Cbd oil for hg

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).

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Data Synthesis:

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

What Does a Recent Study Say About Using Cannabis for Hyperemesis Gravidarum?

A lot of women experience what is referred to as ‘morning sickness’ during pregnancy. This is when the pregnancy causes nausea and vomiting, typically occurring at any part of the day despite its name. However, many women don’t know that there is an extreme version of morning sickness which can be devastating to the mother and the child. Researchers Gideon Koren and Rana Cohen have found promise in the effectiveness of cannabis for this extreme condition known as Hyperemesis Gravidarum.

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What is Hyperemesis Gravidarum?

The HER Foundation explains Hyperemesis Gravidarum (HG) as a potentially life-threatening pregnancy disease that causes extreme morning sickness. HG causes weight loss, malnutrition, dehydration, and debility because of the severe vomiting and nausea associated with HG. The disease may even lead to long-term problems for the mother and her baby(ies).

HG and morning sickness have relations with the body’s human chorionic gonadotropin (hCG), which is a hormone created by the placenta as a result of being pregnant. The body produces a significant amount of this hormone and a fast rate early in the pregnancy, then these levels continue to increase as the pregnancy continues. However, the exact cause of the nausea and vomiting during pregnancy is not certain .

Morning Sickness vs. Hyperemesis Gravidarum

While morning sickness and HG might sound like similar conditions because of the shared symptoms of nausea and vomiting, they are in fact quite different.

Morning sickness includes nausea and vomiting, which may be discomforting but is mostly manageable and does not leave the mother with severe dehydration. The symptoms of morning sickness also tend to disappear around weeks 12-14 of pregnancy and they do not remain present consistently. While morning sickness may cause fatigue and a slight loss of appetite, it is not enough to cause major interference with daily activities.

Hyperemesis Gravidarum includes nausea and vomiting from morning sickness but it tends not to go away and it can lead to severe dehydration. As you can imagine, this would make it rather challenging for these soon-to-be-mothers to keep down food and fluids vital to the baby(ies). Along with the reduced ability to take in nutrients, HG can be extremely debilitating and it can lead to fatigue which can last for several weeks or even months. Women with Hyperemesis Gravidarum also tend to lose their entire appetite. All of this considered, the women with HG then experience (1) the struggle to work and do daily activities, (3) dehydration and malnutrition as well as (4) struggle to gain weight or may even lose weight despite having a baby growing in their belly.

Symptoms of HG

The HER foundation explains that just under half of the women with Hyperemesis Gravidarum experience the symptoms for their entire pregnancy.

  • Constant nausea
  • Complete loss of appetite
  • Vomiting more than three times a day.
  • Dehydration
  • Light-headedness
  • Dizziness
  • Losing more than 10 pounds of weight (or 5% of total body weight before the onset of HG).

If the mother’s symptoms are severe, the fetal can be lost or risks future issues such as infection, early delivery, congenital heart disease, skin abnormalities, low birth weight, undescended testicles, perinatal death, behavior disorders, sensory disorders, and even skeletal malformations. However, the long term effects are not certain due to research finding inconsistency in the long-term implications of Hyperemesis Gravidarum.

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What Does the Study Have to Say About Cannabis for HG?

The 2020 published research of Gideon Koren and Rana Cohen explains that HG responds partially to antiemetic medications and that cannabis possesses antiemetic effects. Antiemetic medications are used to fight against vomiting and nausea. The team took to evaluating women with HG who were counseled by the Motherisk Program before and after consuming cannabis for the symptoms by means of a validated Pregnancy Unique Quantification of Emesis (PUQE) scoring system. Th e PUQE evaluates the severity of nausea and vomiting during pregnancy based on three criteria being (1) nausea, (2) vomiting, and (3) retching .

The study found a significant improvement in the symptoms as well as the quality of life in the participants. The PUQE scores improved from 14.5 (upper range of severity) down to 7.5 (moderate severity). This comes after being administered cannabis with a 20% tetrahydrocannabinol (THC) quantity with only traces of CBD. The team also reported that this cannabis combo had a significant impact on the severity of the condition in the form of reducing it. By reducing the severity of the condition, the mother and child are exposed to less risk of long-term effects as well as malnutrition, dehydration, and weight-loss.

The team also referred to a survey conducted in British Columbia which reported that “ 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’”.

With Hyperemesis Gravidarum being such a potentially threatening condition, it is important to explore all avenues which may offer some relief. Fortunately enough, cannabis has become well known for its ability to alleviate nausea and vomiting and has now been shown to also reduce the severity of conditions such as Hyperemesis Gravidarum. Although, treating HG with cannabis may require some experimentation as women need to find the cannabis strain which offers them the optimal amount of relief, keeping in mind that it should contain THC (as per the study). At this time, research is still much needed in terms of using cannabis during pregnancy and it has not officially been deemed safe. Therefore, it is incredibly important for pregnant people with Hyperemesis Gravidarum to openly consult with their medical physicians over the use of cannabis, or to find a doctor that will be able to consult them on the way forward with cannabis as a treatment.