Acupuncture and Herbal Medicine for Nausea and Vomiting in Pregnancy: An Overview and Quality Assessment of Systematic Reviews

Nausea and vomiting during pregnancy are extremely common problems that affect the great majority of pregnant women. It is estimated that between 70% and 85% of pregnant women experience nausea, while up to half of them also experience vomiting. Although often considered normal pregnancy symptoms, these problems can progress to more serious conditions. Hyperemesis gravidarum, the most severe form of these symptoms, occurs in only 0.3% to 2% of all pregnancies, but it can cause significant impacts on both the mother and the developing baby.

Immediate effects include rapid weight loss, nutritional deficiencies, dehydration, and electrolyte imbalance. In severe cases, it can lead to complications such as jaundice, decreased urine output, and neurologic problems. In the long term, women who go through this experience face increased risks of depression and may even avoid future pregnancies. Alarmingly, about 10% of women with hyperemesis gravidarum end up terminating the pregnancy due to unbearable symptoms.

Given these challenges, many women seek alternatives to conventional medications, especially because of concerns about possible adverse effects on the baby. Traditional East Asian Medicine, which includes acupuncture and herbal medicines, has gained increasing attention as a treatment option. Although some studies suggest benefits, the efficacy of these approaches remains controversial, and the quality of available research varies considerably. This study aimed to systematically review all existing scientific reviews on the use of these traditional therapies for nausea and vomiting during pregnancy, critically assessing the methodologic quality of these studies.

The researchers conducted a comprehensive search across nine scientific databases, from inception through January 2024, with no language restrictions. They included only systematic reviews that evaluated Traditional East Asian Medicine treatments for nausea and vomiting during pregnancy. They used standardized tools to assess methodologic quality, reporting quality, and risk of bias of these studies. Of the 20,121 publications initially identified, only 25 systematic reviews met the inclusion criteria.

These reviews encompassed 221 unique clinical studies, involving from 504 to 8,986 participants. The interventions studied included acupuncture-related techniques such as traditional acupuncture, acupressure, electroacupuncture, and herbal application at specific points, as well as herbal medicines, especially ginger.

The main findings revealed that both acupuncture techniques and herbal medicines demonstrated potential to relieve nausea and vomiting during pregnancy. Ginger stood out as the most studied and consistently effective intervention, showing results comparable to or even superior to placebo and vitamin B6 in reducing symptoms. The doses used in the studies typically ranged from 750 mg to 1.5 g per day, administered in capsules. Side effects were generally mild, including occasional stomach pain and heartburn.

Other herbs such as cardamom and lemon aromatherapy also showed benefits. Regarding acupuncture techniques, acupressure was shown to be beneficial in reducing nausea symptoms, while traditional acupuncture showed mixed results. Injection of vitamin B1 at specific acupuncture points was particularly effective for cases of hyperemesis gravidarum.

For patients and healthcare professionals, these results suggest that ginger may be considered a safe and effective option for the treatment of mild-to-moderate nausea and vomiting during pregnancy, especially for women who prefer to avoid conventional medications. Acupressure also emerges as a promising non-pharmacologic alternative, being a simple technique that can be self-administered by the patient. For more severe cases, acupuncture techniques performed by qualified professionals may offer additional relief. It is important to note that these therapies may be particularly useful when oral intake of medications is hindered by intense vomiting.

However, women who take anticoagulants or medications for cardiac problems should use ginger with caution due to possible drug interactions.

This study has important limitations that should be considered. The methodologic quality of the reviews analyzed was consistently low or critically low, with many failing to meet essential criteria such as prior protocol registration and adequate statistical analysis. None of the reviews fully followed international reporting guidelines, indicating potential problems with the completeness and transparency of the data presented. The substantial variation in intervention techniques, study designs, and data presentation made uniform conclusions difficult to obtain.

In addition, there was a lack of long-term follow-up data, which is particularly important considering that nausea and vomiting in pregnancy may be associated with fetal growth and development over time.

In conclusion, although this study confirms the potential of Traditional East Asian Medicine in the management of nausea and vomiting during pregnancy, it also highlights significant gaps in research quality and reporting of results. Ginger emerges as the most evidence-based promising option, while acupuncture techniques show potential but need more high-quality research. Future research should rigorously adhere to established methodologic guidelines, include comprehensive assessments of long-term clinical outcomes and safety profiles, and standardize doses and techniques to allow more accurate comparisons between studies. For pregnant women considering these therapies, it is essential to consult qualified healthcare professionals who can provide guidance on the most appropriate options for each specific case.