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Study breakdown

A pregnant woman with chronic cannabis use was misdiagnosed with pregnancy-related vomiting when she actually had cannabinoid hyperemesis syndrome

Case ReportPreliminary evidence
The takeaway

A case report of a 20-year-old pregnant woman with multiple hospital admissions for nausea and vomiting found her symptoms were caused by cannabinoid hyperemesis syndrome, not hyperemesis gravidarum, after clinicians noticed her compulsive hot shower behavior.

Obstetricians managing nausea and vomiting in pregnancy; emergency physicians; midwives and prenatal care providers.

CHS in pregnancy can be indistinguishable from hyperemesis gravidarum

What the researchers found

A 20-year-old pregnant woman was admitted multiple times for recurrent nausea and vomiting. She was initially assumed to have hyperemesis gravidarum, a common pregnancy complication.

Clinicians observed that she was taking frequent hot showers, a hallmark behavior of cannabinoid hyperemesis syndrome (CHS). Further history revealed chronic cannabis use.

With no other identifiable cause for her symptoms, she was diagnosed with CHS and managed with antiemetics and cannabis abstinence.

The case highlights how CHS can be masked by pregnancy because its symptoms closely resemble hyperemesis gravidarum, leading to delayed diagnosis and unnecessary workups.

Why it matters

Cannabis use during pregnancy is increasing, and CHS in pregnant women is likely underdiagnosed because nausea and vomiting are expected pregnancy symptoms. Misattributing CHS to hyperemesis gravidarum delays the key intervention (cannabis cessation) and exposes the fetus to continued cannabis.

The numbers in context

Patient was 20 years old with multiple hospital admissions. Daily cannabis use preceded the onset of symptoms. Symptoms resolved with antiemetics and cannabis abstinence.

How the study worked

Single case report of a 20-year-old pregnant woman with multiple hospital admissions. Diagnosis reached by exclusion of other causes and recognition of compulsive hot shower behavior.

What this study cannot tell us

Single case report. No objective confirmation of CHS diagnosis beyond symptom resolution with cannabis cessation. The patient may have had concurrent hyperemesis gravidarum.

How to read the evidence

Preliminary. Single case report highlighting a diagnostic challenge.

When this study was published

Published in 2018. Awareness of CHS in pregnancy has grown as cannabis use during pregnancy has increased.

The bigger picture

This case sits at the intersection of two trends: increasing cannabis use during pregnancy and growing recognition of CHS. When pregnant patients with nausea and vomiting also use cannabis, clinicians need to consider CHS even though the symptoms look identical to a common pregnancy complication.

Questions still open

  • How often is CHS misdiagnosed as hyperemesis gravidarum? Should routine pregnancy intake include screening for cannabis use patterns? Does CHS in pregnancy carry additional fetal risks beyond cannabis exposure alone?

Common questions

What is hyperemesis gravidarum?
Hyperemesis gravidarum is severe, persistent nausea and vomiting during pregnancy that can lead to dehydration, weight loss, and hospitalization. It affects a small percentage of pregnancies and is considered a normal (if extreme) pregnancy complication.
How can doctors tell the difference between CHS and hyperemesis gravidarum?
The key clue is compulsive hot bathing or showering for symptom relief, which is characteristic of CHS but not hyperemesis gravidarum. A detailed history of cannabis use patterns is also essential. Symptoms resolving with cannabis cessation confirms the diagnosis.

Read the original research

Recurrent Nausea and Vomiting in a Pregnant Woman with Chronic Marijuana Use.

Case reports in obstetrics and gynecology, 2018, 9746062

Citation

Kim, Hyunyoung G; Moon, Jeremiah; Dixon, Heather; Tullar, Paul. (2018). Recurrent Nausea and Vomiting in a Pregnant Woman with Chronic Marijuana Use.. Case reports in obstetrics and gynecology, 2018, 9746062. https://doi.org/10.1155/2018/9746062

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