Multidisciplinary management of severe hyperemesis gravidarum complicated by cannabinoid and opioid use: A case report on the complex interplay of hyperemesis gravidarum, opioids and treatment challenges

Hyperemesis gravidarum (HG) presents a significant management challenge in pregnancy due to its debilitating effects on maternal health and fetal outcomes. This case report details the presentation and management of a 34-year-old primigravida at 17 weeks and 4 days gestation with severe HG. The patient’s history includes significant gastrointestinal procedures, a prior child with lissencephaly, and continued opioid use during pregnancy. Her symptoms were refractory to conventional treatments and further complicated by cannabinoid use. A multidisciplinary approach involving gastroenterology, surgery, obstetrics, pharmacists, and dietitians was employed, resulting in significant improvement. This case highlights the importance of a comprehensive care strategy in managing refractory HG complicated by substance use.