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.