For up to 10.8% of pregnant women, hyperemesis gravidarum (HG) turns the joyful experience of pregnancy into a relentless physical and emotional trial. Far more severe than typical “morning sickness,” HG locks women in a debilitating cycle of nausea, vomiting, and dehydration.
These symptoms can lead to serious health complications, including weight loss of over 15%, neurological defects in infants, and even maternal suicide. Yet, despite its life-altering consequences, HG remains misunderstood, underdiagnosed, and inadequately treated. Most women suffering from HG are left to ensure multiple ER visits, desperate for relief.
For OBGYNs, HG presents its own challenges. In a field already stretched thin, many providers are left trying their best to alleviate symptoms in the absence of proven strategies or clinical resources. It’s time for a new approach, one that better serves patients and clinicians.
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Why does our current approach to care fall short?
Our current approach to managing HG is undermined by systemic gaps, including inconsistent diagnostic practices, inconsistent treatment frameworks, and insufficient provider training.
Diagnosis is too often subjective. Many clinicians use general assessments that rely heavily on patient-reported symptoms. Since nausea and vomiting in pregnancy (NVP) exist on a spectrum, this makes it difficult to distinguish between typical “morning sickness” and HG. Different OBGYNs may make varied diagnoses, contributing to inconsistency and delays in care.
Treatment protocol for HG is equally ambiguous; providers are often not trained in the ACOG or HER guidelines used to manage the condition and most OB offices lack the facilities to administer the protocols. This leaves providers to rely on trial-and-error methods and a requirement for hospital assistance, starting with dietary changes and waiting for symptoms to worsen before escalating to prescription medications and the ER. This reactive “wait-and-escalate” approach prolongs suffering and risks negative outcomes, rather than offering proactive, consistent care under the supervision of a physician, which is necessary for the population of women suffering.
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These gaps result in significant inadequacies in care, forcing pregnant women to unnecessarily struggle to survive. But women aren’t the only ones impacted by this cycle of poor management: Babies are at increased risk for developmental complications, avoidable ER visits burden healthcare systems, and the US economy bears a staggering $3 billion annual cost.
A new framework for HG management is urgently needed: one that serves patients, providers, and the healthcare system as a whole. So, what’s the solution?
A better approach: Early, specialized care for HG
In a world where HG is treated with the urgency and expertise it demands, women would no longer feel dismissed or endure unnecessary suffering, and OBGYNs would have the tools and support they need to care for their patients effectively.
This vision is already becoming a reality in clinics dedicated specifically to HG where targeted intervention is provided from the first trimester onward, including infusions, antiemetics, and electrolyte management. Such clinics offer effective care in an outpatient setting designed to minimize hospitalizations and reduce the burdens on OBGYNs; ER visits and healthcare costs are both reduced.
For OBGYNs, recognizing the value of early referral to specialized centers is essential. Women with HG receive expert, compassionate care tailored to their needs. Babies are healthier, with fewer risks of preterm birth and developmental complications. Providers experience less strain, focusing on broader prenatal care while knowing HG patients are in good hands. And healthcare systems see significant cost savings by avoiding repeated ER visits and hospitalizations.
Where available, OBGYNs must refer women to these clinics. However, not every community has access to such centers. That’s why OBGYNs must take steps today to improve HG care, even within the current system.
What practical changes can OBGYNs make?
OBGYNs can start by utilizing tools like the HELP Score during prenatal visits. This can help distinguish between NVP and HG, shifting away from subjective diagnosis. It’s also vital for OBGYNs to educate patients properly and frame HG as the serious medical condition it is. This can encourage patients to speak up, advocate for themselves, and get diagnosed more quickly.
Once identified, HG treatment must be proactive. Instead of initially relying on lifestyle changes and delaying effective treatment, clinicians refer patients and initiate proactive interventions sooner to prevent them from reaching crisis point. Continuity of care is equally crucial in avoiding crises. HG is not a static condition, and symptoms fluctuate throughout pregnancy. Scheduling frequent follow-ups ensures that patients remain supported from the first trimester through to birth.
Lastly, OBGYNs must address the emotional toll HG takes on their patients. Many women with HG experience anxiety, depression, post-traumatic stress, or feelings of isolation that extend into the years following birth. OBGYNs can routinely assess mental health and refer patients to appropriate support networks or mental health professionals to get the support they deserve and need.
Importantly, these changes are not just about alleviating suffering in the present. They’re about building a future where no woman feels dismissed, no provider feels unequipped, and every baby is given the healthiest possible start.
OBGYNs are in a unique position to transform the experience of women with HG, and it starts here.
Photo: Vladimir Kononok, Getty Images
Dr. Robyn Glessner is a board-certified Emergency Medicine physician with over 10 years of experience. As a mother who has experienced two challenging pregnancies herself, she is passionate about making healthcare a better and more accessible place for all women and mothers. Her expertise in Osteopathic Medicine underscores her commitment to a full-scale approach to patient well-being. Dr. Glessner leads the team of nurses Harmonia’s Red Bank, NJ location, and ensures that every expecting mother receives the comprehensive, compassionate care she deserves.
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