Considerations and Implications of Cannabidiol Use During Pregnancy.

PURPOSE OF REVIEW: Cannabis is a naturally occurring plant that is composed of over sixty phytocannabinoids, of which cannabidiol (CBD) has been recently identified as having therapeutic potential. RECENT FINDINGS: Although not clearly understood in its mechanism of action, CBD contains potent anti-inflammatory, anti-hyperalgesia, and analgesic qualities now being further analyzed for its use in the treatment of a plethora of diseases. Related to its large safety profile and lack of psychoactive effects typically associated with cannabis and tetrahydrocannabinol (THC), CBD is being used more frequently for self-treatment of chronic pain, anxiety, and depression. With the help of broad marketing, CBD is being used by numerous people, including pregnant women who use CBD as an anti-emetic. Since marijuana is legalized in many states in the USA, the use of CBD has increased not only in the general population but also in specific groups such as pregnant women with chronic pain. Despite CBD's accessibility, there are limited studies showing its safety during pregnancy. While the use of cannabis has been well explored in terms of the effects on pregnancy, the use of CBD during pregnancy thus far has limited literature. The goal of this investigation is to impart the current understanding of CBD and its effects of pregnancy.

Use of alternative medicine, ginger and licorice among Danish pregnant women - a prospective cohort study.

BACKGROUND: The use of alternative medicines and dietary supplements is constantly changing, as are dietary habits. One example of this phenomenon is the current popularity of ginger products as an everyday health boost. Ginger and licorice has also been shown to ameliorate nausea a common complaint in early pregnancy. Alternative medicines are often regarded as safe. However, they might affect fetal development, such as through alterations of hormone metabolism and cytochrome P450 function. Health care professionals may be unaware of the supplementation habits of pregnant women, which may allow adverse exposures to go unnoticed, especially if the rates of use in pregnancy are not known. We therefore investigated the use of alternative medicines and licorice among pregnant Danish women. METHODS: A total of 225 pregnant women were included in a prospective cohort when attending the national prenatal screening program at gestational weeks 10-16. Participants were asked to complete a questionnaire regarding their socio-economic status and lifestyle habits, including their intake of alternative medicine and licorice. RESULTS: We found that 22.7% of women reported taking alternative medicines, with 14.7% reporting daily consumption. Ginger supplements were consumed by 11.1%, mainly as health boost and 87.1% reported consumption of licorice. Regular or daily licorice consumption was reported by 38.2 and 7.1%, respectively. Notably, the use of licorice was reflected by an increase in blood pressure of the pregnant women. CONCLUSIONS: The use of licorice and alternative medicines appears to be common in pregnant Danish women, supporting the need for further investigations into the safety of alternative medicine use during pregnancy and the importance of up-to-date personalized counseling regarding popular health trends and lifestyle habits.

Recommendations From Cannabis Dispensaries About First-Trimester Cannabis Use.

OBJECTIVE: To characterize recommendations given to pregnant women by Colorado cannabis dispensaries regarding use of cannabis products for nausea during the first trimester of pregnancy. METHODS: This was a statewide cross-sectional study in which advice about cannabis product use was requested using a mystery caller approach. The caller stated she was 8 weeks pregnant and experiencing morning sickness. Dispensaries were randomly selected from the Colorado Department of Revenue Enforcement Division website. The primary outcome was the proportion of marijuana dispensaries that recommended a cannabis product for use during pregnancy. We hypothesized that 50% of dispensaries would recommend use. A sample size of 400 was targeted to yield a two-sided 95% CI width of 10%. Secondary outcomes included the proportion endorsing cannabis use as safe during pregnancy, specific product recommendations, and encouraging discussion with a health care provider. Recommendations were compared by licensure type (medical, retail, or both) and location (rural vs urban). RESULTS: Of the 400 dispensaries contacted, 37% were licensed for medical sale (n=148), 28% for retail (n=111), and 35% for both (n=141). The majority, 69% (277/400), recommended treatment of morning sickness with cannabis products (95% CI 64-74%). Frequency of recommendations differed by license type (medical 83.1%, retail 60.4%, both 61.7%, P<.001). Recommendations for use were similar for dispensary location (urban 71% vs nonurban 63%, P=.18). The majority (65%) based their recommendation for use in pregnancy on personal opinion and 36% stated cannabis use is safe in pregnancy. Ultimately, 81.5% of dispensaries recommended discussion with a health care provider; however, only 31.8% made this recommendation without prompting. CONCLUSION: Nearly 70% of Colorado cannabis dispensaries contacted recommended cannabis products to treat nausea in the first trimester. Few dispensaries encouraged discussion with a health care provider without prompting. As cannabis legalization expands, policy and education efforts should involve dispensaries.

Comparison of quince with vitamin B6 for treatment of nausea and vomiting in pregnancy: a randomised clinical trial.

This trial was performed to compare quince (Cydonia oblonga) fruit with vitamin B6 on 76 pregnant women with a gestational age of 6-14 weeks and mild-to-moderate nausea and vomiting (NVP) (40 in the quince and 36 in the B6 group). The 'Pregnancy-Unique Quantification of Emesis' (PUQE-24) scale was used to examine the severity of NVP. The quince syrup (1 tablespoon/TDS) or vitamin B6 tablets (20 mg/TDS) were used as intervention for 1 week. The mean (±SD) age was 27.5 (±5.2) years. The score of the PUQE was decreased from 9.5 (± 2) at baseline to 5.2 (±2.3) on the 7th day and 5.3 (±2.6) on the 14th day (p < .001) in the quince group. In the other group, the scores were 8.4 (±1.8), 7.3 (±2.4) and 7.7 (±3.8), respectively (p = .001). The change in symptoms were more marked in the quince group (p < .001). Quince syrup seems to be a suitable treatment for NVP. Impact statement What is already known on this subject: Pregnancy-induced nausea and vomiting (NVP) is one of the most common problems during gestation. Treatment is mainly symptomatic, ranging from dietary changes and oral pharmacological treatment to hospitalization in severe forms. In early pregnancy, the use of chemical drugs is avoided, so there is an increasing tendency to use alternative therapies. According to the literature review in Iranian Traditional Medicine (ITM), the quince fruit (Cydonia oblonga) can be useful in NVP. Quince has a wide range of pharmacological activities including antioxidant, antibacterial, antifungal, anti-inflammatory, hepatoprotective and antidepressant effects. ITM literature suggests some therapeutic effects of the quince fruit on important organs like brain, heart, liver and stomach. What the results of this study add: The results of this study demonstrated the significant efficacy of quince in comparison with vitamin B6. What the implications are of these findings for clinical practice and/or further research: This fruit is also safe to be administered in pregnant women suffering from NVP.

Is ginger beneficial for nausea and vomiting? An update of the literature.

PURPOSE OF REVIEW: Nausea and vomiting can pose a significant burden to patients in a variety of clinical settings. Previous evidence suggests that ginger may be an effective treatment for these symptoms; however, current evidence has been mixed. This article discusses recent clinical trials that have investigated ginger as a treatment for multiple types of nausea and vomiting. In addition, the potential mechanisms of action of ginger will be discussed. RECENT FINDINGS: This article identified nine studies and seven reviews that investigated ginger for morning sickness, postoperative nausea and vomiting, chemotherapy-induced, and antiretroviral-induced nausea and vomiting. All studies reported that ginger provided a significant reduction in nausea and vomiting; however, the clinical relevance of some studies is less certain. Common limitations within the literature include the lack of standardized extracts, poorly controlled or blinded studies, and limited sample size. In addition, recent evidence has provided further support for 5-HT3 receptor antagonism as a mechanism by which ginger may exert its potentially beneficial effect on nausea and vomiting. SUMMARY: The results of studies in this article suggest that ginger is a promising treatment for nausea and vomiting in a variety of clinical settings and possesses a clinically relevant mechanism. However, further studies are required to address the limitations in the current clinical literature before firm recommendations for its use can be made.

Effects of ginger for nausea and vomiting in early pregnancy: a meta-analysis.

BACKGROUND: Nausea and vomiting in early pregnancy (NVEP) is commonly encountered in family medicine. Ginger (Zingiber officinale) is a popular nonpharmacological treatment but consensus of its use is lacking. METHODS: We conducted a meta-analysis of clinical trials using ginger for NVEP as published in PubMed and EMBASE, CINAHL, Cochrane Library, and all EBM reviews. Studies satisfying 3 criteria were selected: (1) randomized placebo-controlled design; (2) use of ginger or Z. officinale; and (3) extractable data on improvement in NVEP. Data were synthesized into pooled odd ratios based on the random effects model, and results were tabulated with the aid of Forest plots. RESULTS: We identified 135 potentially relevant records; only 6 studies met the final criteria. Of the total 508 subjects, 256 and 252 subjects were randomly assigned to receive ginger and placebo, respectively. The use of ginger (∼1 g daily) for at least 4 days is associated with a 5-fold likelihood of improvement in NVEP. Heterogeneity among the clinical studies were acknowledged in the final interpretation of results. CONCLUSIONS: Despite the widespread use of ginger in the diet, its clinic value and safety profile in treating NVEP is still unknown. Our meta-analysis suggests that ginger is an effective nonpharmacological treatment for NVEP.

El jengibre como método alternativo para paliar las náuseas y vómitos durante el embarazo / Ginger as an alternative method to alleviate nausea and vomiting during pregnancy

Las náuseas y los vómitos durante la gestación (NVG) son un trastorno común durante las primeras semanas de embarazo y en ocasiones se prolongan más allá de la semana 20. Normalmente no revisten gravedad para la salud de la embarazada y su futuro hijo/a, pero supone un trastorno angustiante que puede interferir en su vida cotidiana. Cada vez son más las embarazadas que recurren al uso de los “remedios naturales” para evitar los posibles efectos secundarios delos medicamentos habituales. El jengibre ha demostrado ser una alternativa segura y eficaz para paliarlas náuseas y vómitos en la embarazada, siempre y cuando se utilice en las dosis recomendadas y teniendo en cuenta el historial médico particular de cada mujer, a fin de evitar posibles interacciones medicamentosas y efectos secundarios que pudieran influir en otras patologías presentes en la gestante. Se debe fomentar la realización de estudios acerca de la seguridad y efectividad de dichos tratamientos en mujeres embarazadas, ya que en numerosas ocasiones la ingesta de las plantas medicinales se hace sin la información necesaria para que sea efectivo y seguro (AU)

Nausea and vomiting during gestation (NVG) are a common disorder during the first weeks of pregnancy, and sometimes continue beyond week 20. Typically they don’t entail any severe health problems for the pregnant woman and her future child, but they represent a distressing disorder which may interfere in her daily life. There is an increasing trend for pregnant women to use “natural remedies “in order to avoid possible side effects by usual medications. Ginger has proven to be a safe and effective alternative to alleviate nausea and vomiting in pregnant women, as long as it is used in recommended doses, and taking into account the specific medical record of each woman, in order to avoid possible drug interactions and side effects which may have an impact on other conditions suffered by the pregnant woman. It is necessary to encourage studies about safety and efficacy of said treatments in pregnant women, because these medicinal plants are often ingested without the information required for their efficacy and safety (AU)

Vitamin B6 supplementation in pregnant women with nausea and vomiting.

OBJECTIVE: To determine whether supplementation with vitamin B(6) improves nausea and/or vomiting in pregnancy. METHODS: This experimental study was conducted with 60 pregnant women experiencing nausea and/or vomiting prior to the 12th gestational week. Of these women, 30 were treated daily with 10mg and the remaining 30 with 1.28 mg of pyridoxine hydrochloride for 2 weeks. The primary outcome was the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) score in each group at the end of treatment. RESULTS: The women experiencing nausea and/or vomiting in pregnancy had significantly lower levels of circulating vitamin B(6) (P=0.007) compared with those without this symptom. Vitamin B(6) supplementation significantly increased plasma vitamin B(6) concentration (P<0.05 in both groups). There were no significant differences in PUQE score or in plasma concentration levels of protein, dopamine, serotonin, unconjugated estriol, and ghrelin after supplementation between the 2 groups at baseline, but there was a significantly lesser decrease in PUQE score and a greater increase in vitamin B(6) level and vitamin B(6) concentration to plasma protein concentration ratios in group 1 than in group 2 after supplementation (P<0.05 for all). CONCLUSION: Although the high-supplementation group had a greater decrease in PUQE score in comparison to the low-supplementation group, the difference is unlikely to affect the severity of symptoms.

Complementary medicine for pregnancy complications.

For some women, pregnancy can bring a myriad of distressing symptoms. Nausea affects up to 85% of women during early pregnancy and about half of these women also experience vomiting. For some women, it can be very debilitating. Conventional anti-emetics bring with them a risk of potential teratogenic effects during the critical stage of early pregnancy. Women tend to feel more comfortable taking a natural or herbal substance to help manage these issues.

A literature review of the effectiveness of ginger in alleviating mild-to-moderate nausea and vomiting of pregnancy.

Mild-to-moderate nausea and vomiting of pregnancy affects up to 80% of all pregnancies. Concern about antiemetic use and the time-limited nature of symptoms has restrained the development of effective treatment approaches, yet supportive, dietary, and lifestyle changes may be ineffective. This article reviews 4 recent well-controlled, double-blind, randomized clinical studies that provide convincing evidence for the effectiveness of ginger in treating nausea and vomiting of pregnancy. It also provides a dosage update for the various forms of ginger.