Many pregnant women feel sick (nausea) and, or may vomit during early pregnancy. This can vary from mild to moderate and still be considered part of the normal experience of pregnancy. People used to call this “morning sickness” but we now refer to it as nausea and vomiting in pregnancy, or NVP.
In mild and moderate NVP women are still able to eat and drink. Around 7 in 10 pregnant women will experience NVP, but they usually feel better after the first trimester.
When nausea and vomiting become severe, lasting for more than a few days, women will find it hard to eat or drink enough. This severe NVP is called hyperemesis gravidarum (HG). Around 1 in 100 pregnant women will experience HG, although this number may be higher. It may lead to dehydration (lack of fluid in the body) and cause weight loss and vitamin deficiencies.
HG usually starts early in pregnancy, before women are 10 weeks pregnant. For most women, HG stops between 13 to 20 weeks, while a few women have HG their entire pregnancy.
HG can have a big impact on women’s emotional, mental and physical health. Women are often so sick they cannot go to work, care for themselves or anyone else, and have great difficulty participating in normal daily activities.
HG can make women feel very unwell and needs to be taken seriously by their health care provider, families and support people and employers.
If you are experiencing nausea and or vomiting, which is interrupting your ability to drink and eat, you should speak to your health care provider. They may ask you questions about how you have been feeling over the past 24 hours. The “PUQE-24” scoring system below shows how they will rate your responses, to understand how severe your nausea and or vomiting has been.
If your PUQE-24 score is:
HG is a real and debilitating medical condition, and it is important that you are listened to and get the treatment you need.
Based on your responses to the questions, your
health care provider will suggest how to manage
your sickness. If you have mild or moderate feelings
of nausea and vomiting you do not usually need
any other tests, however you may be offered some
treatment for your symptoms.
If you have severe NVP or HG, your pregnancy
care provider should do further tests, such as blood
or urine tests. These tests will look for the cause of
your nausea and vomiting and see how dehydrated
you are. The results of the tests will help guide
The first thing to know is that nothing you do or have
done has caused HG. It’s not you or your partner’s
fault and it does not mean there is anything wrong
with your baby or your pregnancy. The exact cause of
HG is not known but there are current studies on what
the causes may be. So far we know that HG can occur
more in some families. If you had severe sickness and
vomiting in a previous pregnancy, you may be more
likely to experience it again in later pregnancies. It
seems to occur more when women have twins or
triplets, however it definitely affects women who are
pregnant with one baby too.
If you are suffering from NVP or think you may have
HG, you should see your pregnancy care provider,
such as your midwife, family doctor or obstetrician.
If you are feeling very unwell you should go to the
Emergency Department at your local hospital for
advice and help.
Symptoms of nausea and vomiting can become harder
to control the longer you are suffering. We encourage
you to see your pregnancy care provider as soon as
possible when you feel that:
Unfortunately, HG is often not always recognised
quickly, so don’t be afraid to ask any questions about
your health during pregnancy.
There is a lot of help available to ease your symptoms
during pregnancy. Your pregnancy care provider
will develop a treatment plan with you based on
your symptoms and their severity. Sometimes the
nausea and vomiting cannot be stopped completely.
The aim of treatment is to reduce your symptoms
enough to allow normal daily activities, especially
eating and drinking.
If you have
mild or moderate NVP, your health care provider may suggest:
If you have mild or moderate NVP, your health
care provider may suggest:
If you have severe NVP/HG, or you are dehydrated,
your health care provider may suggest:
*Some women need to be seen at the hospital or Day
Stay hospital facility to be given IV fluids. You may
need to be admitted (stay in) hospital if you do not
respond to medication, you are losing weight or can’t
keep enough fluid down and become dehydrated.
Anti-sickness (antiemetic) medicine may be needed
if your symptoms are not going away and are severe.
You may be worried about taking medicines while you
are pregnant. The medicines that health professionals
recommend are considered safe and have been
used for many years to treat nausea and vomiting
in pregnancy. For some women, medication may
be needed for several weeks or even months until
Never take any medication without discussing it
with your GP, obstetrician, community pharmacist
Your baby gets its food from your body even though
you may not be eating much when feeling nauseous
or vomiting. If you become dehydrated it could affect
your baby so it’s important you receive treatment and
fluids. Some babies of women with HG may have a low
birth weight when born. However, not all babies born
to women with HG have a low birth weight.
MotherSafe is a free telephone service
for the women of NSW that can provide
counselling and advice on medications
to support nausea and vomiting
Call 1800 647 848 or search
‘MotherSafe NSW’ for more information.