By now, everybody's heard about a celebrity who has suffered from severe morning sickness. First it was Kate Middleton who dealt with it during all three of her pregnancies, and most recently, actress Amy Schumer took to Instagram from a hospital bed to share that she is struggling in much the same way during her first pregnancy.
We're not talking about a little morning sickness, which is par for the course for about 70 percent to 80 percent of all pregnancies during the first trimester. We're talking about nonstop vomiting, severe dehydration and nausea that's so debilitating it's dangerous.
Fortunately, only about 1 percent of women get this extreme type of morning sickness. Here's what you need to know.
Symptoms typically crop up around 9 weeks and tend subside around the 20-week mark, though sometimes they last longer.
"While there is no single definition of hyperemesis gravidarum, when a patient has lost 5% or more of body weight or has been unable to keep anything down, including water for 24 hours, they have what we consider HG and require intervention," says Sharon Mass, M.D., of the University of Medicine and Dentistry of New Jersey. "Of course, diagnosis is subjective; if a patient has kept down one glass of water but is completely miserable, I might still consider that HG."
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When women get this sick, the biggest medical concern is dehydration and electrolyte imbalance. It's mom we're worried about, not baby, because babies don't require many calories at this point and they'll take whatever they need directly from their mothers.
Mom, however, can be at high risk for complications of dehydration including tachycardia (abnormally fast heart rate), low amniotic fluid volume, premature labor — and, in cases where mom receives no medical treatment, dehydration can potentially be deadly.
Expectant women who can't keep any nutrition down for a long period of time are at risk for muscle wasting and bone loss. Women with hyperemesis gravidarum in the early stages of pregnancy don't face a higher risk of miscarriage. In fact, it's usually associated with high levels of pregnancy hormones, which indicate a solid pregnancy.
The weird thing about hyperemesis gravidarum (also known as HG) is that the more dehydrated mom becomes, the more nauseated she'll become and the more likely she is to vomit. The most important treatment for HG is IV hydration and medications to stop the nausea and vomiting.
Most moms-to-be feel a whole lot better after a bag or two of IV fluids though some need more intensive therapy. High doses of vitamin B6, over-the-counter medications (such as Dramamine and Unisom) and such high-octane prescription drugs as Zofran (used for chemotherapy patients with nausea) are often prescribed and usually effective.
Most women feel less miserable and more human by about 20 weeks of pregnancy, though some feel rotten for the entire nine months. Some moms-to-be who can't eat at all need a PICC line (Peripherally Inserted Central Catheter), which is like an IV that's inserted into a vein (usually in the upper arm) and advanced until it reaches a large vein in the chest near the heart. She can get TPN (Total Parenteral Nutrition, a custom-made IV solution) therapy through her PICC line to provide all the nutrients that she and her baby need. This usually requires ongoing hospitalization, though some patients can receive care at home from a home health nurse.