Hanley Sarah, Imcha Mendinaro, Mohamad Mas Mahady
Department of Psychiatry, Health Service Executive, Galway, Ireland.
Department of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Limerick, Ireland.
Obstet Med. 2024 Dec 24:1753495X241307415. doi: 10.1177/1753495X241307415.
Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic nausea and vomiting in the setting of chronic cannabis use. To date, only 11 cases of CHS in pregnancy have been reported.
We describe two cases of uncontrolled vomiting in pregnancy due to CHS. Case 1 represents a 30-year-old Caucasian woman presenting in the 5th week of gestation with nausea, vomiting and abdominal pain intermittently of 1 week duration. Physical work-up was normal, and symptoms resolved with supportive treatment within 3 days, only to occur again at the 14th week of gestation, and again at the 30th week of gestation. Link between symptom relief and hot bathing led to suspicion for CHS, confirmed with positive cannabis urine toxicology screening. Nausea, vomiting and pain subsided with cannabis cessation, and baby was born healthy at 38 + 5 weeks gestation. Case 2 describes a 28-year-old Caucasian woman presenting in the 16th week of gestation with nausea, vomiting and abdominal pain. Physical examination was normal, and symptoms self-resolved. Two weeks later, in the 18th week of gestation, the patient re-presented to the emergency room with sudden re-occurrence of nausea, vomiting and abdominal pain. Once again, a link between symptom relief and hot bathing was noted on admission. The patient was educated on possible links of chronic cannabis use with CHS symptoms and subsequently relayed extensive (>14 years) cannabis use history. Symptoms resolved with cannabis cessation. Baby was born at 37 weeks gestation, with low birth weight of 2180 g requiring 5 days neonatal intensive care unit (NICU) treatment. Regular follow-up up to 5 months post-partum confirmed no CHS relapse with cannabis cessation.
CHS in pregnancy is likely under-reported, reflective possibly of limited physician and patient awareness of this condition, as well as patient concealment of cannabis use in pregnancy. In cases of severe, cyclic nausea and vomiting in pregnancy unresponsive to typical anti-emetic treatment, comprehensive social history including cannabis use should be sought, and associated hot bathing for symptomatic relief out-ruled.
大麻素呕吐综合征（CHS）是一种在长期使用大麻情况下出现的周期性恶心和呕吐综合征。迄今为止，仅报告了11例孕期CHS病例。
我们描述了两例因CHS导致孕期呕吐失控的病例。病例1为一名30岁的白人女性，在妊娠第5周时出现恶心、呕吐和腹痛，持续1周。体格检查正常，症状在3天内通过支持治疗得到缓解，但在妊娠第14周时再次出现，妊娠第30周时又再次出现。症状缓解与热水浴之间的关联引发了对CHS的怀疑，大麻尿液毒理学筛查呈阳性得以证实。停止使用大麻后，恶心、呕吐和疼痛减轻，婴儿在妊娠38 + 5周时健康出生。病例2描述了一名28岁的白人女性，在妊娠第16周时出现恶心、呕吐和腹痛。体格检查正常，症状自行缓解。两周后，在妊娠第18周时，患者再次因恶心、呕吐和腹痛突然复发而到急诊室就诊。入院时再次注意到症状缓解与热水浴之间的关联。患者接受了关于长期使用大麻与CHS症状可能关联的教育，随后透露了广泛（超过14年）的大麻使用史。停止使用大麻后症状缓解。婴儿在妊娠37周时出生，出生体重低，为2180克，需要在新生儿重症监护病房（NICU）接受5天治疗。产后长达5个月的定期随访证实，停止使用大麻后未出现CHS复发。
孕期CHS可能报告不足，这可能反映出医生和患者对这种情况的认识有限，以及患者在孕期隐瞒大麻使用情况。对于孕期严重的周期性恶心和呕吐，对典型止吐治疗无反应时，应询问包括大麻使用情况在内的全面社会史，并排除通过热水浴缓解症状的情况。
