds, you should seek immediate medical attention as this is old blood and can indicate a bleed further down.
Will hyperemesis affect my baby?
Babies born to women who have endured hyperemesis are generally absolutely fine. So, difficult as it can be to believe that something which is making you feel so wretched isn't harming your baby, you shouldn't worry.
The NHS says that if you experience weight loss during pregnancy then there's an increased risk (but only a risk) that your baby may be born with a low birth weight.
The HER says that although research suggests that prolonged stress, malnutrition and dehydration in the mother can potentially put an unborn child at risk for chronic disease (eg diabetes, heart disease) in later life, no long-term follow-up studies have yet been done on babies born to hyperemetic mothers.
And note the words 'potentially' and 'risk' ie it's not inevitable, so try not to worry yourself even sicker.
The effect on your other children
There are sad threads on Talk from mums who feel their other children have been affected by seeing mummy so unwell.
Enlist supportive friends and family, and don't beat yourself up or feel guilty. If you had extreme vomiting and fatigue as a side-effect of an illness, no one would expect you to bustle around caring for others and maintaining all your normal activities (and if they did, you'd justifiably feel hurt and cross).
What Mumsnetters say about getting treatment for hyperemesis
"If you tell most doctors/midwives that you are being sick, they'll just tell you it is a feature of your pregnancy and it will wear off. You need to stress how bad it is." Debsb
"Shout to get treatment quickly! My GP got the injection sorted within 30 seconds of me saying 'I am being rather sick'. Once the injections got on top of it, the tablets are working but they have the killer side-effect on me of total knockout pills. And yes, it is all too possible to be sick on an empty stomach. I found ice worked a bit - couldn't keep water down - but when it comes up still frozen you know things are bad!" Stripeybumpsmum
"It may sound odd but the best times were when I was admitted to hospital as the loneliness of having to stay at home being so physically incapacitated was unbearable. There were days when I didn't think that I would make it through the next hour, let alone to the next day. I think the level of sickness and debilitation plays with your mind and I wouldn't wish some of the blackest days on anyone. I didn't cope very well at all until I got the medication I needed." Harrysmum