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Nausea of Pregnancy

Uses

Principal Proposed Natural Treatments

Other Proposed Natural Treatments

Nausea afflicts the majority of women during the first trimester of pregnancy. However, this is also the precise period in which drug therapy is most worrisome, due to the extreme vulnerability of the fetus at that time. For this reason, conventional medicine has to some extent welcomed alternative medicine’s quest for safe, natural treatment options.

Principal Proposed Natural Treatments

Two natural therapies, vitamin B 6 and ginger , have some evidence supporting their use in the treatment of nausea in pregnancy. In addition, acupressure may be helpful.
For natural treatments relevant to other aspects of pregnancy, see the articles on Pregnancy Support , Breastfeeding Support , Preeclampsia , and Herbs and Supplements to Avoid in Pregnancy and Breastfeeding .

Vitamin B 6

For many years, conventional practitioners have recommended vitamin B 6 supplements to treat morning sickness. In 1995, a large double-blind, placebo-controlled study validated this use. 1 In this trial, a total of 342 pregnant women were given placebo or 30 mg of vitamin B 6 daily. Participants then graded their symptoms by noting the severity of their nausea and recording the number of vomiting episodes. The women in the B 6 group experienced significantly less nausea than the placebo group, suggesting that regular use of B 6 can be helpful for morning sickness. However, despite the benefits for nausea, vomiting episodes were not significantly reduced.
At this dose (30 mg daily), vitamin B 6 is believed to be entirely safe. For more information, including dosage and safety issues, see the full Vitamin B 6 article.

Ginger

Ginger is a nausea remedy recommended by many physicians, as well as by traditional healers from a number of countries. In 2001, a relatively well-designed double-blind, placebo-controlled trial of 70 pregnant women evaluated the effectiveness of ginger for morning sickness. 2 Participants received either placebo or 250 mg of powdered ginger 3 times daily for a period of 4 days. The results showed that ginger significantly reduced nausea and vomiting. No significant side effects occurred.
Benefits were also seen in an earlier double-blind, placebo-controlled trial of 27 women, 3 and in a poorly designed double-blind, placebo-controlled trial of 26 women. 4
One study of 138 women and another of 291 women found ginger equally effective for morning sickness as vitamin B 6 . 15,16 However, a third study of 70 women found ginger to be somewhat better than vitamin B 6 . 22 None these studies used a placebo group.
For more information, including dosage and safety issues, see the full article on Ginger .

Acupuncture and Acupressure

Several studies have evaluated the potential benefits for morning sickness of treatment on a single acupuncture point—P6—traditionally thought to be effective for relief of nausea and vomiting. This point is located on the inside of the forearm, about 2 inches above the wrist crease. Most positive trials have investigated the effects of pressure on this point (acupressure), rather than needling. The most common means used involve a wristband with a pearl-sized bead in it, situated over P6. It exerts pressure by itself while it is worn, and the user can also press on it for extra stimulation.
In general, acupressure has shown good results. 20 For example, a double-blind, placebo-controlled study of 97 women that was reported in 2001 found evidence that wristband acupressure may help relieve symptoms of morning sickness. 5 Participants wore either a real wristband or a phony one that appeared identical. Both real and fake acupressure caused noticeable improvement in more than half of the participants. However, women using the real wristband showed significantly greater improvement. Benefits were also reported the same year in a double-blind, placebo-controlled study of 60 women. 6
These results are consistent with previous studies that also found benefit. 7,8,10,17 Furthermore, a double-blind, placebo-controlled study of 60 pregnant women found that 10 minutes of self-applied manual acupressure on either P6 or a sham point 4 times daily improved symptoms. 9 However, two studies failed to find benefit for severe morning sickness. 18-19 And a review of 8 trials involving over 1,200 pregnant women found no evidence that acupressure or acupuncture reduced nausea and vomiting. 23 One study, though, of 230 pregnant women did find that nausea improved over time with the use of electrostimulation, which involves sending a mild electrical current to acupuncture points.
For more information, including safety issues, see the full Acupuncture article.

Other Proposed Natural Treatments

Multivitamin/mineral tablets have shown promise for morning sickness, possibly due to their vitamin B 6 content. 11,12
A combination of vitamin K (at a dose of 5 mg—enormously higher than nutritional needs) and vitamin C (25 mg) is sometimes recommended for morning sickness, based on an uncontrolled study conducted in the 1950s. 13Red raspberry is also frequently recommended, but there is no evidence that it works. 14
Pregnant women commonly develop iron deficiency anemia. Iron supplements, however, can be hard on the stomach, thereby aggravating morning sickness. One study found evidence that a fairly low supplemental dose of iron—20 mg daily—is very nearly as effective for treating anemia of pregnancy as 40 mg or even 80 mg daily, and it is less likely to cause gastrointestinal side effects. 21

References

1 Vutyavanich T, Wongtra-ngan S, Ruangsri R. Pyridoxine for nausea and vomiting of pregnancy: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol. 1995;173:881-884.

2 Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol. 2001;97:577-582.

3 Fischer-Rasmussen W, Kjaer SK, Dahl C, et al. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol. 1991;38:19-24.

4 Keating A, Chez RA. Ginger syrup as an antiemetic in early pregnancy. Altern Ther Health Med. 2002;8:89-91.

5 Norheim AJ, Pedersen EJ, Fonnebo V, et al. Acupressure treatment of morning sickness in pregnancy. A randomised, double-blind, placebo-controlled study. Scand J Prim Health Care. 2001;19:43-47.

6 Werntoft E, Dykes AK. Effect of acupressure on nausea and vomiting during pregnancy. A randomized, placebo-controlled, pilot study. J Reprod Med. 2001;46:835-839.

7 de Aloysio D, Penacchioni P. Morning sickness control in early pregnancy by Neiguan point acupressure. Obstet Gynecol. 1992;80:852-854.

8 Hyde E. Acupressure therapy for morning sickness. A controlled clinical trial. J Nurse Midwifery. 1989;34:171-178.

9 Belluomini J, Litt RC, Lee KA, et al. Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Obstet Gynecol. 1994;84:245-248.

10 Carlsson CP, Axemo P, Bodin A, et al. Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study. J Pain Symptom Manage. 2000;20:273-279.

11 Czeizel AE, Dudas I, Fritz G, et al. The effect of periconceptional multivitamin-mineral supplementation on vertigo, nausea and vomiting in the first trimester of pregnancy. Arch Gynecol Obstet. 1992;251:181-185.

12 Ussher JM, Dewberry C, Malson H, et al. The relationship between health related quality of life and dietary supplementation in British middle managers: a double blind placebo controlled study. Psychol Health. 1995;10:97-111.

13 Merkel RL. The use of menadione bisulfite and ascorbic acid in the treatment of nausea and vomiting of pregnancy. A preliminary report. Am J Obstet Gynecol. 1952;64:416-418.

14 Aikins Murphy P. Alternative therapies for nausea and vomiting of pregnancy. Obstet Gynecol. 1998;91:149-155.

15 Sripramote M, Lekhyananda N. A randomized comparison of ginger and vitamin B 6 in the treatment of nausea and vomiting of pregnancy. J Med Assoc Thai . 2003;86:846-53.

16 Smith C, Crowther C, Willson K, et al. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol . 2004;103:639-645.

17 Habek D, Barbir A, Habek JC, et al. Success of acupuncture and acupressure of the pc 6 acupoint in the treatment of hyperemesis gravidarum. Forsch Komplementarmed Klass Naturheilkd . 2004;11:20-23.

18 Heazell A, Thorneycroft J, Walton V et al. Acupressure for the in-patient treatment of nausea and vomiting in early pregnancy: a randomized control trial. Am J Obstet Gynecol . 2006;194:815-820.

19 Hsu E, Pei V, Shofer FS, et al. A prospective randomized controlled trial of acupressure vs. sham for pregnancy-related nausea and vomiting in the emergency department. Acad Emerg Med . 2003;10:437.

20 Helmreich RJ, Shiao SY, Dune LS. Meta-analysis of Acustimulation Effects on Nausea and Vomiting in Pregnant Women. Explore (NY) . 2006;2:412-421.

21 Zhou SJ, Gibson RA, Crowther CA, et al. Should we lower the dose of iron when treating anaemia in pregnancy? A randomized dose-response trial. Eur J Clin Nutr. 2007 Oct 10. [Epub ahead of print]

22 Ensiyeh J, Sakineh MA. Comparing ginger and vitamin B 6 for the treatment of nausea and vomiting in pregnancy: a randomised controlled trial. Midwifery. 2008 Feb 11.

23 Matthews A, Dowswell T, Haas D, Doyle M, O'Mathuna D. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev. 2010;(9):CD007575.

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