Poster Session 2
Daniel J. Martingano, DO, MBA, PhD
Clerkship Director, IRB Chair, Associate Program Director / Division Chair
St. John's Episcopal Hospital-South Shore and William Carey University College of Osteopathic Medicine
Far Rockaway, New York, United States
Amanda F. Francis Oladipo, MD, MSCR (she/her/hers)
Director of Research
Hackensack University Medical Center
Hackensack, New Jersey, United States
Marwah Al-Dulaimi, MD (she/her/hers)
OB/GYN Resident
St. John's Episcopal Hospital-South Shore
Far Rockaway, NY, United States
Sandra Kumwong, MS
Medical Student
Touro College of Osteopathic Medicine-Harlem Campus
New York, New York, United States
Andrea Ouyang, MSc
Medical Student
William Carey University
Hattiesburg, Mississippi, United States
Lauren Cue, MD, BA (she/her/hers)
OB/GYN Resident
Rutgers University and the Jersey City Medical Center
Jersey City, New Jersey, United States
Ashley Nguyen, MD
OB/GYN Resident
St. John's Episcopal Hospital-South Shore
Far Rockaway, New York, United States
Francis X. Martingano, MD
Assistant Professor, Senior Minimally Invasive Surgeon
NYU Grossman School of Medicine - NYU Brooklyn
New York, New York, United States
Shailini Singh, MD
Director of Metabolic Syndrome
AtlantiCare Regional Medical Center
Pamona, New Jersey, United States
Mark Rebolos, MD
Director of Patient Safety, Labor & Delivery
St. John's Episcopal Hospital-South Shore
Far Rockaway, New York, United States
Alexander Ulfers, DO
Medical Director, Maternal Infant Care Center; Maj, USAF, MC
Walter Reed National Military Medical Center
Bethesda, Maryland, United States
Kristin Cohen, CNM, DNP
Women's Health Care Practitioner
RWJBarnabas Health - Trinitas Regional Medical Center
Elizabeth, New Jersey, United States
Donald Morrish, MD
Chief Executive Officer
St. John's Episcopal Hospital-South Shore
Far Rockaway, New York, United States
Iffath A. Hoskins, MD
Former ACOG President, Director of Labor & Delivery, Chief Safety Officer
Albert Einstein College of Medicine - Montefiore Medical Center
New York, New York, United States
Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclic vomiting in chronic cannabis users. CHS can both exacerbate and mimic hyperemesis gravidarum (HG) in 1st trimester pregnancies and is often refractory to antiemetic medications use to treat HG alone. This study sought to compare antiemetic regimens in cases of concurrent CHS in first trimester pregnancies.
Study Design:
We conducted a multi-center, prospective observational study from 7/2022 to 7/2024 comparing all pregnant patients with concurrent CHS at gestational age range of 8 0/7 to 13 6/7 weeks. CHS was diagnosed by Rome IV criteria for cyclical vomiting syndrome and cannabis use more than 4 times per week on average. The primary outcomes included need to switch medication and patient-reported resolution confirmed by provider assessment, as discrete events. Patients taking overlapping medications or with allergies to any included medications were excluded. Monotherapy oral medications including metoclopramide, odansetron, cyproheptadine, diphenhydramine, and topical capsaicin were included as covariates. All patients endorsed routine hot-water bathing to aid in resolution of symptoms. Medication choice was determined by physician preference.
Results:
The study included 537 patients diagnosed with CHS. Baseline demographic factors were not significantly different. Patients who received metoclopramide were less likely to need to switch to an alternative medication (56.2% v. 28.3%, p = 0.002) with a 29% decreased risk when adjusted for confounders (RR 0.71, 95% CI 0.43-0.89, p = 0.002). Patients who received topical capsaicin were more likely to report improvement in appetite (51.9% v. 20.2%, p = 0.032), with a 31% increased likelihood when adjusted for confounders (RR 1.31, 95% CI 1.44-1.93, p = 0.001). This same group, however, demonstrated the lowest compliance rate (11.9% v. 45.9%, p=0.005).
Conclusion:
Metoclopramide and topical capsaicin in conjunction with routine hot-bathing are reasonable and efficacious antiemetic regimens for 1st trimester pregnancies complicated by CHS.
