In October of 2018, before I got pregnant with my daughter, I was like most women in this country: I knew next to nothing about what to truly expect from pregnancy. Then, six weeks in, curled around a toilet bowl, or pulled over on a side road in Vermont, or pushing work deadlines that I couldn't fathom completing, I quickly learned one thing: The "morning sickness" that I had heard about in passing from other moms was far more than a fleeting feeling of being sick in the morning.
The ways that women's concerns, symptoms, and pains are minimized in healthcare are many, with the perinatal period of pregnancy and the postpartum period, in particular, being a prime example. For many, the shooing-off-of-symptoms starts early: Around the time of a pregnancy test, more than 70% of women begin to experience nausea and vomiting of pregnancy (sometimes called "morning sickness").
The American College of Obstetricians and Gynecologists says that — despite colloquially being called "morning sickness," nausea and vomiting of pregnancy can happen at any time of the day or night. And while it doesn't usually harm the fetus, it can negatively impact your life, "including your ability to work or go about your normal everyday activities."
If you have them, symptoms tend to peak before nine weeks, fading off as the second trimester begins. But for some, symptoms linger longer, stay with you throughout your entire pregnancy, and completely disrupt your day. Worldwide, anywhere from 0.3 to about 11% of pregnant women experience an extreme form of nausea and vomiting called hyperemesis gravidarum, or HG.
Amy Schumer, Kate Middleton, Kim Kardashian, have all had it, and most recently, Mandy Moore.
The This Is Us actress recently shared that she would feel sick all day long in the first months of her pregnancy. "I couldn't eat. I lost a bunch of weight. I just, like, I just stayed in bed all day," Moore said. "But luckily, I know that's not the case for everybody that it sometimes can, you know, persevere for the entire pregnancy. So, I'm lucky that that kind of trailed off and I feel much better now."
Marlena Fejzo, Ph.D., a researcher at USC who, after her personal experience with the condition, went on to study it, is one of the leading experts in the topic. Fejzo says there's still much to be learned about HG, including what causes it and how many women truly experience it — but talking about it as the very real condition it is is a good place to start.
What’s HG and What Causes It?
If you've experienced HG, you know how serious it is. Schumer talked about it in her 2020 HBO documentary, Expecting Amy. Fejzo even lost a baby to HG in her second trimester.
But too often, women's pain isn't accounted for. Sometimes, there's a suggestion that the experience is psychological; women are making it up.
But the truth is, nausea and vomiting of pregnancy and HG have many roots — many of which are still to be discovered (interest in funding research around these topics is low). As for what we know: While you've likely heard that the nausea and vomiting of pregnancy is caused by the rise of pregnancy hormones (hCG and estrogen) which surge in early pregnancy, Fejzo says that the more likely cause is a hormone called growth differentiation factor-15 (GDF-15), which is produced by the placenta (the organ that develops in your uterus during pregnancy). Biologically, GDF-15 is linked to cachexia, the debilitating chronic nausea that some cancer patients experience. The hormone binds to a receptor in the "vomiting center" of the brain and makes you feel sick. If you have higher levels of the hormone and/or more receptors, you might be more susceptible to severe symptoms, she explains.
Nausea and vomiting of pregnancy is also somewhat heritable. If you have had a sibling with HG, for example, you have 17-fold increased risk of having the disease, Fejzo says.
It's hard to know for sure how many women experience HG. In part that's because (a) incidence rates vary greatly from health system to health system. In countries like China where women might be more likely to go to the hospital with symptoms, incidence rates can be higher. In the U.S., where incident rates float around 2%, many women — perhaps accepting the fate that "morning sickness" is just something that happens — tend to suffer alone.
And (b)? There's no clear-cut definition of what exactly HG is. However, Fejzo says that if you've lost more than 5% of your body weight, if you're not able to eat or drink adequately for weeks or months, if your symptoms keep you from getting through your day-to-day, if you've needed medical treatment, or if symptoms persist your entire pregnancy, you may be diagnosed with HG.
The Problem with Calling Nausea and Vomiting “Morning Sickness”
This summer, only a few weeks pregnant with my second daughter, I felt my symptoms creep back up. That feeling came back. I started getting sick eight to nine times a day at all hours. At times, it felt uncontrollable. This time, on top of work, I was also trying to chase a toddler around. Like Mandy Moore recently described, I lost weight. I lived on a bagel a day. And, while they were serious, I also knew my symptoms paled in comparison to some of the stories I've heard.
Not only is the term “morning sickness” another example of downplaying women’s pain, it arguably puts women at risk — of thinking that their experience is normal; of thinking they don’t need help or support; of not seeking help.
I don't know if I've had HG in my pregnancies (since, again, diagnosis is a blurry line), but I do know that my nausea and vomiting was not "morning sickness"— a detrimental term to describe a very real, very uncomfortable, and, at times, a very serious condition.
Not only is the term "morning sickness" another example of downplaying women's pain, it arguably puts women at risk — of thinking that their experience is normal; of thinking they don't need help or support; of not seeking help.
I feel fortunate. As a health and motherhood reporter, I knew that my symptoms called for more than bland foods, small meals, and vitamin B6 (common remedies for nausea and vomiting of pregnancy). And when she heard of my symptoms, I'm fortunate that my ob-gyn — a caring, considerate doctor — quickly prescribed me a medication (Bonjesta) to help. I've heard plenty of tales of women be written off by their doctors. For me, the medication worked wonders, bringing my vomiting down to about once a day — then nothing at all.
You might not know this: "At least 20% of pregnant women take medication for nausea in the U.S.," says Fejzo. You might also not know this: By some counts, HG is the top reason for hospitalization during pregnancy's first trimester.
Treatment for nausea and vomiting of pregnancy (as well as HG) varies and can range from ginger capsules to feeding tubes. But I fear that for too many, the term "morning sickness" sings like some kind of exciting, I'm-pregnant song that plays one morning as you wake up, ending before breakfast.
And that's just not reality.
“Recognizing women’s very real struggles in pregnancy — on top of the joy and excitement and wonder that can accompany a pregnancy — is important. It’s validating. In some cases, it could even be life-saving.”
Recognizing women's very real struggles in pregnancy — on top of the joy and excitement and wonder that can accompany a pregnancy — is important. It's validating. In some cases, it could even be life-saving. That's, in part, because HG can increase the risk of other pregnancy complications, including preeclampsia.
If you think you have HG, visit the HER Foundation's website, which includes a slew of resources for patients, including support groups, an app that helps you track symptoms (which Fejzo helped in creating), and a referral network of providers who understand HG. And remember: If you're at all concerned about your nausea and vomiting in pregnancy — and especially if you're unable to keep food or water down — reach out to your healthcare provider.
Cassie Shortsleeve is a freelance writer and founder of Dear Sunday, an online platform for pregnancy, postpartum, and new motherhood.
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