Severe burden and treatment gaps reported for hyperemesis gravidarum

Researchers from Flinders University have found a severe emotional and physical burden among pregnant women with extreme morning sickness, publishing their findings in PLOS One.¹

The data also indicated significant rates of considering pregnancy termination, alongside 9 in 10 pregnant women with extreme morning sickness considering not having more children. This highlights the debilitating nature of the condition and the inconsistent efficacy of common treatment methods.

“Women are often prescribed multiple medications in an attempt to manage their symptoms, but the reality is that many of these treatments come with their own burdens,” said Luke Grzeskowiak, PhD, associate professor at Flinders University.

Survey characteristics

The cross-sectional online survey study was conducted to evaluate treatment usage and experiences among women with severe nausea and vomiting of pregnancy (NVP) or hyperemesis gravidarum (HG).² Participants included women residing in Australia with prior or current NVP or HG experience.

There were 4 parts to the study survey, which was completed online between July and September 2020. These parts included respondent characteristics, awareness, and perceived safety of treatments, characteristics of HG, and quality of life impact, and personal experiences.

Quality of life impacts were reported on a 5-point Likert scale, with higher scores indicating a greater impact. Additional questions gauged considerations for pregnancy termination, depression and anxiety experiences, and requests for induction or elective cesarean section.

Treatment experiences included treatment methods used, week of pregnancy beginning or stopping treatment, treatment duration, side effects, reasons for termination, and perceived efficacy of treatment on a 5-point Likert scale. Two consumer representatives and 2 clinical experts assessed the survey’s face validity.

Onset and severity of symptoms

There were 289 participants aged a mean of 33 years included in the final analysis. Of these, 38% were currently pregnant, 94% Caucasian, 95% married, and 87% with complete secondary education. One or more prior births were reported in 88% and not smoking in the current or prior pregnancy in 96%.

NVP onset occurred at a median 6 weeks’ gestation, with all cases beginning during the first trimester. Weight loss during pregnancy was reported by 75% of participants, ranging from 1 to 40 kg, and with a median of 7 kg. Moderate NVP was reported in 41% of participants and severe NVP in 59%.

A formal HG diagnosis was given to 76% of respondents, while 72% were admitted to the hospital for IV fluids during pregnancy. Difficulty eating or drinking as normal was reported by 98% and feelings of anxiety or depression because of HG symptoms by 62%. Thirty-seven percent requested labor induction because of their symptoms.

Considering pregnancy termination was reported by 54% of respondents, and not having more children by 90%. Over half of respondents experienced significant impacts of HG on aspects of life, including social life, work, sleep, ability to undertake daily chores, ability to eat or drink, and taking care of pre-existing children.

Complexity of medication use

The use of at least 1 antiemetic during pregnancy was reported by all participants. A mean of 4.2 antiemetics were used, with a range of 1 to 9. Ondansetron was the most common antiemetic used by 91% of participants, followed by pyridoxine in 70%, doxylamine in 70%, metoclopramide in 69%, and ginger in 53%.

Only 7% of respondents used a single antiemetic in pregnancy. Ginger, metoclopramide, ondansetron, and pyridoxine were initiated earlier than other treatments, at a median 6 weeks’ gestation for each antiemetic. The latest median time of initiation at 12 weeks’ gestation was reported for corticosteroids.

The shortest durations of use were reported for ginger, metoclopramide, and prochlorperazine, at 2 to 4 weeks, while doxylamine and ondansetron had the longest median durations of 16 and 20 weeks, respectively.

Side effects were reported in 78% of women taking doxylamine, 73% ondansetron, and 72% promethazine. Thirty-one percent taking metoclopramide ceased treatment because of side effects, vs 24% for ginger and 23% for prochlorperazine. Common side effects included constipation, sedation, and mood disorders.

Implications

Over half of respondents taking corticosteroids, ondansetron, and doxylamine reported the medication to be effective. However, under 10% reported efficacy for pyridoxine or ginger. This highlighted a complex landscape of medication use for severe NVP and HG.

“We need to move away from a one-size-fits-all approach and toward personalized care that recognizes the full impact of HG,” said Caitlin Kay-Smith, study co-author and founder of Hyperemesis Australia.

References

1. Emotional and medical toll of extreme pregnancy nausea, with many women considering ending pregnancies. Flinders University. September 3, 2025. Accessed September 4, 2025. https://www.eurekalert.org/news-releases/1096797.
2. Wills L, Hsiao H, Thomas A, Kay-Smith C, Henry A, Grzeskowiak LE. Assessing the burden of severe nausea and vomiting of pregnancy or hyperemesis gravidarum and the associated use and experiences of medication treatments: An Australian consumer survey. PLOS One. 2025. doi:10.1371/journal.pone.0329687