Extreme morning sickness during pregnancy, a condition known as hyperemesis gravidarum (HG), can have a devastating emotional and physical impact on pregnant women.
A survey of close to 300 Australian women with HG reveals that more than half considered terminating their pregnancies due to their distressing symptoms.
The findings, published on September 3 in the journal PLOS One, provide a detailed look at the challenging reality for women with this debilitating condition. The study highlights not only the profound suffering caused by HG but also the lack of effective relief from many commonly prescribed medications.
Understanding Hyperemesis Gravidarum
HG is a severe form of nausea and/or vomiting in pregnancy (NVP). It can lead to fluid loss, electrolyte imbalances, and weight loss, which can affect both mother’s and baby’s health.
HG affects up to 10.8% of pregnancies, Australian researchers said.
Lead author Luke Grzeskowiak, a pharmacist and associate professor of medicine and public health at Flinders University in Australia, stated: “Hyperemesis gravidarum is not just morning sickness — it’s a serious condition that can have devastating consequences for women’s mental health, relationships and decisions about future pregnancies.”
He added in a news release: “Our study shows that many women are not getting the support or relief they need, and that’s something we must urgently address.”
Study Findings
For the study, researchers surveyed 289 Australian women who were experiencing severe nausea and vomiting of pregnancy or hyperemesis gravidarum, or who had experienced it in the past.
In all, 54% of respondents said they had considered ending their pregnancy because of their HG symptoms.
The condition also made many women rethink having more children, with 90% saying they had considered not having another pregnancy.
On average, respondents were 33 years old, and 38% were pregnant at the time of the survey in 2020. All reported that their nausea symptoms began in the first trimester.
Many respondents (72%) reported hospital admission for IV fluids at some point during pregnancy, and all respondents reported great difficulties eating and drinking their normal intake during pregnancy.
Emotional Impact
The emotional distress was significant. In all, 62% of respondents reported feelings of anxiety and depression “often” or “always” during their pregnancy.
Treatment Challenges
When it came to managing their symptoms, women reported mixed results from standard treatments. On average, respondents tried four antiemetic medications—drugs that help reduce or prevent nausea and vomiting. Only half of respondents found commonly used medications to be effective, the survey showed.
While ondansetron, doxylamine, and corticosteroids were seen as the most helpful drugs, many women also reported bothersome side effects, including constipation, sedation, and a feeling of “fogginess” or impaired cognition.
Nearly a third of women who tried metoclopramide, another common treatment, stopped due to adverse effects.
The most common remedy was ginger, either on its own or as part of combination therapy, used by 88% of survey respondents. Other common treatments were ondansetron (55%), metoclopramide (49%), and pyridoxine (46%).
Grzeskowiak noted that this cycle of trying multiple medications with limited success and new side effects can add to the burden women already feel.
He stated: “Women are often prescribed multiple medications in an attempt to manage their symptoms, but the reality is that many of these treatments come with their own burdens. We need better evidence to guide treatment decisions and ensure women are supported to make informed choices.”
Life Disruptions
Beyond the physical symptoms, the study also detailed the widespread disruption HG caused in women’s lives.
More than half reported that their ability to work, care for their children, sleep, keep up socially, and even do basic daily tasks was severely affected. Up to 30% also reported negative impacts on their relationship with their partner.
Further, 37% said they requested an early induction of labor to end their pregnancies sooner because of the severity of their symptoms.
Call for Change
Study co-author Caitlin Kay-Smith, founder of the consumer group Hyperemesis Australia, emphasized the need for a fundamental shift in how healthcare professionals approach HG.
She said: “Too often, women’s symptoms are dismissed as a normal part of pregnancy, when in fact they are experiencing a condition that can be life-altering.”
The study calls for further research into the long-term effects of HG and its treatments, along with more investment in support services.
Researchers said their findings underscore the need “for a nuanced and holistic approach” to managing severe nausea during pregnancy and HG.
The study added: “Greater evidence is also urgently needed to help better guide existing and future treatments for this debilitating condition, particularly with respect to exploring immediate and long-term impacts of various medications on maternal, fetal, and infant health and well-being.”
Grzeskowiak concluded: “The message from women is clear: They want to be heard, believed and treated with dignity.”
This research highlights a serious gap in care for women suffering from extreme pregnancy-related nausea, emphasizing the urgent need for better treatment options and more comprehensive support systems to address both the physical and mental health consequences of hyperemesis gravidarum.
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