Medical Conditions

Hyperemesis Gravidarum

Content reviewed against published ACOG, NIH, March of Dimes guidelines

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If your baby has been diagnosed with or you suspect hyperemesis gravidarum, here is what the evidence says.

The short answer

Hyperemesis gravidarum (HG) is severe nausea and vomiting during pregnancy that goes far beyond normal morning sickness. It affects about 1-3% of pregnancies and can cause dehydration, weight loss, and electrolyte imbalances. HG is not your fault and is not caused by anything you did. With appropriate treatment including IV fluids, anti-nausea medications, and nutritional support, most women with HG have healthy babies.

Key takeaways

  • Hyperemesis gravidarum (HG) is severe nausea and vomiting during pregnancy that goes far beyond normal morning sickness. It affects about 1-3% of pregnancies and can cause dehydration, weight loss, and electrolyte imbalances. HG is not your fault and is not caused by anything you did. With appropriate treatment including IV fluids, anti-nausea medications, and nutritional support, most women with HG have healthy babies.
  • Usually normal when: Nausea with occasional vomiting in early pregnancy that allows you to keep some food and fluids down
  • Call your doctor if: You have not been able to keep any fluids down for 24 hours or more, you feel severely dehydrated (dry mouth, racing heart, confusion), or you have blood in your vomit
  • Varies by age — see the age-by-age breakdown below
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
— Fever and Your Child, American Academy of Pediatrics (AAP)

Parents everywhere have the same worry. You are doing the right thing by looking into it.

By Age

What to expect by age

First trimester

HG typically begins between 4-7 weeks of pregnancy, often before a woman even has her first prenatal appointment. Unlike normal morning sickness, HG involves persistent vomiting (often more than 3-4 times per day), inability to keep food or fluids down, weight loss of more than 5% of pre-pregnancy weight, and possible dehydration. Treatment may include anti-nausea medications (ondansetron, metoclopramide, promethazine), IV fluids, and dietary modifications.

Second trimester

Normal morning sickness usually improves by 12-14 weeks, but HG can persist well into the second trimester or even throughout the entire pregnancy. If symptoms continue, your provider will monitor your weight, hydration status, and nutritional intake. You may need ongoing medications, vitamin supplementation (especially thiamine to prevent Wernicke encephalopathy), and sometimes home IV therapy or TPN (total parenteral nutrition) in severe cases.

Third trimester

Most women with HG see improvement by the third trimester, though some continue to experience symptoms throughout pregnancy. Fetal growth will be monitored to ensure the baby is developing normally despite reduced maternal nutrition. Many babies of HG mothers grow normally. Emotional support is important because HG can be isolating and distressing - consider connecting with HG support groups.

Postpartum

Symptoms of HG resolve quickly after delivery in most cases. Nutritional recovery may take some time. Women who had HG may have complicated feelings about pregnancy, including grief, trauma, or anxiety about future pregnancies. HG recurs in about 75-80% of subsequent pregnancies, so planning with your provider in advance can help manage it more effectively next time.

What Should You Do?

When to take action

Probably normal when...
  • Nausea with occasional vomiting in early pregnancy that allows you to keep some food and fluids down
  • Morning sickness that improves by the end of the first trimester
  • Feeling queasy but able to maintain your weight and stay hydrated
  • Nausea that is managed with small meals, ginger, or mild dietary changes
Mention at your next visit when...
  • You are vomiting more than 3-4 times a day or cannot keep any food or fluids down for 12-24 hours
  • You have lost more than 5% of your pre-pregnancy body weight
  • You are producing very little urine, your urine is dark, or you feel dizzy when standing
Act now when...
  • You have not been able to keep any fluids down for 24 hours or more, you feel severely dehydrated (dry mouth, racing heart, confusion), or you have blood in your vomit
  • You develop severe abdominal pain, fever, or signs of neurological problems (confusion, vision changes, difficulty walking) which may indicate complications from prolonged vomiting

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Hyperemesis Gravidarum.

Things to mention

  • You are vomiting more than 3-4 times a day or cannot keep any food or fluids down for 12-24 hours
  • You have lost more than 5% of your pre-pregnancy body weight
  • You are producing very little urine, your urine is dark, or you feel dizzy when standing

Observations to share

  • You are vomiting more than 3-4 times a day or cannot keep any food or fluids down for 12-24 hours
  • You have lost more than 5% of your pre-pregnancy body weight
  • You are producing very little urine, your urine is dark, or you feel dizzy when standing

Urgent signs to report immediately

  • You have not been able to keep any fluids down for 24 hours or more, you feel severely dehydrated (dry mouth, racing heart, confusion), or you have blood in your vomit
  • You develop severe abdominal pain, fever, or signs of neurological problems (confusion, vision changes, difficulty walking) which may indicate complications from prolonged vomiting

My notes

From ismybabyalright.com — free, evidence-based baby health guides

Triage

Vomiting Decision Tree

Evaluate vomiting severity and decide when to call the doctor.

Tool

Growth Percentile Calculator

Plot your baby's weight, length, and head circumference on WHO/CDC growth charts.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is hyperemesis gravidarum normal?
Hyperemesis gravidarum (HG) is severe nausea and vomiting during pregnancy that goes far beyond normal morning sickness. It affects about 1-3% of pregnancies and can cause dehydration, weight loss, and electrolyte imbalances. HG is not your fault and is not caused by anything you did. With appropriate treatment including IV fluids, anti-nausea medications, and nutritional support, most women with HG have healthy babies.
When should I call the doctor about hyperemesis gravidarum?
You have not been able to keep any fluids down for 24 hours or more, you feel severely dehydrated (dry mouth, racing heart, confusion), or you have blood in your vomit You develop severe abdominal pain, fever, or signs of neurological problems (confusion, vision changes, difficulty walking) which may indicate complications from prolonged vomiting
When is hyperemesis gravidarum normal?
Nausea with occasional vomiting in early pregnancy that allows you to keep some food and fluids down Morning sickness that improves by the end of the first trimester Feeling queasy but able to maintain your weight and stay hydrated
What causes hyperemesis gravidarum?
Hyperemesis gravidarum (HG) is severe nausea and vomiting during pregnancy that goes far beyond normal morning sickness. It affects about 1-3% of pregnancies and can cause dehydration, weight loss, and electrolyte imbalances. HG is not your fault and is not caused by anything you did. With appropriate treatment including IV fluids, anti-nausea medications, and nutritional support, most women with HG have healthy babies. Common explanations include: Nausea with occasional vomiting in early pregnancy that allows you to keep some food and fluids down. Morning sickness that improves by the end of the first trimester.
What should I mention to my pediatrician about hyperemesis gravidarum?
You should mention hyperemesis gravidarum at your next visit if: You are vomiting more than 3-4 times a day or cannot keep any food or fluids down for 12-24 hours. You have lost more than 5% of your pre-pregnancy body weight. You are producing very little urine, your urine is dark, or you feel dizzy when standing.
Is hyperemesis gravidarum normal at First trimester?
HG typically begins between 4-7 weeks of pregnancy, often before a woman even has her first prenatal appointment. Unlike normal morning sickness, HG involves persistent vomiting (often more than 3-4 times per day), inability to keep food or fluids down, weight loss of more than 5% of pre-pregnancy weight, and possible dehydration. Treatment may include anti-nausea medications (ondansetron, metoclopramide, promethazine), IV fluids, and dietary modifications.
Is hyperemesis gravidarum normal at Second trimester?
Normal morning sickness usually improves by 12-14 weeks, but HG can persist well into the second trimester or even throughout the entire pregnancy. If symptoms continue, your provider will monitor your weight, hydration status, and nutritional intake. You may need ongoing medications, vitamin supplementation (especially thiamine to prevent Wernicke encephalopathy), and sometimes home IV therapy or TPN (total parenteral nutrition) in severe cases.
Should I go to the ER for hyperemesis gravidarum?
Seek emergency care if you have not been able to keep any fluids down for 24 hours or more, you feel severely dehydrated (dry mouth, racing heart, confusion), or you have blood in your vomit, or if you develop severe abdominal pain, fever, or signs of neurological problems (confusion, vision changes, difficulty walking) which may indicate complications from prolonged vomiting. When in doubt, call your pediatrician's after-hours line for guidance.
Does hyperemesis gravidarum go away on its own?
In many cases, hyperemesis gravidarum resolves on its own, especially when nausea with occasional vomiting in early pregnancy that allows you to keep some food and fluids down. By Postpartum, symptoms of HG resolve quickly after delivery in most cases. Nutritional recovery may take some time. Women who had HG may have complicated feelings about pregnancy, including grief, trauma, or anxiety about future pregnancies. HG recurs in about 75-80% of subsequent pregnancies, so planning with your provider in advance can help manage it more effectively next time.
ACOGNIHMARCH OF DIMES

References

  1. [1]American College of Obstetricians and Gynecologists. Nausea and Vomiting of Pregnancy. ACOG Practice Bulletin No. 189, 2018. ACOG
  2. [2]National Institutes of Health. Hyperemesis Gravidarum. MedlinePlus, 2023. NIH
  3. [3]March of Dimes. Severe nausea and vomiting during pregnancy. March of Dimes, 2023. March of Dimes

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources

Related Resources

Vomiting TriageWell-Baby Visit PrepGrowth Spurts TimelineGrowth Percentile CalculatorPregnancy TrackerBaby Tracker

Bottom line

Most cases of hyperemesis gravidarum are normal. Talk to your pediatrician if you have not been able to keep any fluids down for 24 hours or more, you feel severely dehydrated (dry mouth, racing heart, confusion), or you have blood in your vomit.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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