Study reveals effectiveness of CAM therapies in treating nausea and vomiting in pregnancy: Focus on potential of ginger
Nausea and vomiting are common symptoms of pregnancy, also known as nausea and vomiting in pregnancy (NVP) or morning sickness, as they often occur in the morning.
The mechanism is unclear, but it could be related to hormonal, immunological, or anatomical changes during pregnancy. About 50-80% of pregnant women experience nausea and vomiting in pregnancy, mainly between weeks 6 and 12, which subsides by week 20.
In 9-20% of women, however, nausea and vomiting may last longer.
The symptoms are severe enough to cause fluid and electrolyte imbalances and nutritional deficiencies and require hospitalization. Therefore, nausea and vomiting in pregnancy have a significant impact on pregnant women’s quality of life in terms of social, emotional and psychological health, as well as increasing economic burden. Although drugs are available for treatment, some physicians and patients are reluctant to use them because of reports of fetal malformations associated with antiemetic drugs.
The U.S. Food and Drug Administration (FDA) considers ginger to be a safe herbal preparation containing essential oils that block the vomiting reflex, as well as curcumin and sugorol, both of which have anti-nausea, anti-vomiting, sedative and analgesic effects that may be key to their action.
Some meta-analyses on related aspects have been conducted in the past, such as that of Kannan Sridharan et al. who conducted a net meta-analysis on interventions for nausea and vomiting in pregnancy. However, they did not compare treatment modalities with first-line drugs, which may be out of clinical reality.
Complementary and alternative medicine (CAM) therapies are widely used for nausea and vomiting in pregnancy (NVP) because of the limitations of conventional medicine. However, their efficacy and safety remain controversial. Therefore, this meta-analysis was conducted to evaluate the improvement of CAM therapy on NVP.
Randomized controlled trials (RCTs) were searched in which the test group was CAM and the control group was conventional medicine or placebo for nause a and vomiting in pregnancy.
The search was conducted through 8 databases, including PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, SinoMed, and VIP, from the beginning to October 25, 2022. GRADE (Grades of Recommendation, Assessment, Development and Evaluation) was used to assess the quality of evidence. Stata 15.0 software was used to perform the meta-analysis.
Thirty-three randomized controlled trials were included in this study.
Ginger had more significant effects than conventional drugs with regard to the Rhodes Index [WMD = -0.52, 95% CI (-0.79, -0.24), P ≤ 0.001; moderate-quality evidence] and had the same effect as drugs to relieve vomiting [SMD = 0.30, 95% CI (-0.12, 0.73), P = 0.160; low-quality evidence].
Compared with placebo, ginger had a higher efficacy rate [RR = 1.68, 95% CI (1.09, 2.57), P = 0.018; low-quality evidence] and a lower visual analog scale (VAS) of nausea [WMD = -1.21, 95% CI (-2.34, -0.08), P = 0.036; low-quality evidence]. Ginger had the same antiemetic effect as placebo [WMD = 0.05, 95% CI (-0.23, 0.32), P = 0.743; low-quality evidence].
In conclusion, the results of the study showed that complementary and alternative medicine therapies can relieve nausea and vomiting in pregnancy.
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