Intended for healthcare professionals

Rapid response to:

Clinical Review

Management of nausea and vomiting in pregnancy

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3606 (Published 17 June 2011) Cite this as: BMJ 2011;342:d3606

Rapid Response:

Re: Use of acupuncture in nausea and vomiting in pregnancy

I read this week's article on management of nausea and vomiting in
pregnancy with interest, especially the section on non-pharmacological
approaches available to women. This is an area of particular growing
demand during pregnancy. Many women are concerned by the potential adverse
side effects on their baby from pharmacological agents and hence tend to
refrain from drug treatments initially. Alternative therapies offer an
attractive 'natural' solution, which can provide a more holistic approach
to both mother and baby.

I would like to particularly explore the use of acupuncture and
acupressure briefly mentioned in this article. In traditional Chinese
medicine, morning sickness is thought to be caused by a deficiency of
stomach Qi with an upward flux of foetal Qi disturbing the flow of
maternal stomach Qi. The prescribed treatment is stimulation of a
combination of acupuncture points, one of which is the P6 point on the
wrist called Neiguan. This point has been under investigation for the
effectiveness on reducing nausea and vomiting during pregnancy and post-
surgery. Anecdotal reports have been positive however evidence from
randomized controlled trials does not support this. Matthews et al, 2010
performed a review on the effectiveness of various interventions for
nausea and vomiting in pregnancy, this included stimulation of acupuncture
points of various forms. Four studies with 408 women were reviewed, where
P6 acupressure was compared to placebo, the evidence did not show a
statistically significant effect for acupressure. Norheim et al, 2001
favoured P6 acupressure for reducing intensity of symptoms, however this
was not statistically significant. P6 acupressure was also compared with
treatment with vitamin B6 (one study with 66 women) the results showed no
statistical significant difference between the two interventions. Smith et
al, 2002 compared traditional acupuncture, P6 acupuncture, sham
acupuncture and no treatment. None of the results showed significant
differences for relief of symptoms. The general finding by Matthews et al
was a lack of high quality evidence on this subject and this made their
interpretation of the results difficult.

Clinical evidence currently has not been able to demonstrate a clear
benefit of acupuncture, however this does not stop women from seeking
alternative treatment. In some of these women a clear benefit may be
experienced and, in light of this, should be an area for further rigorous
research.

References

1) Matthews A, Dowswell T, Haas DM, Doyle M, O'Math?na DP.
Interventions for nausea and vomiting in early pregnancy. Cochrane
Database Syst Rev. 2010 Sep 8;(9).

2) Norheim AJ, Pedersen EJ, Fonnebo V, Berge L. Acupressure treatment
of morning sickness in pregnancy A randomised, doubleblind, placebo-
controlled study. Scandinavian Journal of Primary Health Care
2001;19(1):43-7.

3) Smith C, Crowther C. The placebo response and effect of time in a
trial of acupuncture to treat nausea and vomiting in early pregnancy.
Complementary Therapies in Medicine 2002;10(4):210-6.

Competing interests: No competing interests

27 June 2011
Jia L Stevens
CT1 ACCS anaesthesia
Lister Hospital, Stevenage