1. Hyperemesis Gravidarum

The majority of pregnant women experience some form of mild nausea and/or vomiting early in pregnancy. In fact, almost 50 percent of women experience some form of morning sickness. However, a very small percentage of women experience extremely severe and persistent nausea and/or vomiting. This is condition known as hyperemesis gravidarum (HG). This condition can make it difficult for a mother to consume the number of calories she needs, get enough fluids, and simply perform daily activities. If this condition is left untreated, it can lead to malnutrition, vitamin and mineral deficiencies, electrolyte imbalances, weight loss, dehydration, and even possible liver or kidney damage. These symptoms can all be damaging to the development of the fetus as well as to the health of the mother. When HG is treated properly, any adverse outcome to the baby—such as low birth weight, developmental problems, or prematurity—can be avoided.


For some women, HG develops fairly rapidly within just a few weeks. For others, it may develop gradually over a period of a few months. Hyperemesis gravidarum is typically diagnosed through a thorough health exam, blood test, urine test, detailed health history, and the identification of symptoms characteristic to the condition including severe and persistent nausea and vomiting as well as dehydration and weight loss. HG is only considered as the final diagnosis when all other possible causes of severe and persistent nausea and vomiting have been ruled out. The condition typically begins in the period from week four to six and peaks between weeks nine and thirteen. Some women see significant improvements between weeks fourteen and twenty, while others may need significant care throughout the pregnancy.


The exact cause of hyperemesis gravidarum is not known. Though theories abound, none has yet been proven to be conclusive. Most likely, the condition is the result of more than just one factor. The factors may vary from woman to woman, depending on genetic makeup, body chemistry, and overall health. HG does seem to be more common in first-time pregnancies, women who are carrying more than one baby, younger women, obese women, and women who have had hyperemesis gravidarum in past pregnancies. Most theories focus on hormonal changes, such as an increase in estrogen and pregnancy hormone, physical changes, psychological causes, hyperthyroidism, gastric reflux problems, and nutrient deficiencies such as vitamin B6 and zinc.

Signs and Symptoms

There are many different symptoms of HG besides the obvious severe and persistent nausea and vomiting. Additional symptoms may include rapid heartbeat, anemia, dehydration, vitamin and mineral deficiencies, weight loss of 5 percent or more from pre-pregnancy weight, ketosis, excessive salivation, extreme fatigue, headache, strong food aversions and/or cravings, heightened sense of smell, gallbladder problems, and low blood pressure. There can also be complications from extensive vomiting, such as gastric ulcers and esophageal bleeding, that can worsen ongoing nausea. For many women, this condition has a financial impact as well as an emotional and social one. It can begin to greatly affect the quality of life. Sufferers may not be able to work, complete daily household chores, or even care for young children. The earlier proper medical treatment is given, the better chance for a decrease in severity of symptoms and for a quicker recovery with no complications.

When is morning sickness something more serious?

If you vomit more than three or four times a day, are hardly able to keep any food down, lose weight, feel very tired and dizzy, and urinate less than usual, you may have something more serious than run-of-the-mill morning sickness—specifically, you may be suffering from hyperemesis gravidarum (HG). Additional symptoms include increased heart rate, headaches, and pale, dry-looking skin. It is important to diagnose and treat HG as soon as possible, so contact your doctor if you feel any of these symptoms or feel that your morning sickness is more serious.


If you are diagnosed with hyperemesis gravidarum, you may need hospitalization to restore fluids, replace electrolytes, and to administer medications if needed. Some treatment plans may also include vitamin and mineral supplementation. Depending on the doctor, you may not be given food by mouth until the vomiting stops and dehydration has been rectified. Instead, your food will be supplied through a feeding tube, and you will begin on food slowly. Proper nutritional intake is one of the biggest challenges and most important issues for women who suffer from HG. If you are not getting sufficient nutrients to meet your baby’s requirements, your baby will take it from your stores. This can deplete your nutritional reserves very quickly, and it might take months or even years for you to correct these deficiencies. Vitamins, especially the B vitamins, can be depleted very quickly, and if they are not replaced can worsen the symptoms. With hospitalization, you can get the proper care that is needed.

2. Iron Deficiency Anemia

Anemia is defined as a deficiency of red blood cells or red blood cells having a decreased ability to carry oxygen or iron. There are different forms of anemia, such as iron, B12, and folate deficiency. During pregnancy, the most common is iron deficiency anemia.

It is important to be tested for anemia during your first prenatal visit so that measures can be taken for treatment if you are found to be anemic. Even if you test negative for anemia at your first visit, the condition can develop as you progress through your pregnancy. This is especially true in the last three months when the baby is using a lot of your red blood cells for growth and development. Most doctors will test you at different stages throughout your pregnancy, including at your first visit, at twenty-eight weeks, once admitted to labor and delivery, and after delivery.


A diagnostic blood test that indicates hemoglobin and hematocrit levels can help to diagnose anemia. If these levels indicate a problem, additional blood tests and other evaluation measures may be used to properly diagnose you. Possible complications that can occur if anemia is not treated include premature labor, slowing of fetal growth, complications of dangerous anemia from normal blood loss during delivery, and an increased susceptibility of infection to the mother after delivery. Just because you are iron deficient does not necessarily mean you are anemic. For anemia to actually be diagnosed, you need to have a severe depletion of iron stores in your blood, with low levels of hemoglobin as well.

Most women are provided with iron through prenatal supplements before and during pregnancy to help prevent iron deficiency. Eating iron-rich foods such as lean meats, fortified breakfast cereals, spinach, pumpkin seeds, beans, and dried fruits can also be very helpful.


Women at higher risk of anemia are those who are unable to eat a balanced diet due to morning sickness or hyperemesis gravidarum, who pregnant with multiple babies, and who have overall poor eating habits, including inadequate iron intake. Your iron needs increase by 50 percent in pregnancy due to an increase in blood volume. Especially if your iron stores were not optimal before becoming pregnant, your iron can easily get used up to meet the demands of pregnancy, and that can lead to the risk of anemia. Good nutrition and proper supplementation before becoming pregnant and during pregnancy is vital to help build up your stores of iron and prevent the risk of iron deficiency anemia.

Signs and Symptoms

Unless blood cell counts are very low, the signs and symptoms of anemia can be very subtle. Symptoms vary from person to person and depend on the severity of the condition. Some symptoms include fatigue and weakness, headache, dizziness, rapid heartbeat, pale skin, and labored breathing or breathlessness.

Symptoms of anemia can closely resemble those of other health conditions and/or medical problems. Never diagnose or treat yourself. Always consult your doctor for a proper diagnosis.


Treatment for iron deficiency anemia is based on many factors, including the pregnancy, overall health, medical history, the type and severity of the anemia, tolerance for specific medications, procedures, and/or therapies, and the doctor’s protocol. In general, most treatment for iron deficiency anemia includes some form of iron supplement. Some of these are time-release capsules, while others are taken several times throughout the day. The amount of iron provided daily is more than the usual recommended daily allowance. In general, most therapeutic levels prescribed for treatment are between 60 and 120 mg daily. Once the mother’s hemoglobin levels return to normal for her stage of pregnancy, the normal recommended daily allowance is usually resumed.

Iron absorption can be increased with vitamin C–rich foods and/or supplements. It is also helpful to take iron supplements between meals or at bedtime as well as on an empty stomach to help absorption. On the flip side, antacids can decrease the absorption of iron.

For many women, iron supplements can cause nausea and constipation. If these problems occur, ask your doctor about taking them with meals. Be sure you are drinking plenty of fluids, and increase your fiber to help relieve problems with constipation. If the supplements cause problems for you, do not stop taking them until you have spoken with your doctor.

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