The prevalence of cannabis use in parturition is likely to be generally underestimated.
This possibility was reinforced by the absence of a link between symptomatology and cannabis use. This stigma might lead them to hide it when taking of a comprehensive patient history. However, it seems to be somewhat unacceptable socially or medically. Ĭannabis use is increasing among pregnant women. However, that hypothesis was refuted in a prospective study that did not find any changes in plasma endocannabinoid levels in patients with gravidarum hyperemesis. One hypothesis suggested that endocannabinoids played a role in the latter pathology. Some authors have recommended cannabis for treating hyperemesis gravidarum. Nevertheless, and paradoxically, antiemetic effects have been attributed to cannabis, in both the general population and pregnant women. Women that use cannabis during pregnancy are more likely to experience severe nausea than those that do not. However, cannabinoid hyperemesis syndrome is particularly complex in pregnant women. Most individuals with cannabinoid hyperemesis syndrome have consumed cannabis for years, mostly daily, and the symptoms tend to improve after taking a shower or hot bath. On the other hand, there are similarities between non-pregnant and pregnant individuals. Unlike studies in non-pregnant individuals, the low number of studies in pregnant patients makes it difficult to perform statistical analyses. We identified five clinical cases and extracted their characteristics (detailed in the appendix tables) (Tables 1 and 2). We employed the search terms “Cannabinoid,” “Hyperemesis,” and “ Pregnancy” in PubMed and Google Scholar. We conducted a literature search to identify clinical cases of cannabinoid hyperemesis syndrome in pregnant patients. The physiopathology remains unclear, but it is linked to hormonal activity and the production of human chorionic gonadotropin. Hyperemesis gravidarum, which affects only 0.3 to 1% of pregnant women, is defined as persistent vomiting, more than 5% weight loss, ketonuria, and electrolyte abnormalities (particularly hypokalemia). More than half of pregnant women experience nausea and vomiting. First, Δ-9-tetrahydrocannabinol (THC) is a CB1 receptor agonist, and it is assumed that deregulation of the receptor could cause nausea. Although the cause of the syndrome is being discussed continually and remains to be formally clarified, a few known factors are notable. Accordingly, the number of published cases of cannabinoid hyperemesis syndrome has increased, and the pathology is of interest in various related specialties, including pediatrics and forensic pathology. Finally, the syndrome ceases when the patient ceases cannabis use and resumes when they do not.Ĭannabis use is increasing worldwide. A symptomatological and temporary improvement in symptoms is noted when taking a bath or hot shower. The classic clinical picture of cannabinoid hyperemesis syndrome is as follows: chronic, intensive use of cannabis, episodes of uncontrollable vomiting, and abdominal pain. She was discharged home with her infant uneventfully on postpartum day 3.
The pregnancy was uncomplicated, and she gave birth at 39 weeks 6/7 to a healthy 2650-g newborn. Based on the strong suspicion of cannabinoid hyperemesis syndrome and her clinical improvement in the emergency department, the details of this entity were explained to the patient, and she returned home. She was treated with acetaminophen (1000 mg), tramadol (50 mg), metoclopramide (10 mg), and butylhyoscine bromide (10 mg). Obstetrically, she had a normal ultrasound, normal cardio-fetal monitoring. An abdominal ultrasound showed no detectable pathology. The patient had a body temperature of 35.9 ☌ and displayed stable hemodynamics.įurther examinations revealed normal CBC but leukocytosis with WBC of 14.7 with a left shift. Abdominal palpation showed epigastric pain without guarding or rebound. The cardiopulmonary clinical examination was unremarkable.
She reported a decline in symptoms when taking a hot bath. She had consumed 2 g per week for 6 years. She reported no health problems, but she smoked tobacco and cannabis. A 29-year-old patient in her first pregnancy, at 29-week and 1-day gestation, visited the emergency room for uncontrollable vomiting and epigastric pain.
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