The majority of women, 80 percent, experience nausea and vomiting during pregnancy. For most this is an unpleasant but only minor side effect. Thankfully, ‘morning sickness’ tends to disappear at around 16-20 weeks. For some women, however, this nausea and sickness can be extreme. Known as hyperemesis gravidarum, it affects 1-3 percent of pregnant women. There are reports that medicinal cannabis, which is linked to reduced feelings of nausea, can improve the condition and reduce symptoms. Is cannabis for hyperemesis gravidarum a step forward in treatment?
Hyperemesis gravidarum (HG) is a serious complication of pregnancy. There have been some high-profile sufferers who have brought it to public attention. These include comedian Amy Schumer, singer Kelly Clarkson and Kate, Duchess of Cambridge. For these women, nausea and vomiting are not limited to the first trimester. It can continue throughout the pregnancy and lead to hospitalisation.
Hyperemesis gravidarum is an extreme version of morning sickness suffered by many pregnant women. The nausea is severe and long-lasting and accompanied by multiple vomiting bouts. This can lead to dehydration, weight loss and imbalance of electrolytes. It obviously interferes with food intake and sleep at a time when these factors are vital. Sufferers are regularly hospitalised to receive intravenous fluids and to monitor the condition of both the mum and baby.
The severity of nausea and vomiting of pregnancy (NVP) is classified using the Pregnancy-Unique Quantification of Emesis (PUQE) score. Depending on their score women can be treated in the following ways:
Symptoms can decline at around 20 weeks but in severe cases of HG, they only disappear after birth.
If HG is controlled medically, there is unlikely to be any harm to the baby. However, it is possible the mother will experience weight loss during pregnancy. This could lead to a baby being born underweight or smaller than usual.
The combination of long-term nausea and vomiting can affect the sufferer in other ways too.
The causes of HG are unknown but it is likely to be linked to the upheaval of hormones during pregnancy. If a woman experiences HG in one pregnancy, it is likely she will suffer from it during subsequent pregnancies. The Duchess of Cambridge was hospitalised for HG during each of her three pregnancies. There’s a belief that it also runs in families, so if a woman’s sister or mother has suffered from HG, it’s more likely she’ll get it as well. But there is no real understanding of why some women are affected and others aren’t.
Cannabis, or the cannabidiols extracted from it, has many possible medicinal benefits. Although cannabis has been used as a medicine for thousands of years, there is very little research to support its efficacy. The news of its potential therapeutic qualities has spread like wildfire through anecdotal evidence over the last couple of decades. Its reputation has probably increased by social media fanning the flames.
Cannabis, and CBD, have been researched and tested in a few areas and this has led to their regulated use for certain medical conditions. In the UK it has already been formulated to treat rare forms of childhood epilepsy. It can only be prescribed by specialist consultants. Many people with epilepsy, or parents with children who have more common forms of epilepsy, access high strength CBD oil or products to help manage the symptoms. Their campaigns to make the compound more accessible have led to high profile examples of parents importing CBD from places like the Netherlands, where it is more readily available.
Learn more about CBD Oil for Epilepsy
Cannabis is also known as an antiemetic, which is where cannabis for hyperemesis gravidarum may be important. A medicine using CBD or formulated from cannabis is used by the NHS to treat the nausea associated with chemotherapy. This cancer treatment, experienced by so many, can lead to prolonged bouts of nausea. Nabilone is a drug developed to mimic cannabis, in particular the THC effects, and can reduce the feelings of nausea caused by chemo. If it works in this situation, could a drug based on cannabis be useful for treating HG?
A study published in 2020 reports impressive results when cannabis was used to treat HG. The study was, however, extremely small, with only four women taking part. It’s important to note that the study refers to women “smoking through a pipe” and “two-three puffs”. These women were administered cannabis, containing measured amounts of THC and CBD, rather than CBD alone, which tends to be THC-free. Nabilone, the drug to treat nausea in chemotherapy, also mimics the actions of THC. We can assume, therefore, that the reduction in nausea and improvement in these women’s symptoms is closely linked to THC and cannabis and not the CBD oil available to the public.
All four women in the study reported a significant reduction in their PUQE scores, tended to feel immediate relief after smoking cannabis, and all gave birth to healthy, full-term babies. The study reported that taking cannabis “appeared to have a dramatic effect on the course and severity of the condition”. It concluded that “cannabis may be effective for HG, and should be studied in appropriately powered, controlled studies, fully considering potential fetal risks.”
The study mentioned was carried out using strict controls. The cannabis administered was measured and restricted, while levels of THC and CBD were recorded and adjusted. Nor is there any description of the preparation of cannabis used. There is no way that anyone trying cannabis to relieve their own NVP could ingest the same amounts. Any attempt could be dangerous to both the mother and baby.
Medical professionals generally advise expectant and breastfeeding women to avoid all medication and substances like caffeine or alcohol. Even everyday over-the-counter remedies for pain or stomach upsets, for instance, are not recommended. A regular GP would never suggest trying cannabis, or even CBD (which has only minor side effects even when taken in high doses) to combat morning sickness.
In addition, personal use of cannabis may be legalised or decriminalised in some countries or states, but possession can still be illegal. Furthermore, taking cannabis, or any other illegal drug, during pregnancy could be viewed as child neglect or abuse.
An ongoing case in the USA shows this clearly. In 2019, Lyndsay Ridgell gave birth to a healthy baby boy in Arizona. She had suffered from HG during the pregnancy and had been hospitalised twice. Her sickness stopped after the birth. A few days later, a social worker reported Ridgell to the Department of Child Safety, an organisation employing her as a social worker at the time. In addition, she was to be placed on the child abuse register for 25 years. This was a result of Ridgell self-administering medical marijuana to combat HG, an act considered to be child neglect. She was subsequently demoted and suffered a loss of income. However, medical marijuana is not illegal in Arizona. Her case has been taken up as an example of the inconsistency of the law and its being used to target pregnant women.
The American College of Obstetricians and Gynecologists does not recommend the use of cannabis during pregnancy or breastfeeding on the grounds that there is not enough research on its potential harm to the mother or baby. In addition, the U.S. Centers for Disease Prevention and Control support the belief that marijuana can affect foetal brain development and lead to low birth weight.
The small amount of research, combined with anecdotal evidence, suggests that cannabis may be an effective way to relieve nausea and sickness during pregnancy, and in HG. However, when the lack of research into cannabis and its effects on the foetus is considered, there is very little data to support these claims. The relief of HG symptoms appears closely linked to the consumption of cannabis and, more importantly, THC.
Medicinal cannabis is not legal in the UK and possession of cannabis risks a five-year prison sentence. CBD oil and products are legal because they do not, or should not, contain THC, the psychoactive element of the hemp or cannabis plant. Therefore, anyone caught with cannabis and claiming it is being used to relieve HG could be in a dangerous position. It’s also possible that the unborn child could be considered as being at risk.
If adequate research is carried out into the effectiveness of cannabis for hyperemesis gravidarum, it could signal a breakthrough. This unpleasant, exhausting and ultimately dangerous condition could be treated naturally and safely. Let’s hope that the growing interest in cannabis-based medicine extends to HG and that for sufferers, pregnancy becomes the joyful, healthy and rewarding experience it is for most women.
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