Hyperemesis Gravidarum: Severe Nausea at Breakfast Time

Frequent morning sickness can be more than just a passing annoyance. Read on to find out why.
Hyperemesis Gravidarum: Severe Nausea at Breakfast Time

Last update: 18 July, 2022

If, during the first months of pregnancy, you experience nausea or vomiting in the morning, this is quite normal. But when this is constant or worsens, it’s called hyperemesis gravidarum.

There may also be other associated symptoms, such as dizziness, tachycardia, dehydration, and weight loss. If no action is taken, the health of the woman or fetus may be affected.

What does hyperemesis gravidarum mean?

Hyperemesis gravidarum is the term used to refer to severe morning sickness that occurs frequently or excessively, along with other symptoms that we’ll discuss later. And, even though it’s called “morning” sickness, it can actually occur at any time of the day.

Nausea, on the other hand, usually occurs between weeks 6 to 8 of pregnancy, and it tends to disappear as you enter the second trimester.

Hyperemesis gravidarum, on the other hand, lasts longer. Sometimes it improves by week 20, but other times it lasts throughout the pregnancy.

The incidence of this condition can vary. According to research, about 70% of women suffer from nausea, but between 0.3% and 2% of cases are aggravated. It’s possible that more are affected, as probably not all of them will go and see a doctor.

Symptoms of hyperemesis gravidarum

Apart from the strong nausea at breakfast or during other times of the day, accompanied by vomiting, digestive, and other symptoms, may occur in hyperemesis gravidarum, such as the following:

  • Difficulty eating or drinking
  • Excessive salivation
  • A bad taste in the mouth
  • Persistent thirst
  • Increased sensitivity to odors
  • Low urine production
  • Constipation
  • Low blood pressure
  • Tachycardia
  • A sensation of dizziness

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Causes and associated risk factors

Nausea during pregnancy is thought to be caused by an increase in the production of the human chorionic gonadotropin (hCG) released by the placenta. The onset of symptoms corresponds with a rapid increase in this substance.

It’s also believed that other hormones may be involved. These include cortisol, prostaglandins, estrogens (associated with increased olfactory sensitivity), and progesterone (affects peristaltic movements), among others.

The exact cause of the aggravation of nausea and vomiting is unknown. However, some risk factors associated with hyperemesis gravidarum have been identified:

  • Personal and family history
  • Propensity to suffer dizziness (motion sickness) or migraines
  • A multiple pregnancy
  • Molar pregnancy or hydatidiform mole
  • Gestational trophoblastic disease
  • Low blood sugar levels
  • Presence of Helicobacter pylori
  • Excess weight or obesity
  • Stress
Hiperémesis gravídica.
The nausea of this condition is excessive and makes it difficult for the mother to eat, so it’s considered risky for the gestation.

Diagnosis of hyperemesis gravidarum

The diagnosis is made by taking into account the patient’s history and performing both anamnesis and a detailed physical examination. The condition of the fetus and the presence of dehydration are evaluated.

By exclusion, nausea and vomiting should be ruled out if they’re related to other conditions of the digestive or endocrine system or to neurological or psychological problems. Several disorders can cause these symptoms.

In terms of tests, blood and urine tests, abdominal and obstetric ultrasounds, renal function tests, among others, are recommended.

Treatment options

The treatment of hyperemesis gravidarum will depend on how strong the nausea at breakfast time is. In other words, the severity of the symptoms and the consequences.

Intravenous or tube feeding

One of the first measures may include discontinuation of food intake and administration of fluids by tube or intravenously. Depending on requirements, electrolytes, vitamins, as well as medications will be replaced.

Once stabilized, the patient can resume fluid intake. If tolerated, she’ll begin to consume solid food very gradually again.

Medication

Among the medications that can be administered, always under medical recommendation, are vitamin B supplements, antihistamines, and antiemetics or prokinetics, such as doxylamine, promethazine, or metoclopramide.

If this treatment is ineffective, corticosteroids (such as methylprednisolone) can be administered. However, these should be used with caution, for a short period of time, and with the minimum dose.

The decision to use medications is complicated in some cases, as they aren’t always free of effects for the fetus or the mother. Therefore, it should only be done when it’s considered that the potential benefits outweigh the possible risks.

Natural remedies

Some natural herbal remedies can be used when authorized by the physician. In this regard, research indicates that ginger preparations have been successfully tested when seeking to manage certain symptoms in hyperemesis gravidarum.

Other alternative options

Options such as psychotherapy, relaxation techniques, and acupressure bands may be considered, especially when mental health issues are involved in the onset of this condition.

Dietary adjustments

It’s recommended to take note of foods whose smells or tastes may be related to nausea and vomiting. Avoid them as much as possible.

It’s also advisable to replace large meals with smaller, more frequent meals. Instead of three large meals, have about six small meals, plus snacks.

In addition to this, avoid spicy and spicy foods, as well as fried foods and caffeine. Instead, cookies, vegetable porridge, and nutritious smoothies with fruits are good options.

As for liquids, they should be ingested frequently, although in small quantities. However, you shouldn’t drink anything with meals, but plenty at other times.

Finally, it’s better not to go to bed immediately after eating, but to wait a little. Nor should you postpone mealtimes or spend a long time on an empty stomach.

General measures

Apart from medication, or in conjunction with it, some measures such as the following may be useful:

  • Asking someone else to cook
  • Getting plenty of rest and avoiding stress
  • Brushing your teeth after eating
  • Taking medication at night and not in the morning
  • Avoiding strong odors, such as perfumes
  • Not wearing clothes that press on the abdomen
  • Avoiding noises, bright lights, or traveling in a car.
Food during hyperémesis gravídarum

Risks, complications, and consequences

In general, in hyperemesis gravidarum, the prognosis tends to be good and complications are rather rare. However, care should still be taken and the physician’s recommendations should be followed.

An increased incidence of gallbladder problems, and kidney and liver damage has been observed during and after pregnancy. Retinal hemorrhage may also occur.

Conditions resulting from hyperemesis gravidarum are most commonly associated with dehydration and weight loss. This, in turn, can lead to anemia.

Other consequences are also experienced socially, mentally, or psychosomatically, affecting the woman’s quality of life. This includes fatigue, anxiety, and discouragement.

As for the effects on the fetus, hyperemesis gravidarum is associated with premature delivery and low birth weight and size of the baby. Electrolyte imbalances may also be present.

If nausea and vomiting and weight loss continue despite treatment and precautions, further measures may be taken.

When to see a doctor if I suspect hyperemesis gravidarum?

The following are the warning signs to be aware of, and, in these cases, you should contact your doctor immediately:

  • Nausea throughout the day
  • Frequent vomiting 4 or more times in 24 hours
  • Not being able to keep food down
  • Dizziness, lightheadedness, or fainting
  • Abdominal pain
  • Weight loss greater than 2.5 kg
  • A feeling of confusion

Feeling strong nausea at breakfast time may be more than just a passing discomfort. And while complications associated with hyperemesis gravidarum aren’t too common, it never hurts to try to prevent further complications. This is possible, but the causes of the condition aren’t always clear.

The measures to be taken will be similar to those related to daily care: taking vitamins and folic acid, eating at the right times and regularly, and trying to avoid whatever is causing the nausea.

Several of these measures have to do with a change in habits. In short, everything we need to do to ensure a healthy life.

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