Healthcare professionals

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Healthcare professionals

Welcome to the Hyperemesis Ireland section for healthcare professionals. We hope you find the information you need here but if not, or you have further question please do get in touch.

Hyperemesis Gravidarum (HG) is a complex condition effecting around 0.3-3.6% of pregnant women. It can be challenging to treat and get symptoms under control. However, it is important that women with severe symptoms do receive treatment and recent research has shown that there may be risks to both mum and baby if symptoms are not managed.

Historically the condition has been significantly under treated, in part due to stigmas around a psycho-dynamic aetiology which has since been dispoved. Additionally, fears around medication use in pregnancy has contributed to the under-treating of HG. There are national treatment guidelines for Ireland available which should offer prescribers a degree of confidence in the medical options. For information about the range of medications available see out medication and treatment page. For the National Guidelines, click here.

Diagnosing Hyperemesis

The Windsor definition of Hyperemesis Gravidarum is the international consensus definition (Jansen et al 2021):

Each of the following criteria are required for the definition for HG:

  • Symptoms starts in early pregnancy, before a gestational age of 16 weeks. 
  • Characterised by severe nausea and/or vomiting
  • Inability to eat and/or drink normally
  • Strongly limits daily activities

Signs of dehydration were deemed contributory but not mandatory for the definition for HG. Symptoms can be quantified by using validated scoring systems such as the Pregnancy-Unique Quantification of Emesis (PUQE) score.

Clinical indicators include:

  • Constant nausea and/or vomiting >5 x a day for >5 days  or more severe but for less time, ie. >15 times a day for 2-3 days
  • Weight loss >5% pre-pregnancy weight
  • Dehydration and malnutrition
  • Metabolic disturbances
  • Psychosocial morbidity, quality of life affected, inability to perform acts of daily living
It is important to remember that women rarely present at the doctors for regular morning sickness as the vast majority of women expect it and tolerate moderate-severe symptoms before seeking help. Additionally, for many women the nausea is the more troubling symptom and if it is preventing her from eating and drinking then it warrants assessment and possibly treatment, even where vomiting is not present.
For a useful chart detailing the differences between mild, moderate and severe pregnancy sickness, Click Here.

Appreciating the Impacts

Traditionally women have often been told that no matter how sick they are the baby will be fine. Not only do we now have evidence disputing this but we also understand the serious and sometimes life-changing impacts such severe symptoms can have on the mother.

Physical complications and risks for mum include hypokaleamia and hypocalcaemia, the later often being the reason women with HG can seem unresponsive and depressed; every movement is like wading through mud for the hypocalceamic patient.  Wernicke’s encephalopathy is a dangerous complication for women who are vomiting a lot and should be prevented with a Thiamine supplement. Very dehydrated and malnourished women are at risk of re-feeding syndrome when they are first admitted and it is important to remember that, although very rare, there are still cases of fatality due to HG.  Additionally, women may experience oesophageal damage, ongoing gastrointestinal problems, burst blood vessels, torn stomach muscles, VTE and pressure sores.

Mental health problems are well established as a complication of HG rather than a cause of it. Women who find themselves bed bound and sick for months understandably can become depressed and socially isolated. Post traumatic stress disorder is not uncommon following an HG pregnancy (US research suggests 1 in 5 HG patients meet the criteria for PTSD). 

Risks and complications for baby if poorly managed include intrauterine growth restriction, miscarriage, placental abruption, pre-term labour and intrauterine death. Malnutrition in early pregnancy has been linked with cardiometabolic disorders as well as behavioural and development problems in childhood.

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