Cannabis for Hyperemesis Gravidarum; A Risk: Benefit Balance
I see increasing reports in the social media of American women with hyperemesis gravidarum reporting on beneficial effects of cannabis in hyperemesis. What about the fetal risks of cannabis?
Excellent question. There is new evidence of neurodevelopmental risks of hyperemesis gravidarum itself. In contrast, after 40 years and numerous studies, the fetal risks of cannabis have not been substantiated. This review tries to present a risk: benefit balance.
Hyperemesis Gravidarum (HG) affects up to 2% of pregnant women, with strong evidence of serious physical, emotional and behavioral adverse effects on the mother (1). Presently the effectiveness of existing anti-emetic medications on HG symptom relief is meagre. The antiemetic effects of cannabinoid have long been documented. In parallel there is growing evidence outside the realm of clinical studies suggesting efficacy of cannabis for HG symptoms. There are concerns regarding the potential effects of cannabis on fetal brain development, while new research suggests that HG itself may adversely affect cognitive development in exposed children.
Objectvies and Methods
To systematically review:
a) Peer and non- peer review data on the efficacy of cannabis in HG;
b) Published data on fetal safety/risk of cannabis on fetal brain development;
c) Published data on fetal neurodevelopmental risks of HG;
d) To balance these aspects and suggest a research agenda to move forward.
a) There are numerous peer review publications showing the antiemetic effects of cannabis in non- pregnant individuals, but not in pregnancy (2). In contrast, with the legalization of cannabis in the USA there is wide new evidence from social media and self-help women’s websites, describing favorable, and often dramatic effects in women with HG(3). In a proportion of these cases favorable child development is also described, with no reports of adverse fetal outcome. Several peer reviewed questionnaire studies from British Columbia and Hawaii describe high efficacy of cannabis on severe NVP, as reported by the women and physicians (4-5).
b) We describe 4 cases of HG who were treated with cannabis at concentrations of 18-22% and followed up by us. In all 4 there was a dramatic improvement in HG with doses of 2-3 puffs every 2-3 hours. Typical use was of 1 g/d. All 4 children have been described to develop normally (6).
c) Over the last 4 decades, a large number of studies have followed up children exposed in utero to cannabis, comparing them to non- exposed infants. Overall, there were no consistent cognitive deficits, ADHD or other adverse effects. A small number of studies claimed small effect size adverse effects, although there is potential confounding by concomitant maternal drinking, smoking and other lifestyle confounders (7-8).
d) Several longitudinal studies have documented loss of IQ and increased risk of conditions such as ADHD, among offspring exposed in utero to maternal HG. This evidence is consistent with famine studies documenting cognitive fetal effects in the Netherland and China after maternal starvation, and the known nutritional deficits of HG (9).
The balance of the above data suggests that the efficacy and safety of different cannabinoids in HG should be considered. Because of the ethical-medicolegal aspects of such research, it would make sense to study first some of the thousands of the pregnant women using cannabis medically or recreationally in states where cannabis use is legal.
Without well-designed, controlled studies, it would be difficult to address the potential efficacy and safety of cannabis for HG.
1) Clark SM, Costantine MM, Hankins GD. Review of NVP and HG and early pharmacotherapeutic intervention. Obstet Gynecol Int. 2012;252- 676(10):24
2) Mersiades AJ, Tognela A, Haber PS, et al. Oral cannabinoid-rich THC/CBD cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting: a study protocol for a pilot and definitive randomised double-blind placebo-controlled trial (CannabisCINV). BMJ Open. 2018 Sep 12;8(9):e020745. doi: 10.1136/bmjopen-2017-020745.
3) https://www.facebook.com . Accessed June 24, 2019
4) Roberson EK1, Patrick WK1, Hurwitz EL1 Hawaii J Med Public Health. 2014 Sep;73(9):283-7.
5) Westfall RE1, Janssen PA, Lucas P, Capler R. Survey of medicinal cannabis use among childbearing women: patterns of its use in pregnancy and retroactive self-assessment of its efficacy against ‘morning sickness’. Complement Ther Clin Pract. 2006 Feb;12(1):27-33. Epub 2005 Dec 22.]
6) Cohen R, Koren G: The use of cannabis for hyperemesis gravidarum-A report from Motherisk Israel. The Forth Coloqium on Hyperemesis Gravidarum. Amsterdam, Netherland, October10-11, 2019.
7) Sharapova SR, Phillips E, Sirocco K, Kaminski JWet al. Effects of prenatal marijuana exposure on neuropsychological outcomes in children aged 1-11 years: A systematic review. Paediatr Perinat Epidemiol. 2018 Nov;32(6):512-532.
8) El Marroun H, Bolhuis K, Franken IHA, et al. Preconception and prenatal cannabis use and the risk of behavioral and emotional problems in the offspring. IntJ Epidemiol 2019; 48: 287-296
9) Koren G, Ornoy A, Berkovitch M. Hyperemesis gravidarum-Is it a cause of abnormal fetal brain development? Reprod Toxicol. 2018 Aug;79:84-88
Is CBD Oil Good for Morning Sickness? [Is It Safe?]
Morning sickness has become one of the most dreaded side effects of pregnancy. It’s unpredictability, yet constant prevalence, has led many women to seek relief from its discomfort. But most importantly, every expectant mother’s first concern is for the safety and wellbeing of their unborn child.
So, is CBD oil a viable option for easing morning sickness symptoms? And what are the risks associated with using it? Find out in this overview.
What Is Morning Sickness?
According to recent studies, between 70 – 80% of women experience morning sickness during pregnancy. This equates to between 4,000,000 and 350,000 women each year in Canada and the United States alone. So it’s surprising that its cause still remains contentious within the medical community.
Many medical professionals believe that morning sickness is the body’s reaction to excess amounts of a hormone called human chorionic gonadotropin (hCG). During the first trimester of pregnancy, the placenta forms and produces hCG in order to maintain a healthy pregnancy. However, by doing so, hCG also stimulates the maternal ovaries to secrete estrogen. And it is this which can cause feelings of nausea.
Morning sickness typically occurs from the 6th week of pregnancy until the 12th week, when high levels of hCG are produced in the body. Despite the name, morning sickness has no temporal preference and can actually happen during any time of the day.
Morning Sickness Symptoms
For most pregnant women, morning sickness can be described as feelings of nausea, which may or may not result in physical vomiting. However, other less-known symptoms include:
- Abdominal pain
What’s most curious about morning sickness is that women can develop triggers to these symptoms. From smelling cat food to the sound of traffic, these triggers can be unusual and unique. Some of the most common triggers include;
- Spicy foods
- Variations in heat
- Particular smells
- Physical and mental fatigue
- Vitamin or mineral deficiencies
Many of these factors are impossible to avoid in day to day life. In addition, lots of women experience no triggers at all, making morning sickness feel largely uncontrollable.
Hyperemesis Gravidarum (HG) Symptoms
In worst-case scenarios, pregnant women can experience an extreme form of morning sickness called hyperemesis gravidarum (HG). Pregnant women with HG may find themselves experiencing severe symptoms of morning sickness. For instance, they might feel dizzy, confused, and lightheaded. Other symptoms may include:
Similar to morning sickness, many studies highlight that a rapid increase in the hormone hCG contributes to HG. Factors such as estrogen levels and progesterone early in pregnancy may also contribute to the condition. However, much like morning sickness, the exact cause remains ambiguous.
Severe HG may result in hospitalization. So, individuals experiencing any extreme morning sickness symptoms should visit a doctor immediately.
Traditional Remedies for Morning Sickness
Unfortunately, there are no steadfast remedies for combating morning sickness. This is mostly due to differing hormone levels, symptoms, and triggers in pregnant women. However, there are a variety of lifestyle changes pregnant women often use to dispel symptoms. These include:
- Avoid nausea triggers
- Eat food high in carbohydrates and low in fat
- Get lots of rest
- Stay hydrated
- Anti-sickness medicine (an antiemetic)
It’s worth noting that antiemetic or ginger supplements should always come at the recommendation of a doctor.
With so many suggested remedies, naturally, CBD has become a discussed alternative. But how could it help?
Could CBD Be Beneficial for Morning Sickness?
Despite the long list of symptoms associated with morning sickness, the most prevalent continues to be nausea. It’s common for pregnant women to be prescribed medication such as prochlorperazine to combat this. However, prochlorperazine can result in its own list of symptoms, which may include anxiety and insomnia.
Could CBD be an alternative? Well, cannabidiol has long been considered as a possible antiemetic. Some studies have found that nausea and vomiting can be suppressed through the manipulation of the endocannabinoid system. This biological system is made up of cannabinoid receptors that interact with different chemical compounds, including CBD. One group of receptors, in the somatodendritic region, may be the key to minimizing feels of nausea.
There’s no denying that experiencing severe morning sickness symptoms can induce a lot of stress for an expecting mother. This is never a good combination. However, some medical research demonstrates CBD decreasing levels of anxiety.
Studies like this one show a promising correlation between CBD and anxiety disorders, not just by improving short-term anti-compulsive actions but long-term anxiogenic effects of stress. This could be due to cannabidiol preventing the overstimulation of receptors within the endocannabinoid system. However, this is still based on theory.
CBD seems like it could be beneficial for many morning sickness symptoms. But it’s worth noting that there are very few studies that look at the relationship between the two directly.
Is It Safe to Use CBD Oil for Morning Sickness?
To make a long answer short, nobody knows yet. While CBD is considered a safe and effective remedy for many conditions and symptoms, it remains a contentious choice for pregnant women. You’ll find that many medical professionals, including physicians and gynecologists, will advise against using CBD. This is in large due to a lack of research, rather than any known dangers.
You may also find a conservative approach from CBD distributors themselves, with pregnancy warnings on oil and topical labels. If you do want to use CBD, it’s essential to consider where you are buying it. Whether you want oils or topicals, always buy from a transparent and trusted brand. Similarly, it’s a good idea for you to check full ingredient lists before purchasing a product, to ensure you aren’t consuming any harmful or unnecessary chemicals.
Final Thoughts on CBD Oil and Morning Sickness
While often a happy process, pregnancy can create a lot of physical and emotional stress for an expecting mother. And morning sickness is just one example of this.
In theory, CBD could be used as an antiemetic to prevent or subdue morning sickness symptoms, specifically nausea. However, there is simply not enough long-term data to determine accurate benefits and risks. Understandably medical professionals are taking a strict stance on CBD, especially with an unborn life involved.
If you remain curious about using CBD while pregnant, it’s essential to consult with your physician or doctor first.