Up to 80% of pregnant women experience nausea and vomiting, marked by various symptoms. Hyperemesis Gravidarum (HG) is a severe end of vomiting and nausea in pregnancy that affects 1 – 2 percent of pregnant women.
Antiemetic medicine, which is an agent used to prevent or relieve nausea and vomiting, appears to help HG patients. In addition, overwhelmed patients may require hospitalization for rehydration and nutritional care.
Cannabis has antiemetic qualities, as demonstrated by the use of several therapeutic cannabinoids to treat chemotherapy-induced nausea and vomiting.
In this post, we look at Hyperemesis Gravidarum and the function cannabis plays in its treatment.
What is Hyperemesis Gravidarum?
Hyperemesis Gravidarum is a medical term for severe nausea and vomiting (or an extreme form of morning sickness) during pregnancy, usually between the 4th and 6th week. It’s a less frequent ailment that affects around 3% of women; yet, it’s a significant condition that requires medical attention because excessive vomiting can lead to dehydration.
Notably, morning sickness and HG are not the same things. As a result, distinguishing between the two is necessary to appropriately evaluate their symptoms.
Hyperemesis Gravidarum vs. Morning Sickness
Morning sickness is more of nausea which is sometimes accompanied by vomiting. The condition begins in the first month of pregnancy and disappears after 12 to 14 weeks.
Women experiencing morning sickness can get fatigued and slightly lose appetite. This can affect their performance in usual daily activities.
HG causes nausea that doesn’t stop and severe vomiting that can cause dehydration. The dehydration is because the vomiting doesn’t allow you to keep the fluids or food down.
Accordingly, women affected by HG have extended feelings of fatigue for weeks and even a complete loss of appetite (resulting in poor weight gain).
There are no known ways of preventing HG or morning sickness, but there are ways of managing the symptoms.
Common Symptoms of Hyperemesis Gravidarum
Although HG starts in the first trimester of pregnancy, almost half the women with HG experience symptoms throughout their pregnancy.
Common symptoms of the condition include:
- Low Appetite
- Severe and persistent nausea
- Weight loss
- Excessive saliva
- Increased vomiting (3-4 times a day)
- Extreme fatigue
- Dehydration and symptoms of dehydration such as dry skin, headaches, weakness, and feeling lightheaded
- Ketosis. This is the process of your body using up stored fats due to a lack of sufficient carbohydrates in the diet needed in maintaining healthy energy levels
What Causes Hyperemesis Gravidarum
Rapidly rising serum levels of hormones such as human chorionic gonadotropin (HCG) and estrogen are linked to HG and even morning sickness. During pregnancy, the placenta secretes both estrogen and HCG.
Estrogen stimulates the uterus and placenta to create new blood vessels and transfer nutrients to your baby. On the other hand, HCG induces the corpus luteum to produce progesterone to maintain the pregnancy.
Overall, these hormones aren’t the bad guys; it’s just that when they’re released in excess, they exacerbate morning sickness.
In the early stages of pregnancy, your body produces HCG at a rapid rate, and levels may continue to rise throughout your pregnancy, causing acute vomiting for a longer duration than normal.
Who is at risk for Hyperemesis gravidarum
Various factors can increase your risk of getting HG, including:
- Being a first-time mother
- A family history of HG
- Presence of trophoblastic disease (A rare condition that involves abnormal growth of cells inside a woman’s uterus.)
- Having a multiple pregnancy (giving birth to twins, triplets, etc.)
- Being overweight
Will My Baby Be at Risk?
Normal morning sickness will not endanger your baby’s health if you keep food down, consume a well-balanced diet, and drink lots of water.
The developing baby is rarely impacted by the mother’s illness in more severe HG. However, there is some evidence that if the sickness is extended, your baby is more likely to have a low birth weight, which is normally not dangerously low.
How is Hyperemesis Gravidarum Diagnosed?
The doctor will ask about your symptoms, take a medical history, and do a physical exam. The doctor will look for common symptoms such as a fast pulse and very low blood pressure.
Dehydration can be detected using blood and urine samples. The doctor must also clear gastrointestinal problems as a cause of vomiting and nausea.
A multiple pregnancy test may be required to determine whether you are pregnant with twins or have other issues.
The amount of HCG can give information about your pregnancy and the health of your baby:
- Very high levels can signify multiple pregnancies or abnormal growth in the uterus
- Falling levels can mean a miscarriage or a risk of miscarriage
- Levels rising slower than expected may indicate the chances of an ectopic pregnancy. Tan ectopic pregnancy is where the fertilized egg implants in the fallopian tube instead of the uterus.
How is Hyperemesis Gravidarum Treated?
Treatment for HG will involve:
- Reducing food and drink intake until vomiting stops. This may mean taking smaller amounts of dry foods more frequently. Also, drink plenty of fluids to stay hydrated
- Regularly check blood pressure and heart rate
- Hospitalization for severe HG cases. If keeping food down becomes an issue due to vomiting and nausea, there might be a need to start intravenous fluids (IV). An IV is a drip that feeds fluid straight into the bloodstream
- Using a pressure point wristband. This is a non-invasive treatment for nausea and vomiting in pregnancy using acupressure sea bands
- Eating bland foods. These foods are cooked rather than raw, low in dietary fiber, and are not spicy. They include low-fat dairy products, toast, and pasta
- Wait for nausea to improve before taking iron supplements
- Receiving medication such as anti-nausea drugs like promethazine or go natural with antiemetic supplements like ginger, vitamin B6 and CBD
Taking medicine while pregnant can harm the baby’s health, but severe HG can be dangerous to the mother. Discuss the dangers of using any medication with your doctor.
CBD for Hyperemesis Gravidarum
A 2020 study explains that HG responds partially to antiemetic medication, and cannabis has antiemetic effects. The team studied women with HG. The study examined the participants’ symptoms before and after using cannabis and assessed them using a PUQE grading system. The Pregnancy Unique Quantification of Emesis (PUQE) evaluates the severity of sickness during pregnancy based on three criteria: nausea, vomiting, and retching. Retching is the sound or movement of vomiting.
The study found an improvement in the participants’ symptoms and quality of life. There was a shift in severity lowering by 50% from high range severity to moderate severity. The women were given cannabis that contained 20% THC (tetrahydrocannabinol) and trace amounts of CBD. According to the researchers, the combination was found to have a substantial effect on reducing HG symptoms.
A survey was conducted in British Columbia on 79 pregnant respondents. 65% (51) claimed to use cannabis during their pregnancies. 77% (59) of them had experienced nausea and vomiting of pregnancy. 68% (40) of the sickly individuals used cannabis to treat their condition. 37 (92%) deemed cannabis as effective in alleviating their symptoms.
How Does Cannabis Produce Antiemetic Effects
The action of cannabis in suppressing nausea and vomiting is linked to the effects of cannabinoids on the endocannabinoid system. The endocannabinoid system (ECS) is a complex nerve cell signaling system that modulates the central nervous system’s function and helps maintain homeostasis.
The (ECS) is responsible for regulating the central and peripheral mechanisms of food intake, glucose metabolism, lipid synthesis, and even turnover in the liver and adipose tissue.
According to reviews on the gastrointestinal effects of cannabinoids, they act on CB1 receptors to decrease intestinal motility and inhibit emesis. The latter study uncovered that cannabis’ antiemetic activity is mediated through CB1 receptors in the dorsal vagal complex (DVC). It was also discovered that endocannabinoids represent a unique neuroregulatory system involved in emesis regulation.
The DVC is a collection of three neighboring nuclei of the dorsomedial medulla oblongata in our brain. They include the nucleus of the solitary tract (NTS), area Postema (AP), and the dorsal motor nucleus of the vagus (NTTS). The DVC interprets information from the vagus nerve attached to visceral structures like the gut.
The DVC is considered the start of the final common pathway for the induction of emesis symptoms like vomiting.
There is further research on the effect of CBD in curing conditions that cause severe vomiting and nausea where it has proved to be effective:
- For a case of lithium poisoning, using CBD for treatment produces a biphasic effect. Biphasic means when CBD is given in small amounts, it effectively suppresses lithium-induced poisoning. But when taken in high doses, it enhances vomiting.
- In order to reduce the emetic side effects of chemotherapy medication, a low dose of non-intoxicating cannabinoid CBD was given to the test subjects. They were given separate doses of THC (combined with OND) and CBD to help with retching and vomiting. The cannabinoid (CBD) was an effective antiemetic treatment compared to THC doses given in the experiment.
- Cannabinoids are thought to interact with cannabinoid receptors, but research has revealed they go beyond to affect serotonin receptors. Serotonin receptors influence several functions in our gastrointestinal tract (or GI tract). CBD initiates a psychological response when combined with serotonin receptors (like 5HT1) in our gut. This response brands CBD as an agonist to these receptors to alleviate symptoms of vomiting and retching.
- Moreover, the activation of serotonin receptor 5HT1 reduces the firing of 5HT neurons. The reduction in the firing of 5HT release mediates CBD’s antiemetic effects.
Overall, CBD is observed to have a biphasic effect in dealing with emetic conditions. Most studies show that low doses are recommended for nausea and vomiting. High doses worsen the condition. It remains necessary to consult with your doctor before taking any form of medication when pregnant.
What is CBD
CBD, also known as cannabidiol, is a popular natural remedy for many common ailments. It’s one of more than 100 chemical compounds called cannabinoids found in the cannabis plant.
Cannabidiol is the second common and active ingredient in marijuana after THC. THC or tetrahydrocannabinol is a well-known and psychoactive agent in cannabis.
CBD is the central component of medical cannabis, otherwise known as hemp, which does not cause a “high” by itself. Hemp is genetically engineered (in a laboratory setup) to contain only CBD with less than 0.3% THC.
CBD oil is obtained from hemp plants. CBD from hemp is diluted with a carrier oil like MCT oil, hemp seed oil, or coconut oil to get CBD oil. It can be found in various products like dietary supplements and drinks.
CBD affects various chemicals in the brain but produces different effects to THC. The beauty of CBD, according to the World Health Organization, is that it has no effects that could enhance abuse or dependence potential.
Medications containing CBD have been used for remedying conditions like epilepsy, nausea, anxiety, Parkinson’s disease, and pain.
Types of CBD Products
There are various varieties of cannabis products. Each is consumed differently depending on personal choice, but all attempt to provide a comparable medicinal effect. The types include:
The flower or bud is the smokable part of cannabis plants. The buds are normally harvested, dried, and cured before being dispatched to a dispensary, Flowers are preferred for their high bioavailability. The raw state of flowers avails all the cannabinoids of the cannabis plant, causing an entourage effect. The entourage effect occurs when cannabis compounds other than THC work together to produce therapeutic benefits.
They are made by removing excess plant materials and other impurities from the hemp plant and retaining desirable compounds like cannabinoids and terpenes. Concentrates are very potent, allowing the therapeutic effects of CBD to set in quickly.
These are cannabis-infused drinks or food made from cannabis concentrate or flowers. They come in all imaginable forms like chocolate bars, gummies, beverages, and pastries. Consuming CBD in the form of edibles is a preferable method for those who don’t like smoking.
These are cannabis-infused products applied directly to the skin. They include balms, sprays, lotions, and transdermal patches. CBD topicals are ideal for dealing with pain or inflammation and have a low likelihood of causing any form of intoxication.
These are cannabis products made by dissolving the herb in alcohol. Tinctures are consumed sublingually or under the tongue. This ensures that CBD goes directly to the bloodstream. The taste of CBD may not be appealing, but this form allows for more accurate dosing.
Is CBD Legal?
The farm bill passed in 2018 made it legal to sell hemp products in the US. All 50 states have laws legalizing CBD with varying restrictions. Hemp-derived CBD products are permitted on the federal level but illegal in various states.
On the other hand, cannabis-derived CBD products are illegal on the federal level but legal under some state laws.
Therefore, it’s important to check the laws of your state to help you know what you can legally consume. It’s also necessary to be vigilant about checking for FDA approval on CBD products. Nonprescription products aren’t FDA approved and may be inaccurately labeled.
Is CBD Safe to Use for Hyperemesis Gravidarum When Pregnant?
As observed earlier, research has revealed CBD has various benefits for managing HG. However, not much has been done to understand cannabidiol side effects on pregnant women.
The general view is that using cannabis during pregnancy can be dangerous. This is majorly associated with THC use. CBD, with its properties contrary to the qualities of THC, makes it a better option (though not verified) to reap the therapeutic benefits of cannabis.
HG is a serious condition for mothers causing dehydration and weight loss that CBD can alleviate through its therapeutic antiemesis properties.
Mothers have used cannabis to help with morning sickness and have labeled it an effective treatment. Experts advise pregnant mothers to seek a doctor’s advice before using CBD products.
What Are the Possible Risks of Using CBD Oil While Pregnant?
Research reveals that when mothers smoke or eat marijuana, the products cross the placenta and reach the fetus. Infant exposure to marijuana could increase the risk of a small or stillbirth baby. It can also impair normal fetal brain development. Albeit, there is no data to suggest CBD alone has similar risks.
Using CBD for Hyperemesis Gravidarum
Hyperemesis Gravidarum is a potentially serious illness that may necessitate exhausting all possible treatment options. Cannabis has stood out for its potential to alleviate nausea and vomiting, as well as, in our case, to reduce the severity of HG. CBD treatment for HG necessitates moderation and only low doses, according to studies aids with symptoms of HG. High doses can aggravate the illness.
As of now, additional research is required to prove the safety of consuming CBD products while pregnant. Even though research has not proven CBD to be hazardous, pregnant women should check with their doctor before using cannabis for HG. The doctor will assist you in charting a course of action for using cannabis as a treatment.