Dietary Advice for Hyperemesis Gravidarum

This diet sheet is for anyone who is pregnant and is experiencing Hyperemesis Gravidarum.

What is Hyperemesis Gravidarum?

Hyperemesis Gravidarum is a medical term used to describe a severe form of nausea and vomiting during pregnancy which is associated with dehydration and more than 5% unintentional loss of weight. It generally clears after the first 16-18 weeks of pregnancy, but for some women it can continue throughout their pregnancy. It affects just a small percentage of pregnant women but there is a high risk of it recurring in future pregnancies.

Diet and lifestyle advice

Eating small meals or snacks little and often is beneficial.

The important thing is to eat and drink anything tolerable to you to prevent losing weight. If you feel like you might tolerate something it is always worth giving it a go. If it is something that you have previously struggled to keep down, take your time with the meal and chew the food slowly.

Don’t worry if your diet is not the best when you are unwell, you can opt for healthier choices when you feel better. Sometimes you will find foods that you would usually enjoy difficult to tolerate for a duration however, as the pregnancy progresses for many women, they can go back to eating these foods as their symptoms improve.

It is also important to have plenty of fluids throughout the day to prevent dehydration. When drinking it is helpful to take small sips at a time of the fluid that you can tolerate. Anecdotally, for many women water can be difficult to tolerate and adding a small amount of a cordial or fruit juice can make a real difference to the ability to keep this fluid down.

Foods which may be more easily tolerated

Aim to eat little and often.

Dry foods

• Breakfast cereals e.g. Cornflakes, Frosties and Shreddies without milk or with small amounts of milk
• Toast, crackers, crispbreads, oatcakes, rice cakes, flapjack or biscuits

Savoury foods

• Cold meat sandwiches
• Toasted cheese sandwich
• Cheese and crackers
• Jacket potato with light filling such as butter or cottage cheese
• Light meal such as plain meat with potato, rice or pasta
• Soup and wholemeal bread

Bland / Mild foods

• Rice, noodles, mashed potato
• Plain bagel, crumpet, pancake, waffle
• Crackers, breadsticks
• Plain yoghurt or fromage frais

Sweet foods

• A small piece of fruit
• Milk puddings, ice-cream, fruit sorbet and jelly
• Porridge with honey or sugar

Some people may find ginger e.g., crystallized ginger, gingernut biscuits, ginger tea helpful in reducing symptoms.

What if I cannot tolerate food?

Fluids can often be better tolerated than food. Milky drinks are a good option as they provide you with some energy and protein. You should try having small but frequent milky drinks throughout the day.

You may find using a drinking straw and taking sips slowly helpful to prevent dehydration.

Options include:

• Decaffeinated tea
• Decaffeinated coffee
• Glass of milk
• Drinking chocolate
• Milkshakes
• Yoghurt
• Malt drinks such as: Horlicks or Ovaltine

If milky drinks are not well tolerated, small amounts of sugar containing drinks should be taken frequently e.g. 1-2 hourly.

• Fruit juice or fruit smoothies
• Sugary drinks including Lucozade, ordinary squash and fizzy drinks such as lemonade, cola and ginger ale (fizzy drinks should be allowed to flatten as the gas may cause further discomfort)
• Ice-lollies
• Fruits with high water content such as watermelon, melon, strawberries

As tolerance improves, food can be gradually re-introduced into the diet. Small amounts of milky drinks should still be taken between meals but phased out gradually as the meals increase in size.

If you are struggling to drink sufficiently and you notice that your urine is repeatedly a deeper yellow to orange colour please contact your GP or discuss this with your midwife as this is a sign that you are potentially becoming dehydrated.

Nutritional supplement drinks

Nutritional supplement drinks can be used to help supplement your dietary intake. These should be used after food first options have been exhausted.

These high calorie drinks are fortified with vitamins and minerals. Care needs to be taken when consuming these whilst pregnant; as they contain high levels of vitamin A which can be harmful to your baby.

There are varying recommendations regarding vitamin A supplementation in pregnancy, please liaise with your GP or your dietitian before taking any nutritional supplements.

Is there anything I should avoid?

Try to avoid an empty stomach; nutrition is important not just for yourself but also your baby. Some people find an empty stomach can also make their nausea worse and so consuming small amounts of food and drink regularly throughout the day can help improve this.

Strong odours can increase nausea, these include cigarettes, coffee, strong perfume and toothpaste. The smell of some foods, particularly hot meals can also trigger symptoms of nausea. Choosing cold meals and dry foods can often be better tolerated. Try cooking and eating in a well-ventilated area to reduce the impact of the odours.

Foods which are highly spiced, rich or fatty, can be more difficult to tolerate for some women, so try to avoid these foods if they affect you.

Practical tips

• Have some food at your bedside ready to have before you get out of bed
• Try to avoid more than an hour or two between having something to eat or drink to avoid that empty stomach feeling
• Have snacks that you tolerate in your bag, in your car, ready for you when you are out and about as it is common for a sense of hunger to come at any time
• It can be really helpful to have a sick-bag with you and the means to clean up if you find yourself vomiting when out. To help you feel fresher if this does happen having wet wipes and mints can be really helpful
• Have small, regular snacks throughout the day
• Take your time with meals, try to relax, chew well and eat slowly
• Avoid drinking with a meal, have a drink 30 minutes before or after eating
• Cold food options may be easier to manage
• Avoid wearing tight fitting clothes
• Try to get some fresh air before eating a meal
• If possible get a friend or relative to prepare your meal

Your doctor can provide anti-sickness (anti-emetic) medication to help manage your symptoms. There are many different types of anti-sickness drugs so if your symptoms do not improve, please ask your doctor to review your medication.

Further information and support is available

• NHS Severe vomiting in pregnancy (opens in a new tab)
• Pregnancy Sickness Support (opens in a new tab)