The use of cannabis for Hyperemesis Gravidarum (HG)
Hyperemesis Gravidarum (HG) responds only partially to standard antiemetic medications. Cannabis has been known to possess antiemetic effects and there are several medicinal cannabinoids used as anti -emetics for cancer chemotherapy. Its favorable use for HG has been described in social media, but not in the medical literature.
We evaluated 4 women with HG counseled by the Motherisk Program, before and following the use of cannabis. Using the validated Pregnancy Unique Quantification of Emesis (PUQE) scoring system and employing the Student’s paired t test, we compared changes in symptoms following initiation of cannabis.
There was a highly significant improvement in symptoms: PUQE score improved from 14.5+/− 1 to 7.5+/− 0.58(p = 0.0004). Cannabis use was associated with a significant increase in the PUQE Quality of Life scale, from 2+/− 0.82 to 7+/− 0.82 (p = 0.0012).
The results suggest that cannabis may be effective for HG, and should be studied in appropriately powered, controlled studies, fully considering potential fetal risks.
Nausea and Vomiting of Pregnancy (NVP) affect up to 80% of pregnant women and is characterized by varying severity of symptoms that in most women subside by the end of the first trimester of pregnancy. At the severe end of NVP, Hyperemesis Gravidarum (HG) affects between 1 and 2% of pregnant women and is characterized by severe and protracted nausea and multiple vomiting, weight loss, dehydration and electrolyte imbalance, responding only partially to standard antiemetic medications (Dean et al., 2018). Most women experiencing HG need hospitalization for rehydration and nutritional support. Cannabis has been known to possess antiemetic effects and there are several medicinal cannabinoids used as anti -emetics for cancer chemotherapy (Mersiades et al., 2018). A narrative review of PubMed, EMBASE, Cochrane and social media has revealed large numbers of American women claiming favorable effects of cannabis on their HG symptoms (Facebook, 2019). However, these uncontrolled reports are difficult to evaluate due to the unstructured methods of data collection and reporting. In parallel, several epidemiological studies have reported on cannabis use in pregnancy. In Hawai, 2.6% of women reported using marijuana during pregnancy between 2009 and 2011. The 21.2% of women who reported severe nausea during pregnancy were significantly more likely to report marijuana use during gestation (Robertson et al., 2014). To the best of our knowledge, to date there has not been direct clinical research documentation of cannabis effects in HG. We describe four cases of cannabis use among women who called and were followed up by a medical a service focusing on providing information and counseling for pregnant women suffering from HG .
This retrospective study was approved by Shamir Hospital Research ethics board in Israel. All women consented to including their cases in the article, based on anonymous presentation. The study was conducted by the Motherisk Program, an academic counseling and follow- up service for women experiencing NVP and HG. Counseling and follow up telephone interviews are conducted by a trained counselor who has expertise in pharmacy and business administration. The counselor is backed by two pediatric pharmacologists/ reproductive toxicologists and a large team of drug information specialists. The counseling sessions include advice on nutrition, fluid intake, medicinal and non –medicinal therapeutic interventions. In this study, we analyzed cases followed up by us after using cannabis, which was initiated by the women, with support of their physicians (who did not prescribe to cannabis). For each woman we recorded the symptoms of nausea (length and strength) vomiting (numbers) and retching (number) and scored them based on the validated PUQE score (Koren et al. 2002) (Table 1). We scored the PUQE score and its Quality of Life scale reported before cannabis was started, and subsequently after at least 3 days of use. The PUQE score ranges from 3 (no symptoms) to 15 (maximal symptoms). The Quality of life scale is based on a visual analogue scale, ranging from 0(the worst possible) to 10 (best) PUQE Score (from Koren et al., 2002).
The PUQE scores before and after starting cannabis were compared by the Student’s t test for paired data. The Kolmogorov –Smirnov test of Normality was used to verify whether the data were normally distributed, with calculation of Skewness and Kurtosis.
A 32 year old physician in her third pregnancy. Her first pregnancy was characterized by HG between weeks 6–20, with no response to Diclectin (doxylamine and pyridoxine) and partial response to intravenous ondansetron. A healthy 3.4 Kg baby boy was born at 40 weeks. Her second pregnancy was also complicated by HG between weeks 6–16, again with no response to Diclectin and partial response to ondansetron. A healthy 3.14 Kg aby girl was born at 40 weeks.
In her third pregnancy HG started at 6 weeks, responding partially to Diclectin but with a marked sedative effect. Her PUQE score before starting cannabis was at 13. Starting at 11 weeks of gestation she tried 3 different types of cannabis containing 18–23% THC and 0.8–1% CBD by smoking through a pipe. The nausea and vomiting completely resolved after 2–3 puffs and the effect was sustained for 3 h. After several weeks the response weakened, covering only 2 h. The PUQE score following cannabis was at 7. Her Quality of life score was 3 prior to cannabis and was raised to 7. Overall, she was using 1–2 g cannabis per day. Before starting the cannabis she had lost weight, which reversed with cannabis and overall she gained 7 Kg over her pregnancy. She continued with cannabis till birth due to continued symptoms. The cannabis effectively controlled vomiting but she continued to be nauseated. She gave birth to a healthy 3.4Kg 39 wk. boy at Apgar 9–10 who had a short bout of transient tachypnea of the newborn. Long term follow up by the Denver scale suggested normal development and achievement of milestones.
A 32 year old woman who experienced HG between weeks 6–14 of her first pregnancy. She was treated with metoclopramide but developed an allergic reaction.
In her 2nd pregnancy HG started at 4 weeks with up to 70 bouts of vomiting a day necessitating repeated hospitalizations and use of a nasogastric tube and parenteral nutrition. She was continuously hospitalized with her vomiting responding to Diclectin and ondansetron but with continued severe nausea, which prevented her from eating. Her PUQE score was at 15. While continuing Diclectin and ondansetron, she started at 14 weeks of gestation smoking cannabis, trying 3 different types containing 18–20% THC and 0.1% CBD. Two-three puffs resulted in total relief of nausea and vomiting, ability to eat and keeping the food down. Each round of puffs sustained its effect for 3–4 h, and for the remaining of her pregnancy she was not hospitalized despite continuation of her symptoms. Her PUQE score decreased to 7. Her Quality of Life score increased from 2 to 7. She experienced a mild sedative effect with the different types of cannabis, and hypotension with the Sativa. She asked to be delivered at 36 weeks due to her symptoms of HG, and a healthy baby boy of 2Kg was born, who, at 1 year of age appears to meet his developmental milestones.
A 33 year old woman experienced mild NVP in her first pregnancy responding to metoclopramide, giving birth to a healthy girl.
In her second pregnancy she experienced HG starting at 10 weeks, unresponsive to Diclectin, ondansetron or ginger. She experienced up to 20–25 bouts of vomiting a day, extreme weakness, falls, and needed 3 hospitalizations receiving ondansetron intravenously, which controlled the vomiting but with continuous severe nausea, precluding eating. She was maintained on home-care infusions plus ondansetron.. Her PUQE score was at 15.
At 12 weeks gestation she started smoking different cannabis preparations containing 20% THC and 0.1% CBD. She also tried to use THC in sublingual drops, but with no effect.
With the combination of IV ondansetron and smoking cannabis 2–3 puffs every 2 h for a total of 1 g/d her vomiting decreased from 6 to 15 a day to only 6 a day. Her PUQE score was at 8. Her Quality of Life scale increased from 2 to 8. Her overall status improved dramatically, with significantly less depression, improved appetite and substantially less nausea. Prior to cannabis she had lost 3 Kg of body weight, but with cannabis she resumed weight gain. She continued with cannabis till one week prior to birth. A full term baby boy was born at 2.6 Kg with normal developmental trajectory.
A first pregnancy of a woman suffering from colitis and fibromyalgia who had been treated with medical cannabis that was stopped before pregnancy at 2 g/d as 2–3 puffs every 2–3 h.
She experienced HG starting at 7 weeks of gestation. Her PUQE score was 15. The use of cannabis was associated with major improvement in nausea and vomiting. Her PUQE score improved to 8. For religious reasons she did not used cannabis on Saturdays, resulting in nausea and lack of appetite. She was also treated with 5 amino salycilic acid and citalopram for her colitis and fibromyalgia. Her Quality of Life scale improved from 1 to 6.
A healthy 2.6 Kg baby girl was born at term. At 4 years of age she is healthy and appears to be developing well.
The PUQE and Quality of Life values in our patients followed normal distribution evidenced by the Kolmogorov-Smirnov test and calculation of skewness and kurtosis. The data did not differ significantly from that which is normally distributed, with D value of 0.41, skewness of 0 and Kurtosis of − 3. Following use of cannabis, the mean PUQE score decreased from 14.5+/− 1 (mean +/− standard deviation) to 7.5+/− 0.58 (p = 0.0004). Cannabis use was associated with a significant increase in Quality of Life scale, from 2+/− 0.82 to 7+/− 0.82 (p = 0.0012). For both comparisons variances were very close, meeting parametric assumptions.
In all 4 cases, the women experienced weight loss prior to using cannabis, which was reversed following cannabis. In 4 cases there was improved appetite. One woman reported hypotension and sedation while on cannabis.
In these 4 severe cases of HG, cannabis preparations containing 20%THC and traces of CBD appeared to have a dramatic effect on the course and severity of the condition. We included all 4 cases collected by us, hence there was no bias in applying statistical analysis, and despite the small numbers, the differences following cannabis were highly significant. The concentrations of the cannabis compounds were measured as part of the quality assurance programs of the official suppliers to the Ministry of Health. The mean PUQE score improved from 14.5 which is in the upper range of severity, to 7.5, corresponding to the middle range of moderate cases. To put these changes into perspective, this is a very large effect size of 7 using Cohen’ d. In studies on NVP, the typical effect of anti emetics such as diclectine has been of medium effect size. Although the cannabis was produced in several different laboratories, the ranges of concentrations of active THC and CBD were similar. Small doses of 2–3 puffs appeared to deliver optimal relief. In British Columbia, of 79 pregnant respondents, 51 (65%) reported using cannabis during their pregnancies. While 59 (77%) of the respondents who had been pregnant had experienced nausea and/or vomiting of pregnancy, 40 (68%) had used cannabis to treat the condition, and of these respondents, 37 (over 92%) rated cannabis as ‘extremely effective’ or ‘effective’ (Westfal et al., 2006). A major issue is the existence of numerous different preparations of cannabis, without appropriate comparator data among them, leaving the women with the need for trial and error. Other important issues that must be adequately addressed are the fetal safety of cannabis (Sharapova et al., 2018) and balancing it with the fetal risks of undertreated HG (El Maroun et al. 2019).
In our cases, three of the four children had evidence of growth restriction which is a typical outcome of the HG- induced severe calorie and protein restriction, in parallel to missing numerous micronutrients (Koren et al., 2018). All 4 children appeared to have developed normally although no formal testing were performed on them and no control group was available. Concerns about long term child development have been a major reason for the ACOG to warn about cannabis use in pregnancy, (Committee on bostetric practice, ACOG, 2017). Previous studies were all done among recreational users who have numerous confounders for developmental delay. This may not be the case in women using cannabis for HG. In contrast, women with HG may be needing larger doses of cannabis for longer durations than are used by recreational users. To date, after large numbers of follow up studies, there is still controversy whether fetal cannabis exposure is associated with independent developmental delays. Associations between cannabis use and offspring achievements among recreational users has been affected by residual environmental and parental confounders (Sharapova et al., 2018). In a recent review, Metz and Borgelt (2018) documented that there are many legitimate concerns regarding the safety of marijuana in pregnancy, including animal studies and biological plausibility.
Presently the safety of marijuana in pregnancy has not been demonstrated and its use is advised against by many professional societies. While it is possible that risks of untreated HG are higher than previously thought (Koren et al., 2018), this issue will have to be addressed by future research and fetal cannabis exposure cannot be assumed to be safe for HG.
While more research is needed before cannabis can be considered for use in HG, this report suggests that cannabis should be tested in appropriately- powered control trials for this severe and protracted maternal condition, addressing both maternal effect and potential adverse fetal effects.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
CBD Oil and Pregnancy: Safety & Efficacy For Maternity
Pregnancy can be both a beautiful and uncomfortable experience. Many expecting mothers experience cramping, insomnia, anxiety, morning sickness, and many more symptoms throughout the course of their pregnancy.
One of the newer and more exciting health supplements to hit the market recently that’s been shown to support many of these symptoms is CBD Oil. This oil is made from one of the active compounds in the hemp plant known as cannabidiol — CBD.
But exactly what is CBD oil? How do you take it, and what effects can it have on your pregnancy? Read on to learn everything you need to know about taking CBD oil during pregnancy.
What is CBD Oil and Is It Safe During Pregnancy?
CBD stands for cannabidiol — one of over 400 different compounds found in the cannabis plant. The chemical structure of CBD is unique in that it closely resembles some of the hormones produced by our body known as the endocannabinoids.
The similarities in the structure of CBD to these hormones allow CBD to interact with the endocannabinoid system — made up of a series of receptors around the human body. This system has many uses but the most important is its role in regulating homeostasis (balance).
This ability to interact with regulatory systems like the endocannabinoid system is what gives CBD so many health benefits. Instead of working through just one organ, it’s able to interact with organs all around the body.
CBD has been shown to support muscle relaxation (such as cramping or muscle injuries) , boost immune function , reduce inflammation , block excessive pain transmission from reaching the brain , and regulate the nausea center in the brain to fight morning sickness and other forms of nausea or vomiting .
You can find CBD in many different forms, including capsules, edibles, and oils. Out of all the different types of CBD products, CBD oils are the most popular. They’re easy to use, the dose can be tailored to match your specific needs, and they have a long shelf life.
What’s the Difference Between CBD & THC?
CBD and THC are the two most common compounds in the cannabis plant. Both compounds are similar in structure — they even have the same molecular structure: 30 hydrogen atoms, 21 carbon atoms, and 2 oxygen atoms.
Although similar in structure, CBD and THC each have a very different effect on the body.
THC is the main psychoactive compound in the marijuana plant — it’s what produces the high associated with marijuana use. It works by stimulating the endocannabinoid receptors in the body, activating the release of serotonin, and other neurotransmitters.
CBD, on the other hand, is completely non-psychoactive. It doesn’t activate the endocannabinoid receptors directly, and will instead work indirectly by slowing the breakdown of our naturally occurring endocannabinoids.
It also interacts with other receptors in the body associated with inflammation and the transmission of pain in the spinal cord. Many of the medicinal effects associated with cannabis owe these benefits to the CBD content.
In basic terms — THC makes you high, CBD makes you feel better.
All cannabis plants manufacture both CBD and THC — however, depending on the type of cannabis, the ratios can be radically different. There are big differences between hemp and marijuana plants where CBD, THC, and other cannabinoids are extracted.
Hemp plants, for example, produce almost no THC but will contain high levels of CBD instead.
Marijuana plants (the type people smoke to get high), are the opposite, producing primarily the psychoactive cannabinoid THC and lower levels of CBD.
For the context of this article, the CBD oils we’re talking about are all made from the hemp plant — not marijuana.
Why Are Pregnant Women Taking CBD Oil?
Pregnancy, in all its beauty, places a lot of strain on the body. There are a lot of side-effects pregnant women may experience that can impact daily life — some more severe than others.
For example, a common condition a large number of women experience during pregnancy is hyperemesis gravidarum — excessive morning sickness.
This condition can be debilitating, making it nearly impossible to leave the house when it’s at its worst. Additionally, frequent vomiting can easily result in dehydration — which is dangerous for both the mother and baby.
There are medications available for this condition, but most of them come with their own set of negative side-effects.
One such medication doctors frequently prescribe is called Prochlorperazine. This medication stops the feeling of nausea by acting directly on the nausea center of the brain. The problem is that it also causes side-effects such as insomnia, dizziness, blurred vision, and anxiety. It merely shifts the problem from nausea to something else.
CBD is becoming one of the most popular alternatives to medications like this for expectant mothers. It offers many of the same benefits of reducing nausea symptoms — without the negative side effects.
In fact, CBD actually addresses many of the side-effects anti-nausea medications like Prochlorperazine produce — including anxiety and insomnia.
This is only one example, but there are a number of different reasons why pregnant women are seeking out CBD-infused products to support various symptoms throughout the course of their pregnancy.
The most common reasons pregnant women may want to consider using CBD supplements:
- Sleeping problems and insomnia
- Mood disorders
Are Cannabinoids Safe During Pregnancy?
There are well over 67 different cannabinoids in the cannabis plant — only a small handful of which are psychoactive. This includes THC as the primary psychoactive component.
The first thing we need to make crystal clear here is that THC-containing products, like marijuana, are not safe during pregnancy. There’s evidence that suggests smoking marijuana during pregnancy results in a lowered birth-weight and delays in brain development [1, 2].
When we smoke marijuana or use products that contain THC — we have to remember that this compound is going to pass straight through the placental barrier and interact with our baby’s brain.
This goes for most other supplements we take while pregnant. Everything we put into our body will ultimately reach the baby — everything from the food we eat to the air we breathe.
But What About CBD & Other Non-Psychoactive Cannabinoids?
There are experts who are hesitant to recommend CBD during pregnancy — but this isn’t because the compound is inherently dangerous in any way — in fact, there’s a lot of anecdotal evidence  and preliminary research , indicating that CBD is indeed safe during pregnancy.
The hesitation of CBD comes purely from the lack of research available on the topic.
Currently, there’s no long-term research available in the scientific literature exploring whether CBD oil is safe and effective during pregnancy — However, there isn’t anything that proves this compound is dangerous either.. This is a topic that’s been relatively ignored despite the widespread interest in cannabis research in recent decades.
Without the research to prove that CBD is indeed safe and effective during various stages of pregnancy — most experts will err on the side of caution and avoid it.
This lack of pregnancy-specific research is common when it comes to health supplements. Many supplements thought to be safe and effective are generally avoided anyway simply due to the lack of research.
There Are 3 Good Reasons for This Lack of Research:
1. It’s Hard to Get Research Involving Pregnant Patients Approved
In order to conduct any research, especially on humans, a professional ethics board needs to approve the study parameters. These boards are especially strict when it comes to pregnancy and will often deny any research requests if there hasn’t already been enough proof that the substance is safe through other studies.
2. Pregnancy Makes it Hard to Account for All the Variables of the Study
Pregnancy is a complex chemical process and affects women differently. No pregnancy is alike — we all experience the side-effects differently.
This makes it very hard to study the effects of a supplement like CBD because what might work for one person won’t for another — not because the CBD doesn’t work, but because the causes of that particular symptom might be different from one person to the next. This makes interpreting the data into something meaningful very challenging.
3. Research Takes Place Over Long Periods of Time
The last point we’ll touch here is that the research for determining the safety of a health supplement needs to be done over long periods of time — often several years.
Research like this is tedious and very expensive. A single randomized, double-blind clinical trial can cost several million dollars and take a decade or more to complete.
There are institutions that will pay for research like this, but as of yet, no one has stepped up to take it on for this particular question.
There are simply other areas of interest more important to research at the moment (like some of the exciting clinical trials currently underway exploring the use of CBD with anxiety or other common medical conditions).
On top of that, there simply isn’t any indication that CBD poses any threat to a fetus or pregnant mother as it is. It would be nice to have some rock-solid research behind us to definitively prove it — but there’s a good chance all this time and effort will only prove what we already know — that CBD poses little threat during pregnancy.
There Are Virtually No Indications That CBD is Unsafe During Pregnancy
Despite the lack of research on using CBD during pregnancy, there are virtually no examples of research to draw on that suggest the compound is unsafe.
In an ideal world, you won’t need to take anything during your pregnancy aside from wholesome food and mild herbal teas. However, sometimes you may need relief from the uncomfortable symptoms of pregnancy.
CBD is an excellent option to try before escalating to some of the more harmful pharmaceutical options doctors may prescribe in its place.
Women around the world are using CBD to manage spikes in uncomfortable symptoms and avoid using pharmaceutical drugs as much as possible during their pregnancy. This has been going on for years, and I have yet to hear of even one case study to suggest CBD has any significant adverse effects on the mother or the baby.
With that said, there are a few important steps you can take to keep your level of risk to a minimum when using CBD, as well as any other supplement while pregnant.
How to Use CBD Safely While Pregnant?
1. Start Low & Go Slow
When it comes to using health supplements during pregnancy, the key is to start low and slow — meaning that you should always start with the lowest possible dose, and build it up gradually until you reach the recommended dosage.
2. Talk to Your Doctor Before Using CBD
It’s also important to remain transparent with your doctor about any health supplement you plan on taking.
Pregnancy is a complex process, and there are a number of individual factors to consider depending on other medical conditions you may have and what medications you may be taking.
Your doctor has the medical know-how to decide whether CBD is appropriate for your individual case.
3. Keep Notes on Your Doses and Progress
One of the best steps you can take when introducing a new supplement or medication in your health regimen is to take notes of your dose and how you respond to it during the course of the treatment. This will help you and your medical practitioner understand how the CBD or other supplement is working (or not).
Keep Track of Things Like:
- What dose of CBD did you take?
- How did your symptoms feel today?
- Were symptoms improved after taking the CBD?
- Did you experience any side-effects?
- Which CBD product did you take?
5. Only Use High-Quality Products
Many health supplements are unregulated — meaning that virtually anybody can buy the raw materials and put together health supplements. This leaves a lot of room for low-quality products on the market — some of which contain harmful compounds you wouldn’t want to bring anywhere near your baby.
In the case of CBD oils, the biggest problem is the contamination of heavy metals, pesticides, and organic solvents. All of these things can be harmful to the health of your baby.
Luckily, there’s a solution to this issue — which comes in the form of third-party testing.
This is an optional step CBD manufactures can do to prove the quality of the products they produce. A company will send a sample of its batch of products to an independent lab (not connected to the company). This lab will test the sample and provide a detailed analysis of the heavy metal, pesticide, solvent, and organic contaminant contents.
I recommend doing some research before you buy. Look for these third-party tests and make sure they’ve all passed before you buy that particular product.
You may also want to consider using creams during your pregnancy as they are safer than ingestible forms because the CBD doesn’t pass into the bloodstream.
6. Use CBD Products Made from Isolate Only
There are two main types of CBD product available — full-spectrum extracts and CBD isolate.
Full-spectrum extracts contain all the phytochemicals naturally produced in cannabis, while CBD isolate has had all compounds except the CBD removed.
While both options have their own positives and negatives, for pregnancy it’s recommended that you opt for a CBD isolate. These products have removed the other cannabinoids, including THC — which is considered unsafe during pregnancy.
This way you can rest assured the only compound you’re using is the one you planned for — CBD.
How to Use CBD Products (After Pregnancy)?
There are a few different ways you can use CBD oils. Let’s go over the three most common.
1. Oral Ingestion
Most expectant mothers who take CBD oil choose to orally ingest the oil.
This simply involves applying the dropper directly in the mouth and swallowing the oil. Alternatively, you can mix the oil in with a smoothie or other meal to disguise the naturally bitter flavor.
The bottom line is that CBD oil taken this way ends up in the gut where it’s absorbed over the course of about 2 hours into the bloodstream.
CBD oil products can be purchased online from trusted vendors such as CBDistillery, Royal CBD, Charlotte’s Web. They come in a variety of options (ranging from 250mg, 500mg to 1000mg) in the form of tinctures, beverages, edibles, and capsules, which are all easily consumed.
2. Sublingual Administration
“Sublingual” refers to holding something underneath your tongue where the oil and active ingredients are absorbed by the capillaries beneath the tongue.
This means of administration produces effects relatively quickly (within about 15 minutes). Once done, you can simply swallow what’s left of the oil.
This form of administration is best for symptoms that appear suddenly as it allows you to address them in a shorter window of time.
3. Topical Application
You can also use CBD oils topically for things such as skin irritations, inflammation, wounds, and muscle aches. This form of use has far fewer restrictions than other forms of supplementation and is the safest form of administration.
Only a small fraction of the CBD content actually makes its way into the bloodstream when used topically. So you can use higher doses, and you don’t need to be as cautious about monitoring for side-effects.
With that said, this form of administration will only provide relief for symptoms involving the skin and muscles. It won’t do much for any of the systemic effects CBD is suggested to support.
I know many women that use CBD oil topically in this way on the abdomen for cramping and on the lower back to alleviate pain.
Final Thoughts: Using CBD During Pregnancy
There are many reasons why a pregnant mother may want to give CBD a try. This compound is useful for common side-effects experienced by pregnant women — including muscle cramping, abdominal pain, headaches, insomnia, anxiety, and nausea.
The safety of CBD during pregnancy is taken with a lot of caution — and with good reason, we don’t have any reliable studies to prove or disprove the safety of this compound on the developing fetus.
We’re caught in a situation where CBD hasn’t been proven safe, nor has it been proven unsafe.
Therefore, the best course of action is to remain cautious when using CBD oil. This is the case with all supplements while pregnant.
Pay attention to how your body responds and be transparent with your doctor about anything you’re taking or thinking of taking while pregnant.
With all of that said, there really isn’t any clear reasons why CBD would pose any danger to yourself or your baby. There have been dozens of studies on the supplement with populations including small children — all of which have concluded that CBD is both a safe and effective supplement for a wide range of symptoms — even at high doses.
- Jaques, S. C., Kingsbury, A., Henschke, P., Chomchai, C., Clews, S., Falconer, J., … & Oei, J. L. (2014). Cannabis, the pregnant woman and her child: weeding out the myths. Journal of Perinatology, 34(6), 417.
- The National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. National Academies Press.
- Choukèr, A., Kaufmann, I., Kreth, S., Hauer, D., Feuerecker, M., Thieme, D., … & Schelling, G. (2010). Motion sickness, stress and the endocannabinoid system. PloS one, 5(5), e10752.
- Su, J. Y., & Vo, A. C. (2007). 2-Arachidonyl Glyceryl ether and abnormal cannabidiol-induced vascular smooth muscle relaxation in rabbit pulmonary arteries via receptor-pertussis toxin-sensitive G proteins-ERK1/2 signaling. European journal of pharmacology, 559(2-3), 189-195.
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- Russo, E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1), 245.
- Crippa, J. A., Crippa, A., Hallak, J. E., Martín-Santos, R., & Zuardi, A. W. (2016). Δ9-THC intoxication by cannabidiol-enriched cannabis extract in two children with refractory epilepsy: full remission after switching to purified cannabidiol. Frontiers in pharmacology, 7, 359.
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Livvy is a registered nurse (RN) and board-certified nurse midwife (CNM) in the state of New Jersey. After giving birth to her newborn daughter, Livvy stepped down from her full-time position at the Children’s Hospital of New Jersey. This gave her the opportunity to spend more time writing articles on all topics related to pregnancy and prenatal care.
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Can I Use CBD While Pregnant?
Elisa is a well-known parenting writer who is passionate about providing research-based content to help parents make the best decisions for their families. She has written for well-known sites including POPSUGAR Family and Scary Mommy, among others.
Verywell Family articles are reviewed by board-certified physicians and family healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.
Andrea Chisolm, MD, is a board-certified OB/GYN who has taught at both Tufts University School of Medicine and Harvard Medical School. She has over 20 years of clinical experience and is currently is in practice at Cody Regional Health in Cody, Wyoming.
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Pregnancy comes with a slew of unpleasant side effects, like extreme nausea or persistent backaches, but many common medications are no longer safe once you have a baby on the way. If you’re on the hunt for something natural to cure your morning sickness, a strained lower back, or even pregnancy-related anxiety, you may start to wonder about CBD.
As wonderful as this substance may seem, it is not safe to use during pregnancy. Although there isn’t enough research yet to say for sure what could go wrong, there are a few potential concerns to know about. And until we know more, it’s best to err on the side of caution and avoid CBD while pregnant.
What is CBD?
Cannabidiol (CBD) is a component of the cannabis plant. CBD has many therapeutic benefits, such as helping to alleviate chronic pain, anxiety, and depression, insomnia, and nausea and vomiting. There are a few choices for how to take CBD, including topicals, gum, sublingual drops, and gel caps.
CBD won’t make you stoned, though. Unlike Tetrahydrocannabinol (THC), another well-known component of the cannabis plant, CBD does not intoxicate. Many people prefer to use CBD because it gives them the benefits of cannabis without the associated “high.” In general, you can get CBD anywhere in the country, since it’s federally legal.
Is It Safe to Use CBD During Pregnancy?
The Federal Drug Administration (FDA) says it “strongly advises against” taking CBD while pregnant or breastfeeding. You should avoid CBD during pregnancy, largely because its effects on a developing fetus are simply unknown. We do know that THC can enter a developing baby’s brain, so there is reason to believe CBD may be able to as well.
“There is the potential risk that [CBD] could affect embryo implantation and promote miscarriages,” cautions Felice Gersh, MD, a California-based OB/GYN and award-winning author of two books on fertility and polycystic ovarian syndrome.
The FDA is still collecting data on the exact risks of taking CBD during pregnancy, but until we hear any different, you should not consider CBD as a safe option when you are expecting.
Every pregnancy is different. Be sure to consult with a healthcare provider about your circumstances if you have any questions about taking CBD while pregnant.
What If I Use CBD Before Realizing I’m Pregnant?
If you regularly use CBD, or you just happened to try it out before you got that positive pregnancy test, don’t panic. According to Marco Mouanness, MD, an OB/GYN and fertility expert at the Rejuvenating Fertility Center in New York City, you are probably fine. Along with discontinuing your CBD use, he advises reaching out to your OB/GYN so they can monitor you as necessary.
Since we really don’t know enough about CBD’s effects on pregnancy and a developing fetus, we have to rely on what we know about THC, since they are both cannabis components. Animal studies show a connection between THC and early miscarriage, but Dr. Mouanness points out that if you get a positive pregnancy test, you haven’t miscarried. As long as you stop using CBD right away, the earlier CBD use won’t cause miscarriage.
In some cases, your OB/GYN may prescribe progesterone to offset any potential miscarriage risk, notes Dr. Gersh. “Taking supplemental progesterone may provide some protection from the effects of CBD exposure early in pregnancy. [as it] sometimes helps prevent miscarriage.”
CBD is not safe to take during pregnancy. There are a few potential risks to know about.
Potential Risk of Miscarriage
Animal studies have found a link between CBD use and early miscarriage. While animal studies do not directly translate to humans, you may want to stop taking CBD as a precaution if you are actively trying to conceive.
Potential Reproductive Harm
Another animal study linked CBD use in pregnancy with lower sperm production in male offspring. So, if you give birth to a boy, there could be a risk to his future reproductive health. Again, results from animal studies do not always carry over to humans. However, it is best to play it safe.
Worsening of Pregnancy-Related Side Effects
Many people like CBD because of its minimal side effects. However, some people experience tiredness or diarrhea when using CBD. These side effects could negatively affect your pregnancy. No one wants to be even more tired than pregnancy already makes a person, and diarrhea may lead to dehydration—a dangerous state when pregnant.
When Can I Resume Using CBD?
If you choose to breastfeed your baby, you should continue to hold off on CBD use. “CBD. will cross into the breast milk and go to the baby,” warns Dr. Gersh.
There is some evidence that CBD in breastmilk may negatively affect infant motor development. And since it stays in your milk for a while, this isn’t something you can “pump and dump.” “Some studies have shown that CBD oil derivatives can be found in breastmilk for up to six days after use,” Dr. Mouanness points out.
Once you have fully weaned your baby from the breast, it is safe to start using CBD again. At this point, there is no longer any risk to your child. There are pros and cons to taking CBD, but those are up to you to discuss with a doctor once you’re no longer sustaining your child with your body.
Pregnancy Safe Alternatives
If you are seeking relief from certain pregnancy symptoms, there are a few natural remedies that may help.
Ginger is an ancient remedy proven to help with nausea and vomiting. Dr. Gersh notes that you can consume ginger in any of its forms, including candied, pickled, or as a tea, to get the positive effects.
If you can’t get the sleep you need, magnesium, an essential vitamin, may help. Magnesium has a calming effect when taken regularly, which, along with promoting good sleep, may help combat anxiety and depression. Taking a magnesium supplement blocks pain receptors, so it may also decrease headaches and other aches and pains.
Dr. Mouanness notes that vitamin B can significantly reduce pregnancy-induced nausea. However, he also points out that you should not take any more vitamin B than the amount already included in your prenatal vitamins unless directed to by a doctor, since we don’t know enough about its effects on a developing fetus.
Be sure to consult with a healthcare provide before starting any new supplements or medications.
A Word From Verywell
CBD has many benefits, but the possible risks to a developing fetus make it unsafe to use during pregnancy. Miscarriage and effects on future fertility or infant motor development are possibly related to its use, and until we learn more, the risk is not worth it.
That doesn’t mean you have to suffer through uncomfortable or unbearable pregnancy side effects, though. Don’t hesitate to reach out to an OB/GYN, midwife, or healthcare provider for ideas on how to safely treat your symptoms.