Hyperemesis Gravidarum Support Playbook: Survive + Thrive in 2025
- Clemmie
- Jul 10
- 7 min read
(An evidence-packed guide for every UK parent who’s discovering that “morning sickness” can, in fact, last 24 hours a day.)
Your Hyperemesis Gravidarum Support Quick Links
If you’re googling hyperemesis gravidarum support at 3 a.m., welcome.
Why you can trust this guide
I’m Clemmie—doula, hypnobirthing teacher and four-time HG survivor and a volunteer peer supporter for the UK charity Pregnancy Sickness Support (PSS). That means PSS matches me with parents who are currently riding the HG roller-coaster, and I:
check in frequently via WhatsApp;
share evidence-based treatment info (and the scripts to get it);
remind them they’re not making a fuss...
...Because I've been there.
I’ve taken IV fluids, argued with various consultants and thrown up in more tube stations than I care to count. Everything below is the mix of international HG guidelines + lived-experience hacks I wish someone had handed me at week 7.
Is it Hyperemesis Gravidarum or "just" savage morning sickness?
In 2021, researchers, clinicians, and patient groups finally agreed on a global HG definition (EHGOS/FIGO consensus):
Must-have criteria | Plus any ONE of these |
Intractable nausea/vomiting before 16 weeks | ≥ 5 % pre-pregnancy weight loss OR |
Symptoms cause functional disability (can’t keep work/home life going) | Need for anti-emetics / IV therapy OR |
Lab signs of dehydration (elevated creatinine, haemoconcentration) |
Note on ketones: Current evidence shows urinary ketones do not reliably track dehydration or predict severity, so they’re no longer required for diagnosis or treatment decisions.
If you’re losing weight, dehydrated or your life has shrunk to bed–loo–A&E, you’re in HG territory, full stop.
My own week 8 snapshot: bed-bound, down 5 kg, throwing up blood, unable to brush my teeth without retching, living on ice cubes. That’s HG, not “tough it out, love.”
Why this isn't your fault (science in 3 bullets)
Your placenta pulled the biochemical fire alarm, not you.
Around week 6, the developing placenta releases a flood of the hormone GDF15. In recent Nature and Cell papers, researchers measured a 1,000-fold jump over pre-pregnancy levels, enough to slam the brain-stem’s vomiting switch (the area postrema) into overdrive.
Genetic studies show that many HG sufferers run unusually low GDF15 in everyday life. Their bodies are “naïve” to the hormone, so when pregnancy sends levels sky-high, the reaction is violent. By contrast, people with chronically higher GDF15 (for example, those with β-thalassaemia) are almost immune to HG as their brains are already desensitised.
Large genome-wide analyses have pinpointed variants in both GDF15 and its brain receptor GFRAL that quadruple HG risk. Your DNA set the stage long before the positive test; will-power, ginger or “just thinking positive” can’t rewrite those base pairs.
Guilt-free takeaway: you didn’t cause Hyperemesis Gravidarum by eating the wrong breakfast, lacking grit, or “worrying too much.” Your placenta and your genes teamed up on your gag reflex. Now we focus on treatment and support so you can regain control.
Road-map to feeling human again
Step | Medication / intervention | Why it helps (evidence) | Common side-effects & cautions | Pro tip |
1 | Pyridoxine + Doxylamine (B6 10-25 mg, Doxylamine 12.5 mg, up to QID) | First-line in 2021 international HG guideline; ↓ nausea scores by ≈30 % with very low foetal risk. | Mild sedation, dry mouth. | Take the first dose before getting out of bed; set an alarm 30 min early. |
2 | Cyclizine or Promethazine (25 mg TID) | Antihistamines proven safe for decades; good “middle-of-the-night” rescue. | Drowsiness, blurred vision (warn drivers). | If one knocks you out, swap—not quit. |
3 | Prochlorperazine (5-10 mg buccal TID) | Dopamine-blocker; helpful for retching. | Restlessness, rare dystonia—stop if muscle spasms. | Great add-on to B6/Doxylamine rather than replacement. |
4 | Ondansetron (4–8 mg every 8 h) | 2024 pooled data: best symptom control; no significant ↑ in congenital anomalies when benefits > risks. | Constipation (combat with water + lax), rare QT-prolongation (if heart hx). | Keep earlier meds on board; symptoms often ramp up, the drug didn’t “stop working.” |
5 | Metoclopramide (10 mg TID) | Speeds gastric emptying; good for “nothing moves past my ribs” feeling. | Fatigue, rare dystonia (max 5 days). | Layer for short bursts when bloat is brutal. |
6 | IV fluids + Thiamine (1–2 L Hartmann’s + 100 mg thiamine) | Reverses dehydration, prevents Wernicke’s. Clinical assessment—not ketone strip—decides. | Fluid overload if severe heart / kidney disease (rare in HG age-group). | Ask for thiamine before glucose to dodge neuro risks. |
7 | Steroids (Methyl-prednisolone) (16 mg TID → taper) | Last-line; 60 % dramatic improvement within 3 days. | Transient mood swings, ↑ blood glucose; possible cleft risk if <10 w (still debated). | Use for “can’t keep meds down” crisis—you’ll know the day. |
Layer, don’t leapfrog.
If Cyclizine helped last week and seems useless today, odds are the symptoms escalated, not that the drug failed. Keep what helped, add the next rung. Many HG mums need three to five meds simultaneously to reach “tolerable.”
When to seek IV help (no ketones needed):
<500 ml oral fluid in 24 h or
unable to swallow meds or
weight-loss ≥5 % or
clinical signs: tachycardia, postural drop, dry mucous membranes.
Print this list; if A&E tries the “your ketones are only +1” line, hand it over and ask for fluids.
HG Myth of Fact?
❓ Statement | Myth / Fact | Reality-check & latest evidence |
“Sip ginger tea and you’ll be fine.” | Myth (and every HG survivor’s eye-roll) | Cochrane 2023: ginger may ease mild nausea but has no clinically meaningful effect on HG and can worsen reflux. Enjoy if it helps taste-wise—just don’t rely on it. |
Hypersalivation (constantly filling a spit cup) is part of HG. | Fact | Excess saliva—ptyalism gravidarum—shows up in ≈ 30 % of HG cases. It’s driven by the same brain-stem reflex and often triggers more vomiting. Chewing gum, ice chips, or simply spitting into tissues are coping, not cures. |
Ketones must be +3 before you qualify for IV fluids. | Myth | 2021 international guideline dropped ketonuria; decisions rest on clinical dehydration, weight-loss or functional disability. |
Ondansetron in the first trimester is too risky. | Myth | 2024 meta-analysis (> 90 000 pregnancies) found no significant rise in congenital anomalies when benefits outweigh risks. |
Hyperemesis Gravidarum is caused by anxiety. | Uber-Myth | Genetics (GDF15 / GFRAL variants) plus a massive early-pregnancy hormone surge drive HG; mood fallout is secondary. |
IV thiamine is optional. | Myth | Skipping thiamine with prolonged vomiting or IV glucose risks Wernicke’s; RCOG & FIGO list it as mandatory. |
Early, multi-drug treatment can prevent hospital admission. | Fact | Cohort data show starting pyridoxine/doxylamine (± ondansetron) before or right after a positive test halves admissions in next pregnancies. |
Most people with HG feel markedly better after 20 weeks. | Fact* | About 70 % peak 16–18 w, then improve; ~10 % vomit to delivery. |
≈ 80 % of HG survivors will face it again next pregnancy. | Fact | Recurrence studies put risk at 70–84 %. Plan a preventive protocol early. |
Mind survival! Because HG is a full-body and head-game
Phone a friend who gets it.
Pregnancy Sickness Support (PSS). Call 0800 055 4354 or fill the online form and you’ll be matched with a trained peer-supporter (all HG survivors) for WhatsApp chats, late-night tears and “is this normal?” questions. I volunteer on the team, so you may even land with me.
CBT: rewiring the nausea spiral.
Cognitive Behavioural Therapy sounds fancy; in practice it’s a therapist teaching bite-size thought swaps (“I’m failing” → “This is a medical condition, not a character flaw”). Randomised trials show CBT halves HG-related depression scores within six weeks.
Safe SSRI options. Yes, really.
NICE lists sertraline and citalopram as first-choice antidepressants in pregnancy. Large 2024 meta-analysis found no significant rise in birth defects; benefits of stabilising mood and sleep far outweigh the tiny theoretical risks. (Always discuss dose with your GP or perinatal-mental-health team.)
Daily micro-joys
Audiobooks or lightweight podcasts (eyes closed = less dizzy)
Video playdates with your toddler while you both lie on the sofa for a bit of connection without effort, oxytocin without movement
A “vomit soundtrack” playlist you actually like (makes the inevitable slightly less grim)
Tip: set a three-joy minimum per day; even ticking off “podcast + cuddle + ice lolly” counts as a win.
HG Partner Checklist
Your loved one is plagued with HG and you don't know what to do to support them? Here's a list of where to start:
Medication matrix on the fridge (what, when, refill date).
Prep Dioralyte ice cubes every evening.
Hospital grab-bag stocked: charger, lip balm, blanket (and snacks for them).
Odour patrol: bin out, windows open and doors closed before cooking, unscented soap, shampoo etc.
Advocacy script practice: “She’s lost > 5 % weight and can’t keep fluids; the international guideline calls for IV fluids now.”
Light at the end & planning baby #2
Most HG peaks around weeks 16 – 18; about 10 % of us ride it all the way to delivery (solidarity hug).
Recurrence reality: if you had HG once, studies put your odds of getting it again at ≈ 80 % (range 70-84 %).
Pre-emptive meds: international guidelines now suggest starting preventive treatment before conception if possible or at the very latest, the moment you pee on the stick. Typical plan: pyridoxine + doxylamine from Cycle Day −14 onward, with ondansetron on standby to add as soon as symptoms whisper. Women who begin the combo early report milder nausea scores and fewer hospital days in the next pregnancy.
Need tailored help fast?
Before we wrap, please bookmark Pregnancy Sickness Support (PSS) — the UK charity dedicated solely to Hyperemesis Gravidarum and severe pregnancy sickness.
What they do
Helpline & email support - expert-led, evidence-based answers when Google has you in tears.
Peer-support network – pairs you with someone who‘s been through HG and lived to brunch again.
GP & hospital resources – printable guideline sheets (great for the “eat a cracker” crowd).
Advocacy & research – funds studies and lobbies for better NHS pathways.
Clemmie x
Sources: FIGO/EHGOS International HG Definition 2021, NICE CG62, RCOG Green-top 69 (2023), Cambridge GDF-15 meta-analysis 2023, Cochrane Ondansetron Safety 2024, Fejzo et al. Mental Health 2022.
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