Hyperemesis Gravidarum (HG) is hell during gestation—–that’s my definition from watching pregnant women go through months on end of nausea and vomiting at least three times a day, feeling ill, even to the point of fainting, and losing weight because they cannot keep anything down. This may start around four week’s gestation or sometimes even earlier. Many women are debilitated by HG even when taking strong medication or doing IVs to be re-hydrated.

HG is an extreme form of morning sickness, more than only nausea which is still truly miserable.  ( See my blog on nausea in pregnancy) HG seems to strike randomly among pregnant women with approximately 1 in 1000 women being affected. It may be more likely to occur in a first pregnancy, a multiple pregnancy (twins, etc.), or if there is a family history of having it. Other factors may be obesity or an eating disorder. If a woman has had HG previously then she is more likely to have it again. I know a few women who, though they would love more kids, never want to be pregnant again because of HG. If this is you, take heart! There may be a simple explanation for the majority of women: H-Pylori!

Helicobacter Pylori (H. pylori) is a bacteria found in the stomach. Approximately 50% of the world is infected with it. H. pylori is transferred primarily through saliva but also through feces. A study done at the University of Vienna in Austria found that over 90% of pregnant women with hyperemesis gravidarum were infected with H. Pylori. This is a phenomenal association! It is thought that changes with pregnancy fluid (blood volume), hormones, and stomach acidity may activate latent H. pylori.  A small study of women with hyperemesis gravidarum found all of them tested positive for H. pylori using a stomach biopsy (one of the most accurate forms of testing). There are four ways of testing for H. pylori: blood serum antigens, breath, stool, and biopsy. The stool test is the only way I recommend to test because it is very accurate but not invasive.

Multiple studies showed a high correlation between h. pylori with hyperemesis gravidarum when tested by blood, feces, and biopsy. Many women also tested positive for h. pylori who did not develop HG. There were woman with HG that were not positive for H. pylori, which could be because it was tested using blood serum (not the most accurate way to test) or that there are other reasons for HG, which I don’t doubt. I have read a few testimonies of women who had HG and then eradicated H. pylori and then with their next pregnancies did not have hyperemesis gravidarum.  This is very exciting news for health care providers and for woman wanting to get pregnant.

As with many health issues, we do not know the exact way h. pylori affects the body to stimulate HG, but here are some thoughts backed up by evidence.

Liver Function

Liver dysfunction and damage due to H. pylori infection is a documented fact. One study showed that for women with high liver enzymes once the H. pylori infection was eliminated their liver enzymes returned to normal.

It makes a lot of sense to me as a midwife that liver congestion causes nausea and vomiting. I learned from another midwife to support the liver and help the body detoxify in order to lower or eliminate nausea in pregnancy.  During pregnancy there is an increased demand on the liver and it makes sense that if the liver is toxic before pregnancy it will have difficulty keeping up during pregnancy.

Active Ulcers

H. pylori is the cause of 80% of ulcers. One study states that persistent nausea and vomiting beyond the second trimester could be due to active peptic ulcers caused by the h. pylori infection.

Blood Sugars

I have a hypothesis concerning HG and h. pylori connection: cortisol, a hormone produced in the adrenal glands, has many roles, including being anti-inflammatory and helping to regulate blood sugar levels. H. pylori is an infection that causes inflammation in the body. When there is a long-term, latent, or low-grade infection in the body, such as H. pylori, it can reduce the amount of cortisol available, either because the body is using the cortisol, it has to lower the inflammation caused by the infection, or because the adrenals are getting tired of continuously making cortisol and are therefore making less of it. (Long-term H. pylori infection can contribute to adrenal fatigue.) Less cortisol means less ability to balance blood sugars, which means a need to eat more frequently. For many women with HG, eating simple carbohydrates is one of the few things they can keep down and the only way to manage the nausea. Simple carbohydrates (bread, crackers, pasta, potatoes, and sugars) are what H. pylori bacteria love to feed on. If you increase the amount of these then you are likely just feeding the H. pylori—–a vicious cycle!

Hormone Fluctuations

Hormonal fluctuations can trigger H. pylori. Before the placenta takes over making hormones, around 12-16 of pregnancy, a woman’s hormones go through a large changes which can lower available cortisol levels and trigger latent H. pylori. This would explain why some women with severe nausea feel better after 12-16 weeks when the hormonal changes lessen. H. pylori’s connection to hormonal fluctuation causing nausea would also explain why some women feel sick at the beginning of their cycles when hormones are shifting drastically.

All this is fascinating—except when you are constantly puking up your dinner. How do you know if you have H. pylori and how do you get rid of it? It can be a challenge to get rid of H. pylori, and it is even harder during pregnancy when you have less treatment options. The best time to eradicate it is when you are not pregnant or breastfeeding. There are safe treatment options for pregnancy and it is important to treat it because it may be passed to the baby and it may play a role in colicky babies.

Interested in getting tested for H-pylori I use Diagnostic Solutions H-Pylori Profile. This stool test is mailed to the privacy of your home to be completed and returned to the lab. I will receive the results in approximately 3 weeks and contact you to go over the results and give my recommendations. The H-pylori profile is also included in the GI Map a comprehensive pathogen test. You can find more information on ordering the H-pylori Profile and GI Map Here






Hyperemesis Gravidarum Updated: Jan 04, 2017 Author: Dotun A Ogunyemi, MD; http://emedicine.medscape.com/article/254751-overview#a6

The effect of Helicobacter pylori eradication on liver enzymes in patients referring with unexplained hypertransaminasemia

Hyperemesis Gravidarum Updated: Jan 04, 2017 Author: Dotun A Ogunyemi, MD; http://emedicine.medscape.com/article/254751-overview#a6



Jarosz M. 1998. Effects of high dose vitamin C treatment on Helicobacter pylori infection and total vitamin C concentration in gastric juice. Eur J Cancer Prev 7:449-454.


Imoto, I et al. Suppressive Effect of Bovine Lactoferrin against Helicobacter pylori. Helicobacter 2004 (A11.27); 9: 487-604.


Picture are copyright by creative commons for free use with out attribution unless otherwise noted. Picture of H-pylori bacteria is by AJC1.