Hyperemesis Gravidarum

Overview of Hyperemesis gravidarum (HG)

Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting during pregnancy, far more extreme than the typical "morning sickness" experienced by many pregnant women.

It’s characterized by:

• Persistent vomiting: Occurs frequently throughout the day, leading to dehydration.
• Weight loss: Often significant, exceeding 5% of pre-pregnancy weight.
• Electrolyte imbalances: Dehydration can lead to imbalances in essential minerals.
• Ketonuria: The presence of ketones in urine, indicating the body is breaking down fat for energy due to lack of food intake.
  
   

While the exact cause of HG is unknown, it’s believed to be related to hormonal changes during pregnancy.

Other factors, such as a history of HG, multiple pregnancies, or certain medical conditions, may also increase the risk.

HG is a serious condition that requires prompt medical attention.

If left untreated, it can lead to complications for both the mother and the fetus. Treatment typically involves:

• Medications: To control nausea and vomiting.
• Intravenous fluids: To rehydrate the body and correct electrolyte imbalances.
• Nutritional support: May involve dietary changes or, in severe cases, tube feeding.

Epidemiology of HG

Causes of Hyperemesis Gravidarum

• There are numerous theories regarding the cause of HG, but the cause remains controversial. It is thought that HG is due to a combination of factors which may vary between women and include genetics. Women with family members who had HG are more likely to develop the disease.
• One factor is an adverse reaction to the hormonal changes of pregnancy, in particular, elevated levels of beta human chorionic gonadotropin (β-hCG).
• More recently, another cause of HG was discovered: "Evidence suggests abnormal levels of the hormone GDF15 are associated with HG. [1]

Types of Hyperemesis Gravidarum

There isn’t a universally accepted classification of hyperemesis gravidarum (HG) into distinct types. However, HG can be categorized based on its severity:

• Mild HG: This is the least severe form, where the woman experiences nausea and vomiting that significantly impacts her daily life but doesn’t lead to severe dehydration or weight loss.
• Moderate HG: This form is characterized by more frequent vomiting, weight loss (5-10% of pre-pregnancy weight), and mild dehydration. Women with moderate HG may require hospitalization for intravenous fluids and medication.
• Severe HG: This is the most severe form of HG, where the woman experiences persistent vomiting, significant weight loss (over 10% of pre-pregnancy weight), severe dehydration, electrolyte imbalances, and ketonuria. Women with severe HG require hospitalization for intensive treatment, which may include intravenous fluids, medications, and nutritional support. [7]

Risk factors of Hyperemesis Gravidarum 

• first pregnancy
• multiple pregnancy
• obesity
• prior or family history of HG,
• trophoblastic disorder, 
• history of eating disorders.[1]

Pathogenesis of Hyperemesis Gravidarum

The exact pathogenesis of hyperemesis gravidarum (HG) remains unclear, but several factors are believed to contribute:

Hormonal Changes:

Elevated levels of human chorionic gonadotropin (hCG) and estrogen during pregnancy are strongly implicated. These hormones peak around the time when HG symptoms are most severe. Additionally, altered thyroid function and increased sensitivity to progesterone may play a role.

Gastrointestinal Factors:

Delayed gastric emptying, abnormal gastrointestinal motility, and increased sensitivity to gut distension have been observed in women with HG. These factors can exacerbate nausea and vomiting.

Genetic Predisposition:

There appears to be a genetic component to HG, as women with a family history of HG are at higher risk. Specific genes related to hormone metabolism and appetite regulation have been implicated.

Psychological Factors:

Stress, anxiety, and depression may contribute to the development or worsening of HG symptoms in some women.

Helicobacter pylori Infection:

Some studies suggest a possible association between H. pylori infection and HG, although the evidence is not conclusive. [8]

It’s important to note that these factors may interact and contribute to HG in varying degrees in different individuals. The complex interplay of hormonal, gastrointestinal, genetic, and psychological factors makes it difficult to pinpoint a single cause for HG.

Pathophysiology of Hyperemesis Gravidarum

Although the pathophysiology of HG is poorly understood, the most commonly accepted theory suggests that levels of β-hCG are associated with it. Leptin, a hormone that inhibits hunger, may also play a role.

Possible pathophysiological processes involved are summarized in the following table:

[1]

Clinical Features of Hyperemesis Gravidarum

The clinical features of Hyperemesis Gravidarum (HG) are a spectrum, ranging from mild to severe:

Early Stage (usually first trimester):

• Persistent Nausea and Vomiting: This is the hallmark of HG and often occurs multiple times a day, sometimes triggered by specific smells or tastes.
• Food Aversions: Strong aversions to certain foods or smells are common.
• Weight Loss: Gradual or rapid weight loss, exceeding 5% of pre-pregnancy weight.
• Dehydration: Signs include decreased urine output, dark urine, dry mouth, and dizziness.

Progressive Stage (if untreated):

• Electrolyte Imbalances: Sodium, potassium, and chloride imbalances can occur due to dehydration and vomiting.
• Ketonuria: Ketones in urine indicate the body is breaking down fat for energy due to inadequate food intake.
• Malnutrition: Severe vomiting can prevent nutrient absorption, leading to deficiencies.
• Wernicke Encephalopathy: A rare but serious neurological complication caused by thiamine (vitamin B1) deficiency.

Other Possible Symptoms:

• Ptyalism: Excessive salivation.
• Fatigue: Feeling constantly tired or weak.
• Headache: Often related to dehydration.
• Constipation: Due to decreased food and fluid intake.
• Hypotension: Low blood pressure due to dehydration.
• Tachycardia: Rapid heart rate, also a potential sign of dehydration. [9]

Sign & Symptoms

When vomiting is severe, it may result in the following i.e.:

• Loss of 5% or more of pre-pregnancy body weight
• Dehydration, causing ketosis, also constipation
• Nutritional disorders, such as vitamin B₁(in other words, thiamine) deficiency, vitamin B₆ (in other words, pyridoxine) deficiency or vitamin B₁₂ (cobalamin) deficiency
• Metabolic imbalances such as metabolic ketoacidosis or thyrotoxicosis
• Physical and emotional stress
• Difficulty with activities of daily living
• Symptoms can aggravate especially by hunger, fatigue, prenatal vitamins and diet.

Other symptoms

• Many women with HG are extremely sensitive to odors in their environment; certain smells may exacerbate symptoms.
• Excessive salivation, also known as sialorrhea gravidarum, is another symptom experienced by some women.
• Hyperemesis gravidarum tends to occur in the first trimester of pregnancy and lasts significantly longer than morning sickness. While most women will experience near-complete relief of morning sickness symptoms near the beginning of their second trimester, some sufferers of HG will experience severe symptoms until they give birth to their baby, and sometimes even after giving birth
• A small percentage rarely vomit, but the nausea still causes most of the same issues that hyperemesis with vomiting does.[1]

Clinical Examination

A clinical examination for hyperemesis gravidarum (HG) aims to assess the severity of the condition and identify any potential complications. The examination typically includes the following components:

1. General Assessment:

   • Vital Signs: Monitoring blood pressure, heart rate, and temperature for signs of dehydration or infection.
   • Weight: Comparing current weight to pre-pregnancy weight to assess the degree of weight loss.
   • Hydration Status: Assessing skin turgor (elasticity), mucous membranes (moisture), and capillary refill (time taken for color to return to nailbed after pressure is applied) to determine dehydration.

2. Physical Examination:

   • Abdominal Examination: Palpating the abdomen for tenderness or masses, which could indicate other causes of nausea and vomiting.
   • Neurological Examination: Assessing mental status and reflexes, as Wernicke encephalopathy (a rare complication of severe HG) can cause neurological symptoms.

3. Laboratory Tests:

   • Urine Analysis: Checking for ketones (indicating fat breakdown for energy) and specific gravity (indicating dehydration).
   • Blood Tests: Measuring electrolytes (sodium, potassium, chloride) to assess imbalances, liver function tests, and thyroid function tests.

4. Additional Tests (if needed):

   • Ultrasound: To assess fetal well-being and rule out other pregnancy complications.
   • Upper Endoscopy: To examine the esophagus and stomach for inflammation or ulcers, which can contribute to nausea and vomiting. [10]

Diagnosis Hyperemesis gravidarum (HG)

• Hyperemesis gravidarum considered a diagnosis of exclusion. HG can associated with serious problems in the mother or baby, such as Wernicke’s encephalopathy, coagulopathy and peripheral neuropathy.
• Women experiencing hyperemesis gravidarum often dehydrated and lose weight despite efforts to eat. The onset of the nausea and vomiting in hyperemesis gravidarum is typically before the 20th week of pregnancy.[1]

Differential Diagnosis 

Here are some key differentials to consider:

1. Gastrointestinal Disorders:

   • Gastroenteritis: Inflammation of the stomach and intestines, often caused by infection.
   • Peptic ulcer disease: Sores in the lining of the stomach or duodenum.
   • Gastroparesis: Delayed stomach emptying.
   • Cholecystitis/Cholelithiasis: Inflammation or stones in the gallbladder.
   • Pancreatitis: Inflammation of the pancreas.
   • Appendicitis: Inflammation of the appendix.

2. Infections:

   • Urinary tract infection (UTI): Infection of the urinary system.
   • Pyelonephritis: Kidney infection.
   • Hepatitis: Inflammation of the liver.

3. Endocrine Disorders:

   • Diabetic ketoacidosis: Complication of diabetes characterized by high blood sugar and ketone buildup.
   • Hyperthyroidism: Overactive thyroid gland.

4. Neurological Conditions:

   • Migraine headaches: Severe headaches, often accompanied by nausea and vomiting.
   • Increased intracranial pressure (pseudotumor cerebri): Increased pressure within the skull.

5. Other:

   • Medication side effects: Certain medications can cause nausea and vomiting.
   • Psychological disorders: Anxiety and depression can exacerbate nausea and vomiting.
   • Molar pregnancy: Abnormal growth of trophoblastic tissue in the uterus. [11]

Complications

Maternal Complications:

• Dehydration and Electrolyte Imbalances: Severe vomiting can lead to dehydration and imbalances in electrolytes such as sodium, potassium, and chloride. This can result in fatigue, weakness, muscle cramps, dizziness, and even seizures in severe cases.
• Malnutrition and Weight Loss: The inability to keep food down can lead to malnutrition and significant weight loss, which can negatively impact the mother’s health and energy levels.
• Wernicke’s Encephalopathy: A rare but serious neurological condition caused by thiamine (vitamin B1) deficiency due to prolonged vomiting. Symptoms include confusion, vision problems, and difficulty with coordination.
• Psychological Issues: HG can take a toll on mental health, leading to depression, anxiety, and even post-traumatic stress disorder (PTSD).
• Other Complications: Rare complications include esophageal rupture, Mallory-Weiss tears (tears in the esophagus), and central pontine myelinolysis (a neurological disorder).

Fetal Complications:

• Low Birth Weight: Malnutrition and dehydration in the mother can lead to poor fetal growth and low birth weight.
• Preterm Birth: HG has been associated with an increased risk of premature birth.
• Small for Gestational Age (SGA): Infants born to mothers with HG may be smaller than expected for their gestational age. [12]

Investigations of Hyperemesis gravidarum (HG)

• Common investigations include blood urea nitrogen(BUN) and electrolytes, liver function tests, urinalysis, and thyroid function tests.
• Hematological investigations include hematocrit levels, which are usually raised in HG.
• An ultrasound scan may be needed to know gestational status and to exclude molar or partial molar pregnancy.[1]

Treatment of Hyperemesis gravidarum (HG)

• Hyperemesis gravidarum (HG) a severe and prolonged form of nausea and/or vomiting during pregnancy.
• HG affects 0.3-2% of pregnancies and define by dehydration, ketonuria, and more than 5% body weight loss. Initial pharmacologic treatment for HG includes a combination of doxylamine and pyridoxine.
• Additional interventions include ondansetron or dopamine antagonists such as metoclopramide or promethazine. The options are limited for women who are not adequately treat with these medications. [1]

Prevention

There is no definitive way to prevent hyperemesis gravidarum (HG), as its exact cause is unknown. However, some strategies may help reduce the risk or severity of symptoms:

1. Preconception Care:

   • Maintain a healthy weight: Obesity is associated with a higher risk of HG.
   • Optimize nutrition: Take a prenatal vitamin containing folic acid before and during pregnancy.
   • Manage chronic conditions: If you have any underlying health conditions, such as diabetes or thyroid problems, ensure they are well-managed before conceiving.

2. Early Pregnancy Management:

   • Identify and avoid triggers: If you experience nausea or vomiting, try to identify and avoid any potential triggers, such as certain foods, smells, or activities.
   • Dietary modifications: Eat small, frequent meals throughout the day, and avoid greasy, spicy, or acidic foods.
   • Hydration: Stay hydrated by drinking plenty of fluids, such as water, clear broth, or sports drinks.
   • Consider alternative therapies: Some women find relief from nausea and vomiting with ginger, vitamin B6, or acupressure wristbands. However, consult your doctor before starting any new supplements or treatments.

3. Early Intervention:

   • Seek medical advice: If you experience persistent nausea and vomiting that interferes with your daily life, consult your doctor as soon as possible. Early intervention may help prevent HG from worsening. [13]

Homoeopathic Treatment

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution, family history, presenting symptoms, underlying pathology, possible causative factors etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions.

What Homeopathic Doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’. The disease diagnosis is important but in homeopathy, the cause of disease is not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness are also looked for.

No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition. The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology is not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can be greatly improved with homeopathic medicines.

Homeopathic medicines for Hyperemesis gravidarum (HG)

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy.

Medicine of Hyperemesis gravidarum:

ARSENICUM ALBUM:

• Persistent, deathly nausea during pregnancy. Moreover, The entire inner part of the stomach seems raw.
• Constrictive pain when the stomach is empty. Additionally, Nausea 11 a.m. and 3 p.m. and in forenoon, obliging her to lie down.
• Violent vomiting excited by taking any substance taken into the stomach. In detail, Vomiting brings no relief. Loathes food. Constant thirst for cold water, the smallest part of which cannot be retained.
• Patient thinks she will die. Severe prostration.
• Worse – cold drinks, after midnight, right side. On the other hand Better – heat, warm drinks.

KREOSOTUM:

• The nausea also vomiting are frequently associated with soreness at the pit of the stomach.
• Nausea with burning in mouth. Furthermore, Urging to vomit, but only saliva appears. Retching. Fasts in the morning. Besides this, Fretful in morning to the point of weeping.
• Face is pale also puffy.
• Worse – open air, cold, rest, lying. whereas Better – motion, warmth, warm food.

NUX VOMICA:

• General, Vomiting and nausea every morning. Aversion to food. Needs to lie down.
• Nausea to the odours of food. Additionally, Nausea in morning with chilliness.
• Worse – especially after eating a little, walking.

TABACUM:

• Persistent nausea also vomiting of pregnancy, with deathly nausea, pale face, coldness in stomach.
• Nausea in morning on rising, on motion. Violent vomiting, bitter, sour, even before breakfast.
• Faint and weakness after vomiting. Pale face, covered specifically with cold sweat.

IPECACUANHA:

• In brief, Vomiting with mucus and sometimes blood, bile, and green gelatinous mucus. Often caused by nervous irritability.
• Nausea with empty eructations and salivation, distressing, with compulsive but ineffectual retching.
• Lastly, Nausea with clean moist tongue.

LACTIC ACID:

• Nausea, vomiting, morning sickness especially in pale anemic women.
• Hot, acrid eructations. Nausea, better eating.

LOBELIA:

• Basically, Faintness and sinking in pit of stomach with nausea and vomiting.
• Worse – afternoon, slightest motion, cold. On the other hand Better – warmth, rapid walking, water.

ASARUM:

• Nausea, eructations and vomiting during pregnancy. Nausea with loathing and shuddering.
• Violent, empty retching which < all symptoms. Melancholy, tearful, peevish.
• Worse – penetrating sounds, cold, dry weather. Whereas Better – washing, in damp cold weather.[2]

Diet & Regimen 

Diet:

• Small, Frequent Meals: Instead of three large meals, aim for 5-6 small meals throughout the day. This keeps your stomach from getting too empty or too full.   
   
• Bland Foods: Choose foods that are easy to digest and low in fat, such as crackers, toast, plain rice, and baked potatoes.
   
• Hydration: Sip fluids consistently throughout the day, even if you can only manage small amounts at a time. Consider clear broths, ginger ale, or diluted fruit juices.
   
• Ginger: Ginger has been shown to help with nausea. Try ginger tea, ginger candies, or ginger ale. 
   
• Vitamin B6: Studies suggest vitamin B6 may reduce nausea. Talk to your doctor about appropriate supplementation.  Foods to Avoid:
• Fatty, Greasy, or Spicy Foods: These can be harder to digest and may worsen nausea.
   
• Strong Smells: Avoid foods with strong odors that trigger nausea.
   
• Iron Supplements: Iron can sometimes worsen nausea. Discuss alternatives with your doctor if needed.
   

Regimen:

• Rest: Get plenty of rest and avoid overexertion.
   
• Acupressure: Wristbands that apply pressure to the P6 acupressure point (inner wrist) may provide relief.
   
• Medications: Your doctor may prescribe anti-nausea medications safe for pregnancy. 
   
• IV Fluids: In severe cases, hospitalization for intravenous fluids and nutrition may be necessary.

Do’s & Don’ts 

Hyperemesis gravidarum (HG)  do’s & don’ts

Do’s:

• Seek medical attention: Consult your doctor immediately if you experience persistent nausea and vomiting during pregnancy. Early diagnosis and treatment are crucial.
• Follow your doctor’s advice: Adhere to the prescribed treatment plan, which may include medications, intravenous fluids, and nutritional support.
• Rest: Get plenty of rest and avoid overexertion.
• Stay hydrated: Drink fluids regularly, even if you feel nauseous. Sip small amounts frequently throughout the day.
• Eat small, frequent meals: Opt for bland, easy-to-digest foods and avoid greasy, spicy, or acidic foods that can trigger nausea.
• Identify and avoid triggers: Keep a food diary to track foods and smells that worsen your symptoms and try to avoid them.
• Seek emotional support: Talk to your partner, family, friends, or a therapist about how you’re feeling. HG can take a toll on mental health.
• Consider alternative therapies: Some women find relief with ginger, vitamin B6, or acupressure wristbands. Consult your doctor before trying any alternative therapies.

Don’ts:

• Don’t ignore symptoms: Persistent nausea and vomiting are not normal pregnancy symptoms. Seek medical help if you’re experiencing them.
• Don’t try to "tough it out": HG is a serious condition that requires medical attention. Don’t try to manage it on your own.
• Don’t wait to get help: Early intervention is key to preventing complications. Don’t hesitate to seek medical advice if your symptoms worsen or don’t improve with home remedies.
• Don’t self-medicate: Don’t take any over-the-counter or prescription medications without consulting your doctor.
• Don’t force yourself to eat: If you’re feeling nauseous, don’t force yourself to eat. Wait until you feel able to tolerate food.
• Don’t isolate yourself: HG can be isolating, but try to stay connected with your support network. Talk to your loved ones about how you’re feeling.

Terminology 

Hyperemesis Gravidarum (HG):

A severe form of nausea and vomiting during pregnancy, characterized by persistent vomiting, weight loss, dehydration, and electrolyte imbalances.

Nausea:

A feeling of sickness with an inclination to vomit.

Vomiting:

The forceful expulsion of stomach contents through the mouth.

Dehydration:

A condition caused by excessive loss of water and fluids from the body.

Electrolyte Imbalances:

Disruptions in the normal levels of minerals in the body, such as sodium, potassium, and chloride.

Ketonuria:

The presence of ketones in the urine, indicating the body is breaking down fat for energy due to inadequate food intake.

Intravenous (IV) Fluids:

Fluids administered directly into a vein to rehydrate the body and correct electrolyte imbalances.

Anti-emetics:

Medications used to prevent or treat nausea and vomiting.

Nutritional Support:

Additional nutrients provided through dietary changes or, in severe cases, tube feeding.

Prenatal Vitamins:

Supplements containing essential vitamins and minerals to support a healthy pregnancy.

Human Chorionic Gonadotropin (hCG):

A hormone produced during pregnancy, high levels of which are associated with HG.

Estrogen:

A female sex hormone, elevated levels of which are also linked to HG.

Thyroid Function:

The activity of the thyroid gland, which produces hormones that regulate metabolism. Abnormal thyroid function can contribute to HG.

Common Homeopathic Remedies for HG:

• Ipecacuanha: Indicated for persistent nausea and vomiting, especially when there is a feeling of constant nausea even after vomiting.
• Nux vomica: Often used for morning sickness with retching, vomiting, and irritability. It’s also suitable for women experiencing constipation alongside HG.
• Sepia: Helpful for women experiencing intense nausea aggravated by the smell of food and feeling better after eating.
• Tabacum: Indicated for severe nausea and vomiting accompanied by cold sweats and dizziness.
• Colchicum: Suitable when even the thought or smell of food triggers nausea, especially with an aversion to eggs and fish.
• Cocculus indicus: Used for nausea and vomiting caused or worsened by motion, such as traveling in a car.

References 

1. https://en.wikipedia.org/wiki/Hyperemesis_gravidarum
2. Homoeopathic Body-System Prescribing – A Practical Workbook of Sector Remedies
3. Prakash, C., & Noronha, J. (2020). Hyperemesis gravidarum: A review. Journal of Family Medicine and Primary Care, 9(9), 4399–4405.
4. Krishna, S., & Sharma, J. B. (2016). A study to identify clinical and laboratory parameters in cases of excessive vomiting in early pregnancy. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 5(7), 2697–2702.
5. Nithiyasri, P. (2023). Prevalance and Risk Factors of Hyperemesis Gravidarum: A Retrospective Study. International Journal of Obstetrics and Pregnancy, 6(1).
6. Patel, R. R., & Shah, V. A. (2022). A Prospective Case Control Study of Maternal-Fetal Outcomes in Pregnant Women with Hyperemesis Gravidarum at Tertiary Care Hospi. Impact Factor Journal of Pharmacy and Clinical Research, 15(4).
7. Williams Obstetrics, 25th Edition, 2018, by F. Gary Cunningham, Kenneth J. Leveno, Steven L. Bloom, Catherine Y. Spong, Jodi S. Dashe, Barbara L. Hoffman, Brian M. Casey, Jeanne S.
   
   Sheffield, Published by McGraw Hill Professional
8. Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice, 8th Edition, 2019, by Robert Resnik, Charles J. Lockwood, Thomas R. Moore, Michael J. Paidas, Published by Elsevier
9. Obstetrics by Ten Teachers, 20th Edition, 2023, by Louise Kenny, Jenny Kurinczuk
10. Maternity and Women’s Health Care, 12th Edition, 2020, by Deitra Leonard Lowdermilk, Shannon E. Perry, Mary Catherine Cashion, Kitty Ernst, Published by Elsevier
11. CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 12th Edition, 2019, by Alan H. DeCherney, Lauren Nathan, Lisa Hollier, Published by McGraw Hill Professional
12. Danforth’s Obstetrics and Gynecology, 11th Edition, 2019, by Ronald S. Gibbs, Karoline M. Pahl, James L. Simpson, Published by Lippincott Williams & Wilkins
13. UpToDate: Hyperemesis Gravidarum by Robert L. Barbieri, MD

Also search as 

There are several ways people can search for homeopathic articles on hyperemesis gravidarum (HG):

1. Online Databases:

   • The Faculty of Homeopathy: This organization’s website and journal often feature articles on homeopathic research and clinical cases, including HG.
   • National Center for Homeopathy (NCH): The NCH is a U.S.-based organization that publishes articles and resources on homeopathy, including research and clinical applications for various conditions.
   • PubMed: While not exclusively focused on homeopathy, PubMed includes some articles and studies on homeopathic treatments, potentially including HG.

Search Engines:

• • Use specific search terms like "homeopathy hyperemesis gravidarum," "homeopathic treatment HG," or "homeopathic remedies for nausea and vomiting during pregnancy" to narrow down results.
  • Consider adding additional terms like "case studies," "clinical trials," or "research articles" to find relevant publications.

Homeopathic Journals and Publications:

• • The Homeopathic Links: This online journal features articles and research on homeopathy from around the world.
  • Homeopathy: A peer-reviewed journal that publishes original research and reviews on homeopathic medicine.
  • Simillimum: The journal of the Homeopathic Academy of Naturopathic Physicians.

Homeopathic Organizations and Practitioners:

• • Contact local or national homeopathic organizations for recommendations on articles or resources.
  • Consult with a qualified homeopathic practitioner who may have access to relevant publications or case studies.

Libraries:

• • University libraries or libraries with a focus on alternative medicine may have homeopathic journals and books in their collection.

Online Search Engines:

• • Use search terms like "hyperemesis gravidarum," "HG pregnancy," or "severe morning sickness."
  • Specify your search by adding terms like "causes," "symptoms," "treatment," or "research."
  • Use reliable sources like medical websites, health organizations, and research databases.

Medical Websites and Databases:

• • PubMed: A database of biomedical literature that includes research articles and studies on HG.
  • National Institutes of Health (NIH): The NIH website offers information on HG, including research findings and treatment options.
  • HER Foundation: A non-profit organization dedicated to HG awareness, research, and support. Their website provides comprehensive information and resources.  
    
     

Medical Professionals:

• • Obstetrician/Gynecologist (OB/GYN): Your doctor is the best source for personalized information and treatment options for HG.
  • Maternal-Fetal Medicine Specialist: If your HG is severe, your doctor may refer you to a specialist for more specialized care.

Support Groups:

• • Online forums and communities: Connecting with other women experiencing HG can provide valuable support and information.
  • Local support groups: Some areas have in-person support groups for women with HG.

Books and Publications:

• • Medical textbooks: Textbooks on obstetrics and gynecology often have chapters on HG. 
    
     
  • Research articles: Scientific journals may publish research findings on HG.