MAKALAH

KETIDAKNYAMANAN IBU HAMIL TRIMESTER 1

HEARTBURN (Rasa Panas pada Bagian Dada)

Disusun Oleh :

1. Devi Suparyeti NIM: P27224020491

2. Ove Novia Dian Istiqomah NIM: P27224020509

KEMENTERIAN KESEHATAN REPUBLIK INDONESIA

POLTEKKES KEMENKES SURAKARTA
JURUSAN KEBIDANAN
TAHUN 2021

i
 KATA PENGANTAR

Rasa syukur kami haturkan kepada Tuhan Yang Maha Kuasa, karena
berkat karunianya kami dapat menyusun makalah ini dengan baik dan selesai
tepat pada waktunya. Makalah ini kami beri judul “Ketidaknyamanan pada Ibu
Hamil Trimester 1 tentang Heartburn (Rasa Panas pada Bagian Dada)”.

Penyusunan makalah ini bertujuan untuk memenuhi tugas Asuhan

Kehamilan dari Dosen pengampu mata pelajaran. Selain itu, makalah ini juga
bertujuan untuk memberikan tambahan wawasan bagi kami sebagai penulis dan
bagi para pembaca. Khususnya dalam hal ketidaknyamanan kehamilan trimester 1
dengan Heartburn (Rasa Panas pada Bagian Dada).

Terakhir, kami menyadari bahwa makalah ini masih jauh dari

kesempurnaan. Maka dari itu kami membutuhkan kritik dan saran yang bisa
membangun kemampuan kami, agar kedepannya bisa menulis makalah dengan
lebih baik lagi. Semoga makalah ini bermanfaat bagi para pembaca, dan bagi kami
khususnya sebagai penulis.

Surakarta, 06 Januari 2021

Penulis

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 DAFTAR ISI

HALAMAN JUDUL...........................................................................................i

KATA PENGANTAR.......................................................................................ii

DAFTAR ISI.....................................................................................................iii

BAB I PENDAHULUAN..................................................................................1
A. Latar Belakang................................................................................................1
B. Rumusan Masalah...........................................................................................2
C. Tujuan.............................................................................................................2

BAB II PEMBAHASA......................................................................................3
A. Pengertian Heartburn pada Ibu Hamil............................................................3
B. Penyebab Heartburn pada Ibu Hamil..............................................................3
C. Penanganan Heartburn pada Ibu Hamil..........................................................4

BAB III PENUTUP...........................................................................................5

A. Kesimpulan.....................................................................................................5
B. Saran...............................................................................................................5

DAFTAR PUSTAKA........................................................................................6

iii
iv
 BAB I
PENDAHULUAN

A. Latar Belakang

Salah satu target global yang tertuang dalam Sustainable Development Goals
(SDGs) adalah menurunkan angka kematian ibu (AKI). Hal tersebut selaras
dengan arah pencapaian Indonesia sehat 2030 yaitu menjamin kehidupan yang
sehat dan mendorong kesejahteraan bagi semua orang di segala usia. Hasil Survey
Demografi dan Kesehatan Indonesia (SDKI) tahun 2012,AKI masih berada pada
359 per
100.000 kelahiran hidup. (Badan Pusat Statistik et al., 2013)

Kehamilan menjadi pengalaman baru bagi seorang perempuan, perubahan

fisik serta psikologis dan perubahan sosial menimbulkan ketidaknyamanan dan
kecemasan tersendiri. Prevalensi kecemasan selama kehamilan sekitar 3-17%,di
negara maju 10% dan di negara berkembang 25%,di Indonesia angka kejadian
kecemasan pada kehamilan berkisar 28,7%. (Kemenkes RI,2011;Rubertsson et
al.,2014; Shahhosseini et al., 2015)

Salah satu perubahan fisik yang dapat menimbulkan ketidaknyamanan pada

ibu hamil yaitu heartburn yang sering terjadi pada trimester pertama. Heartburn
adalah suatu kondisi dimana asam lambung naik dengan sensasi terbakar di sekitar
dada bagian bawah hingga tenggorokan bagian bawah. selama kehamilan, hormon
progesteron menyebabkan katup rileks, yang dapat meningkatkan frekuensi
mulas. Ini memungkinkan asam lambung masuk ke kerongkongan dan mengiritasi
lapisan.

Menurut J. E. RICHTER Department of Medicine, Temple University School

of Medicine, Philadelphia (2005), heartburn diperkirakan terjadi pada 30-50%
kehamilan, dengan insiden mendekati 80% di beberapa populasi. Biasanya,
mulas/Heartburn selama kehamilan hilang segera setelah melahirkan, namun,
kadang-kadang menunjukkan eksaserbasi penyakit refluks gastroesofagus yang
sudah ada sebelumnya. Kebanyakan pasien mulai memperhatikan gejala mereka
di
1
akhir trimester pertama atau trimester kedua kehamilan dengan mulas menjadi
lebih sering dan parah pada bulan-bulan terakhir kehamilan. Indeks massa tubuh
sebelum kehamilan, kenaikan berat badan selama kehamilan, atau ras tidak
memprediksi mulas/ heartburn dan usia ibu yang lebih tua tampaknya memiliki
efek perlindungan pada heartburn.

Berdasarkan uraian tersebut, maka kami penulis tertarik untuk berdiskusi

mengenai ketidaknyamanan yang sering terjadi pada ibu hamil trimester pertama
dengan keluhan rasa panas pada bagian dada atau sering disebut dengan
Heartburn.

B. Rumusan Masalah

1. Apa pengertian dari Heartburn pada ibu hamil?

2. Apa penyebab hearburn pada ibu hamil?
3. Bagaimana penanganan Hertburn pada ibu hamil?
C. Tujuan
1. Untuk mengetahui pengertian heartburn pada ibu hamil
2. Untuk mengetahui penyebab heartburn pada ibu hamil
3. Untuk mengetahui bagimana penanganan heartburn pada ibu hamil

2
 BAB II

PEMBAHASAN

A. Pengertian Heartburn pada Ibu Hamil

Heartburn adalah suatu kondisi dimana asam lambung naik dengan sensasi
terbakar di sekitar dada bagian bawah hingga tenggorokan bagian bawah. Kondisi
ini banyak dialami oleh ibu hamil. Heartburn saat hamil memang tidak berbahaya,
namun akan mengganggu kenyamanan ketika kondisi ini terus berulang. Kondisi
seperti ini disebabkan perut kembung selama kehamilan dan terjadi di trimester
kedua. Namun, sebagian juga merasakan heartburn saat trimester pertama.
Menurut American Pregnancy Association, selama kehamilan, hormon
progesteron menyebabkan katup rileks, yang dapat meningkatkan frekuensi
mulas. Ini memungkinkan asam lambung masuk ke kerongkongan dan mengiritasi
lapisan. Mulas dan gangguan pencernaan justru lebih sering terjadi selama
trimester ketiga karena rahim yang tumbuh memberi tekanan pada usus dan
lambung. Tekanan pada perut juga dapat mendorong isi kembali ke
kerongkongan. ( Heartburn pada ibu hamil, Phani fauziah, 2020)

B. Penyebab Heartburn pada Ibu Hamil

1. Hormon Kehamilan (Progesterone) Peningkatan hormone kehamilan
(progesterone) sehingga menyebabakan penurunan kerja lambung dan
esophagus bawah akibatnya makanan yang masuk cenderung lambat
dicerna sehingga makanan menumpuk hal ini menyebabakan rasa penuh
atau kenyang dan kembung
2. Tekanan dari rahim yang semakin membesar karena kehamilan pada isi
lambung
3. Faktor hormone kehamilan (HCG), yang menstimulasi produksi estrogen
pada ovarium dan hormon estrogen diketahui meningkatkan mual muntah

3
4. Faktor pencernaan, hormon estrogen dapat memicu peningkatan asam
lambung sehingga membuat mual muntah
5. Faktor psikologis, perasaan bersalah, marah, ketakutan dan cemas dapat
menambah mual dan muntah
6. Faktor keturunan, ibu yang mengalami mual muntah maka anak yang
dilahirkan memiliki resiko 3 % mengalami mual muntah sampai
mengalami HEG.
(Patimah Meti,570-579,2020) (Phani fauziah. 2020. heartburn pada ibu
hamil)

C. Penanganan Heartburn pada Ibu Hamil

1. Makan dengan jumlah kecil tapi sering setiap 1-2 jam

2. Hindari makan sebelum tidur, beri jeda 2-3 jam agar makanan dapat
dicerna terlebih dahulu

3. Hindari makanan pedas, makanan berminyak/berlemak seperti

gorengan

4. Hindari makanan yang asam seperti buah jeruk, tomat, dan jambu

5. Kurangi makanan yang mengandung gas seperti kacang-kacangan

6. Konsumsi makanan tinggi serat seperti roti gandum, buah (papaya),

kacangkacangan dan sayuran (seledri, kubis, bayam, selada air, dll)

7. Sebaiknya minum setelah selesai makan dan hindari makan dengan

terburu-buru

8. Hindari minum kopi, minuman bersoda dan alcohol serta hindari rokok

9. Atur posisi tidur senyaman mungkin dengan posisi setengah duduk

10. Gunakan pakaian yang longgar dan nyaman

(Patinah Meti 570-579, 2020) (Phani fauziah.2020.heartburn pada ibu

hamil)

4
11. Konsumsi jahe dapat menurunkan asam pada lambung. Jahe adalah
karminatif, yakni bahan yang mampu mengeluarkan gas dari dalam
perut; hal ini akan meredakan perut kembung. Jahe juga merupakan
stimulan aromatik yang kuat, disamping dapat mengendalikan muntah
dengan meningkatkan gerak peristaltik usus.

Berdasarkan jurnal dengan judul “Effect of ginger in the treatment of

nausea and vomiting compared with vitamin B6 and placebo during
pregnancy : a meta-analiysis” oleh Hu, Youchun, et all (2020)
menunjukkan bahwa suplementasi jahe secara signifikan
mengurangi gejala umum mual dan muntah dibandingkan dengan
plasebo, tetapi tidak efektif secara signifikan pada muntah. Selain
itu, jahe lebih efektif daripada vitamin B6 dalam pengobatan mual
muntaj, meskipun tidak ada perbedaan yang signifikan.

12. Mengurangi asam lambung atau mual muntah agar tidak terjadi
heartburn maka dapat dilakukan akupresur PC6. Stimulasi
tekanan pada titik akupuntur Neiguan (PC6) adalah metode yang
sangat kuno dalam akupunktur Cina, yang telah digunakan secara
efektif untuk mengontrol mual [9]. Titik akupuntur PC6 terletak
tiga ujung jari di bawah pergelangan tangan di lengan bawah di
antara dua tendon [9]. Telah dinyatakan bahwa tekanan titik
akupuntur PC6 dapat mengontrol mual dan muntah dengan
mengontrol fungsi usus.

Menurut Tara, et all dalam penelitiannya yang berjudul “The Effect

of Acupressure on The Severity of Nausea, Vomiting and Retching in
Pregnant Women : A Randomized Controlled Trial” tahun 2020
menunjukkan bahwa tekanan titik akupuntur PC6 dapat
menurunkan beratnya mual, muntah, dan muntah. Oleh karena
itu, karena sedikit efek samping, biaya rendah, dan aplikasi yang
mudah dibandingkan dengan terapi lain, terapi ini dapat
digunakan

5
 sebagai pilihan terapi yang tepat dalam meredakan gejala ibu
hamil.

BAB III
PENUTUP

A. Kesimpulan
Berdasarkan makalah diatas dapat disimpulkan jika ketidaknyamanan ibu
hamil dengan heartburn dapat dialami oleh beberapa ibu hamil yang diakibatkan
naiknya hormone estrogen selama kehamilan. Ketidaknyamanan ibu hamil dengan
heartburn juga dapat diatasi tanpa menggunakan obat kimia, contohnya dengan
memperbanyak minum air putih setiap hari dan cukup istirahat.

B. Saran
Penulis menyadari sepenuhnya jika makalah ini masih banyak kesalahan dan
jauh dari sempurna. Oleh karena itu, untuk memperbaiki makalah tersebut penulis
meminta kritik yang membangun dari para pembaca.

6
 DAFTAR PUSTAKA

Meti Patimah.2020. “Pendidikan Kesehatan Ibu Hamil Tentang Ketidaknyamanan

Pada Kehamilan Trimester I dan Penatalaksanaannya”Jurnal Pengabdian
Masyarakat. Vol. 41, No. 3 September 2020, Hal. 570-578

J. E. RICHTER.2005. Review article: the management of heartburn in pregnancy.

22: 749–757

decastro LP. Reflux esophagitis as the cause of heartburn in pregnancy. Am J

Obstet Gynecol 1967; 98: 1–10.

Phani fauziah. 2020. Heartburn pada ibu hamil. Diakses pada 2 februari 2021.

Tara, Fatemeh, et all. 2019. The effect of Accupressure on The Severity of Nausea,
Vomiyinh, and Retching in Pregnant Woman : A Randomized Controlled
Trial. Complementary Medicine Reached : DOI : 10.1159/000505637

Hu, Youchun, et all. 2020. Effect of Ginger in The Treatment of Nausea and
Vomiting Compared with Vitamin B6 and Placebo During Pregnancy : A
Meta-Analysis. The Journal of Maternal-Fetal & Neonatal Medicine :
ISSN: 1476-7058 (print) 1476-4954 (online).

7
 Research Article / Originalarbeit
Complement Med Res Received: July 14, 2019
Accepted: December 24, 2019
DOI: 10.1159/000505637
Published online: February 4, 2020

The Effect of Acupressure on the Severity of

Nausea, Vomiting, and Retching in Pregnant
Women: A Randomized Controlled Trial
Fatemeh Taraa Hamidreza Bahrami-Taghanakib
Masoud Amini Ghalandarabadc Ziba Zand-Kargard Hamideh Azizid
Habibollah Esmailye Hoda Azizib
a
Department of Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran;
b
Department of Chinese and Complementary Medicine, School of Persian and Complementary Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran; c Medical student, Faculty of Medicine, Mashhad University of
Medical Sciences, Mashhad, Iran; d Gynecologist, Mashhad, Iran; e Department of Biostatistics, School of Health,
Mashhad University of Medical Sciences, Mashhad, Iran

Keywords sea, vomiting, and retching was done based on the

Acupressure · Pregnancy-induced nausea and vomiting ·
Hyperemesis gravidarum · Nausea · Vomiting
Abstract
Introduction: Nausea and vomiting are common
problems during pregnancy. Previous studies have
shown that stimu- lation at Neiguan (PC6) acupoint can
be effective in control- ling pregnancy-induced nausea
and vomiting. However, more evidence is required for
approving this method on controlling pregnancy-induced
nausea and vomiting. The aim of this study was to
determine the efficacy of PC6 acu- point pressure
stimulation on the severity of nausea, vomit- ing, and
retching in pregnant women. Method: This ran-
domized, multi-center clinical trial was conducted on
preg- nant women referring to Health Centers and
Ommolbanin Hospital in Mashhad, Iran, during
December 2016 to Sep- tember 2017. Women with first
singleton pregnancy and be- low 12 weeks were
included. Patients were randomly allo- cated into three
groups of (1) PC6 pressure (4 times a day, for 10 min), (2)
sham acupressure, and (3) medication with vita- min B6
and metoclopramide. Assessment of severity of nau-
Rhodes Index on the first and fifth day (before and after
the interven- tion). Pearson chi-square test, one-way
ANOVA, Kruskal-Wal- lis, and Wilcoxon tests were used
for statistical analysis using SPSS version 18. This
clinical trial was registered at the Iranian Registry of
Clinical Trials (IRCT) with the code
IRCT201512187265N6. Results: Ninety patients with a
mean age of 26.40 ± 4.73 years were studied in 3
groups of 30. There was no significant difference
between the 3 groups in terms of the severity outcomes
before the intervention, while, after the intervention, the
three groups were signifi- cantly different on the fifth day
in terms of vomiting frequen- cy, distress from retching,
distress from vomiting, duration of nausea, distress from
nausea, amount of vomiting, fre- quency of nausea, and
frequency of retching (p < 0.001 for each outcome).
According to the linear regression analysis, the correlation
between occupation with vomiting frequen- cy (beta
coefficient = 0.252) and nausea severity (beta coef-
ficient = –0.213) was statistically significant. Conclusion:
It seems that PC6 acupoint pressure can reduce the
severity of nausea, vomiting, and retching in pregnant
women.
Göteborgs Universitet Downloaded by:

© 2020 S. Karger AG, Basel

karger@karger.com © 2020 S. Karger AG, Hoda Azizi

www.karger.com/cmr Basel School of Persian and Complementary Medicine
Mashhad University of Medical Sciences
Azadi Square, Pardis University Campus, Mashhad 9135913556 (Iran)
azizi
h@
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tung durchWirkung der Akupressur
die Übelkeit, Menge des auf den
Erbrochenen,
Schweregrad von Übelkeit, Erbrechen
Häufig- keit der Übelkeit und Häufigkeit des und
Würgereiz bei Schwangeren: eine
Würgereizes (p < 0,001 für jedes Zielkriterium).
randomisierte
Gemäß linearer Regres-kontrollierte Studiefiel die
sionsanalyse
Korrelation zwischen Beschäftigung und der Häufigkeit
des Erbrechens (Betakoeffizient = 0,252) sowie der
Schwere der Schlüsselwörter
Übelkeit (Betakoeffizient =
Akupressur
–0,213) statistisch · schwangerschaftsinduzierte
signifikant aus. Schlussfolgerung:
Es scheint, dass Erbrechen
Übelkeit und · Hyperemesis am
die Druckstimulation
gravidarum · Übelkeit · Erbrechen
Akupunkturpunkt PC6 die Schwere von Übelkeit,
Erbrechen und Würgereiz bei Schwangeren verringern

Zusammenfassung
Einleitung: Übelkeit undIntroduction
Erbrechen treten in der
Schwangerschaft häufig auf. Frühere Studien
haben gezeigt, dass die Stimulation des
Akupunkturpunkts Nei- guan (PC6) Übelkeit und
Erbrechen in der Schwanger- schaft wirksam
kontrollieren kann. Für die Zulassung die- ser
Methode zur Behandlung von Übelkeit und Erbrechen
in der Schwangerschaft sind jedoch weitere
Belege er- forderlich. Mit der vorliegenden Studie
sollte die Wirksam- keit der Druckstimulation am
Akupunkturpunkt PC6 auf den Schweregrad von
Übelkeit, Erbrechen und Würgereiz bei
Schwangeren ermittelt werden. Methode: Die
vorlie- gende randomisierte multizentrische
klinische Studie wurde an schwangeren Frauen
durchgeführt, die sich zwischen Dezember 2016
und September 2017 in Ge- sundheitszentren und
im Ommolbanin Krankenhaus in Mashhad, Iran,
vorgestellt hatten. In die Studie wurden
Erstgebärende mit einer Einlingsschwangerschaft bis
zur
12. Schwangerschaftswoche aufgenommen. Die
Patien- tinnen wurden nach dem Zufallsprinzip
einer von drei Gruppen zugewiesen: (1) PC6-
Druckstimulation (viermal täglich für 10 Minuten), (2)
Scheinakupressur und (3) me- dikamentöse
Behandlung mit Vitamin B6 und Metoclo- pramid.
Die Bewertung des Schweregrads von Übelkeit,
Erbrechen und Würgereiz erfolgte an Tag 1 und Tag
5 (vor und nach der Intervention) mithilfe des
Rhodes-Index. Bei der statistischen Analyse kam
SPSS Version 18 zur An- wendung und es wurden
der Pearson-Chi-Quadrat-Test, eine einfaktorielle
ANOVA sowie Kruskal-Wallis- und Wil- coxon-Tests
durchgeführt. Die klinische Studie war beim
iranischen Register für klinische Studien (Iranian
Registry of Clinical Trials, IRCT) unter der Kennung
IRCT201512187265N6 registriert. Ergebnisse:
Neunzig
(90) Patientinnen mit einem Durchschnittsalter von
26,40
± 4,73 Jahren wurden in drei Gruppen mit je 30
Pregnancy is often associated with many problems,
the most common of which is nausea and vomiting,
which is reported by 50–80% of women between 6
and 12 weeks of pregnancy [1–3], although it is
reported that morning nausea and vomiting can
continue until the 20th week of pregnancy in 20% of
cases [1, 2]. Hyperemesis gravi- darum, which is
commonly reported as a frequent and severe nausea
and vomiting in pregnant women, is less common,
accounting for 0.3 to 3% of pregnancies [3, 4]. Various
therapeutic interventions are recommended for
pregnancy-induced nausea and vomiting, which are
di- vided into two groups of pharmaceutical and non-
phar- maceutical treatments [5, 6]. Pharmaceutical
treatments include antihistamines and vitamins B6
and B12 as well as dopamine antagonists and H3, or a
combination of them [2, 7]; however, the results of the
studies show that these therapeutic interventions are
rarely successful to lead to a complete recovery in
affected mothers [1, 2, 8]. In addi- tion, pregnant
women’s concern of possible side effects of drugs and
their teratogenic effects on the fetus sometimes causes
improper and insufficient consumption of such
medication in this group of people. Therefore, finding
a safe, immediate, and strong intervention with high
access at any location, even at the patient’s home, has
seemingly remained a research priority [2, 4, 8].
Pressure stimulation at Neiguan (PC6) acupoint is
a very ancient method in Chinese acupuncture, which
has been used effectively to control nausea [9]. The
PC6 acu- point is located three fingerbreadths below
the wrist on the inner forearm in between the two
tendons [9]. It has been stated that the PC6 acupoint
pressure may control nausea and vomiting by
controlling the functioning of the intestine [10]. In
addition, other researchers believe that acupressure
acts through inhibition of cerebrospinal flu- id
function by neurostimulation, which reduces the de-
gree of nausea and vomiting [10, 11]. So far,
pressure stimulation at the PC6 acupoint has been
used to control chemotherapy-induced vomiting, and
some studies have also shown that this intervention
can also be effective in
Göteborgs Universitet Downloaded by:

2 Complement Med Res Tara et al.

DOI: 10.1159/000505637

pregnancy-induced nausea and vomiting [3, 4, 12, 13]. A review study conducted by Cluver et al. [2]
indicated a need for further interventional studies,
although there is evidence regarding the effect of
pressure stimulation at the PC6 acupoint on controlling
pregnancy-induced nau- sea and vomiting. Therefore,
this study was conducted with the aim to determine
the efficacy of PC6 acupoint pressure stimulation
intervention compared with the sham group and also,
to examine the impact of drug in- tervention in the
severity of nausea, vomiting, and retch- ing in
pregnant women.
Materials and Methods
Study Design and Setting
This randomized, single-blind, multi-center clinical trial
was conducted on pregnant women referring to health
centers in Mashhad, Iran, during December 2016 to
September 2017. In this study, the Daneshamooz and
Villashahr Health Centers as well as the Ommolbanin
Hospital, Mashhad, Iran were selected as the study locations.
The study was conducted according to the extend- ing
Consolidated Standards of Reporting Trials (CONSORT)
statement of Revised Standards for Reporting Interventions in
Clinical Trials of Acupuncture (STRICTA).
Participants
The inclusion criteria were: (1) first pregnancy, (2)
pregnancy below 12 weeks, and (3) singleton pregnancy. The
exclusion crite- ria included: (1) proof of fetal death, (2) history
of underlying or associated disease, (3) history of mental
disorders (based on being hospitalized in a psychiatric hospital),
(4) pregnancy after infertil- ity treatment, (5) smoking, (6)
acupressure history for any disease,
(7) any gastrointestinal problems like gastritis, GERD,
heartburn, IBS, etc. and urinary tract infection, (8)
dehydration, (9) hyper- emesis gravidarum, and (10) history
of infertility.
Sampling Methods, Blinding, and Allocation
Patients were allocated into one of the three groups of (1)
acu- pressure at PC6 4 times a day, for 10 min, (2) sham
acupressure, and (3) vitamin B6 plus metoclopramide
treatment, using the ran- domized block method. This is a
small-sample pilot study with a sample size of 30 individuals
for each group. The patients in both the acupressure and sham
acupressure groups were unaware of their group. The
interviewer and the statistical analyst were blind, but there was
no possibility for blinding the intervener.
Interventions
The acupressure group was treated with Neiguan (PC6)
acu- point pressure. The sham acupressure group was treated
by pres- sure at Waiguan (TE5), and the medication group by
vitamin B6 (tab 40 mg, oral, Darou Pakhsh Co., Iran) ½ tab
every 8 h and metoclopramide (tab 5 mg, oral, Hakim Co.,
Iran) 5 mg every 8 h before meals. All study assistants were
trained for the acupressure by one acupuncturist who was a
medical doctor, PhD in acupunc- ture, and university assistant
professor with 10 years of clinical acupuncture experience.
The study assistants consisted of mid- wives of Daneshamooz
and Villashahr Health Centers and Om- molbanin Hospital.
The education included how to locate PC6 and TE5, the
duration of acupressure 4 times a day (in the morning after
getting up, at noon, in the evening, and at night before bed-
time) for 10 min, and the strength at the maximum possible
endur-
ance of the patient (with constant pressure and not with
massag- ing). The PC6 point location was described as 2 cun
(three finger- breadths) below the wrist on the inner forearm
in between the two tendons of the palmaris longus and flexor
carpi radialis muscles. The TE5 point location was described
as 2 cun (three finger- breadths) above the transverse crease
of the dorsum of the wrist, between the radius and ulna. Then
the study team taught patients to do the acupressure
themselves. In all the 3 groups, the first day was dedicated to
the control phase, and the intervention was initi- ated on the
second day, which continued until the end of the fifth day. In
the acupressure group, this pressure was applied to the
Neiguan (PC6) acupoint 4 times a day (in the morning after
getting up, at noon, in the evening, and at night before
bedtime) for 10 min at the maximum possible endurance of
the patient (with constant pressure and not with massaging). If
the patients had severe nausea during the pressure intervals,
they could just once undergo the ex- periment earlier than the
four specified times during a day. In the sham acupressure
group, pressure was applied to Waiguan (TE5), the counterpart
of Neiguan, located on the dorsal aspect of the forearm.
During the study period, all the patients received the same
training on diet (using low-fat foods, solid foods, frequent
meals, low volumes per meal, etc.).
Data Collection
For each patient, a checklist including demographic
informa- tion such as age, sex, education, occupation, body
mass index (BMI), gestational age by week, type of pregnancy,
as well as infor- mation related to the assessment of severity of
nausea, vomiting, and retching based on the Rhodes Index
was completed. The reli- ability and validity of the Rhodes
Index of nausea, vomiting, and retching have been confirmed
in previous studies in different countries [14, 15]. In Iran, the
validity and reliability of this ques- tionnaire has been
confirmed by Modares and colleagues [16]. This index has also
been used frequently in other studies in Iran [17, 18]. The
questionnaire consisted of eight questions that in- cluded the
times of vomiting episodes per day, the volume of the
vomiting, the degree and length of nausea and retching, as
well as the distress associated with the conditions. The
questionnaire was completed at the end of each day by the
patient, and its findings on the initial day (before intervention)
and fifth day (after the inter- vention) were used for
comparison. In addition, the frequency of patients who felt
recovery from nausea, vomiting, and retching at each day of
study in the study groups was recorded daily. The training
of the patients, prescribing medications to them, and ar-
rangements for their follow-up in this project were performed
by the study team trained by one faculty member
acupuncturist.
Outcomes
The primary outcome of this study was the severity of
nausea, vomiting, and retching based on the Rhodes Index
including vom- iting frequency, distress from retching, distress
from vomiting, du- ration of nausea, distress from nausea,
amount of vomiting, fre- quency of nausea, and frequency of
retching. The secondary out- come was the frequency of
patients who felt recovery from nausea, vomiting, and retching
at each day of study.
Ethics
Written informed consent was received from all the
patients. The patients had the right to withdraw from the
study and a phone number was given to them as a 24-h
support service in case of any urgent inquiries. According to
the provisions of the Helsinki Dec- laration, the project
executives were required to preserve the con- fidentiality of
the patients and conduct the research without men- tioning
their names. The questionnaires were kept confidential and
the names and characteristics of the patients were disclosed.
Acupressure for Nausea in Pregnancy Complement Med Res 3
DOI: 10.1159/000505637

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 Table 1. Baseline characteristics of patients in three groups of PC6 acupressure, medication, and
placebo
Variables Acupressure Medication Sham p
acupressure valu
e
(n = 30) (n = 30) (n = 30)

Age, years 26.0±4.7 26.5±4.3 26.6±5.2 0.8

53
Weight, kg 64.9±9.4 58.7±7.8 68.6±9.0 0.024
*
Body mass index 24.1±2.9 22.8±3.4 24.4±3.6 0.1
53
Pregnancy duration, weeks 9.6±1.7 9.3±1.3 8.7±2.2 0.081
Education level
Elementary school 3 (10.0) 1 (3.3) 3 (10.0) 0.2
08
Middle school 3 (10.0) 1 (3.3) 5 (16.7)
High school 15 (50.0) 14 (46.7) 11 (36.7)
Higher education 9 (30.0) 14 (46.7) 11 (36.7)
Job
Housewife 25 (83.3) 29 (96.7) 26 (86.7) 0.001
*
Practitioner 5 (16.7) 1 (3.3) 4 (13.3)

Data are presented as mean ± SD or n (%). * Significant.

This research was approved by the Ethics Committee of

Mashhad University of Medical Sciences under the code
IR.MUMS. REC.1388.100. Also, this clinical trial was
registered at the Iranian Registry of Clinical Trials (IRCT)
with the code IRCT201512187265N6.
Sample Size
For a pilot study with 95% confidence and 80% power to
reach a standardized effect size (f = 0.75), at least 30
samples were re- quired in each group [19].
Statistical Analysis
Pearson chi-square test was used to analyze the nominal
data. In cases where more than 20% of the expected
frequencies in the tables were less than 5, Fisher’s exact test was
used. Moreover, one- way ANOVA, Kruskal-Wallis, and
Wilcoxon tests were used for statistical analysis using SPSS
version 18.0 (released 2009; PASW Statistics for Windows,
Chicago: SPSS Inc.). The significance level in all the tests was
less than 5%.
Results
Baseline Characteristics
This study was performed on 90 patients with a
mean age of 26.40 ± 4.73 years. The patients were
studied in 3 groups of 30. The distribution of the
variables of age, BMI, gestational age, and education
level were homoge- neous in the three groups of
acupressure, drug therapy, and placebo; however,
there were significant differences between the three
groups in terms of weight and occupa- tion (Table 1).
Within-Group Comparison of the Severity of
Retching, Nausea, and Vomiting before and after
the Intervention
In the acupressure group, vomiting frequency (p
= 0.004), distress from retching (p < 0.001), distress
from
vomiting (p < 0.001), duration of nausea (p < 0.001),
dis- tress from nausea (p = 0.001), amount of
vomiting (p = 0.007), frequency of nausea (p = 0.002),
and frequency of retching (p = 0.007) were decreased
post-intervention compared to baseline.
In the sham acupressure group, all the mentioned
se- verity outcomes were increased post-intervention
com- pared to baseline (p = 0.013, 0.005, 0.006,
0.042, 0.002, 0.009, 0.024 for vomiting frequency,
distress from retch- ing, distress from vomiting, distress
from nausea, amount of vomiting, frequency of nausea,
and frequency of retch- ing, respectively) except for
the duration of nausea (p = 0.470).
In the medication group, no significant changes
were observed in any of the severity outcomes post-
interven- tion compared to baseline (p > 0.05).
Comparison of the Severity of Nausea, Vomiting,
and Retching among Study Groups
Based on the statistical analysis performed in
this study, the results of Kruskal-Wallis test showed
no sig- nificant difference between the three groups
based on the frequency distribution of vomiting
frequency (p = 0.165), distress from retching (p =
0.548), distress from vomiting (p = 0.27), duration
of nausea (p = 0.923), dis- tress from nausea (p =
0.489), amount of vomiting (p = 0.075), frequency
of nausea (p = 0.663), and frequency of retching (p
= 0.224) before the intervention, while, after the
intervention, the three groups were significant- ly
different on the fifth day in terms of the severity
out- comes (Table 2).
Furthermore, 90% of the subjects in the sham
acupres- sure group stated that pressure at the
Waiguan not only did not reduce nausea, retching,
and vomiting, but also increased the severity of them.
Also, the data showed that

4 Complement Med Res Tara et al.

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 Table 2. Severity of nausea, vomiting, and retching 5 days after intervention based on Rhodes Index

Variables Medicatio Sham p

n acupressure value
Acupressure
(n = 30) (n = 30) (n = 30)

Vomiting
frequency 7 1 (3.3) 11 (36.7) 2 (6.7) <0.00
and more 1
5–6 0 4 (13.3) 6 (20.0)
3–4 0 2 (6.7) 10 (33.3)
1–2 7 (23.3) 9 (30.0) 9 (30.0)
None 22 (73.3) 4 (13.3) 3 (10.0)
Distress from retching
None 16 (53.3) 2 (6.7) 1 (3.3) <0.00
1
Mild 10 (33.3) 7 (23.3) 1 (3.3)
Moderate 0 4 (13.3) 11 (36.7)
Great 2 (6.7) 5 (16.7) 13 (43.3)
Severe 2 (6.7) 12 (40.0) 4 (13.3)
Distress from vomiting
None 17 (56.7) 3 (10.0) 4 (13.3) <0.00
1
Mild 9 (30.0) 3 (10.0) 1 (3.3)
Moderate 3 (10.0) 4 (13.3) 8 (26.7)
Great 0 7 (23.3) 12 (40.0)
Severe 1 (3.3) 13 (43.3) 5 (16.7)
Distress from nausea
None 12 (40.0) 1 (3.3) 2 (6.7) <0.00
1
Mild 12 (40.0) 7 (23.3) 1 (3.3)
Moderate
4–6 h 0 2 (6.7) 7 3(23.3)
(10.0) 12 7(40.0)
(23.3)
More than 6 h Amount of vomitingGreat 3 (10.0) 5 (16.7) 12 (40.0)

None 22 (73.3) 4 (13.3) 3 (10.0) <0.001

Small (up to ½ cup) 3 (10.0) 4 (13.3) 2 (6.7)
Moderate (½–2 cups) 2 (6.7) 5 (16.7) 9 (30.0)
Large (2–3 cups) 2 (6.7) 5 (16.7) 11 (36.7)
Frequency of nausea
Very large (3 cups or 1 (3.3) 12 5 (16.7)
more) (40.0)
7 times and more 2 (6.7) 10 4 (13.3) <0.001
(33.3)
5–6 times 2 (6.7) 6 (20.0) 11 (36.7)
3–4 times 3 (10.0) 5 (16.7) 10 (33.3)
1–2 times 6 (20.0) 6 (20.0) 3 (10.0)
None 17 (56.6) 3 (10.0) 2 (6.7)
Frequency of retching
7 and more 2 (6.7) 10 4 (13.3) <0.001
(33.3)
5–6 2 (6.7) 6 (20.0) 5 (16.7)
3–4 3 (10.0) 3 (10.0) 11 (36.7)
1–2 9 (30.0) 9 (30.0) 7 (23.3)
None 14 (46.7) 2 (6.7) 3 (10.0)

medication therapy had no significant effect on Regression Analysis

nausea, and almost 50% of the patients reported
Based on the results of the regression test, the
complete ineffi- cacy of this method, while for
correla- tion between occupation with vomiting
acupressure intervention, 86.7% of patients were
frequency (beta coefficient = 0.252) and nausea
cured during a 7-day follow-up (Table 3).
severity (beta coefficient
= –0.213) was statistically significant (Table 4). No im-
portant adverse event was observed in the study groups.
Göteborgs Universitet Downloaded by:

Acupressure for Nausea in Pregnancy Complement Med Res 5

DOI: 10.1159/000505637

Table 3. Frequency of patients who felt recovery from

nausea, vomiting, and retching at each day of study in the Variables Acupressure Medication Sham
study groups (n = 30)(n = 30)acupressure
(n = 30)
Nausea
apy intervention, which is consistent with the findings
Initial day 2 (6.7) 6 1 of the majority of other studies. A study published
(20.0) (3.3
)
recently in 2017 states that PC6 acupressure
1st day 11 (36.7) 4 0 intervention for 12 h for 3 days can significantly reduce
(13.3) (0) pregnancy-induced nausea and vomiting [11]. In a
2nd day 11 (36.7) 2 (6.7) 1 study conducted in Tur- key, it was shown that in
Sum of recovery 26 (86.6) 15 (50.0) 3 (3.3
(10.0) Vomiting subjects undergoing PC6 acu- pressure between days 4–6,
Initial day 2 (6.7) 7 1 there was less severity of nau- sea, frequency of vomiting,
(23.3) (3.3 and feeling of discomfort after nausea [20]. Another study
) showed that the frequency of vomiting, nausea, and
1st day 9 (30.0) 3 0 retching, as well as the discomfort caused by nausea
(10.0) (0)
2nd day 11 (36.7) 2 (6.7) 1
and vomiting were significantly lower in the PC6
Sum of recovery 26 (86.6) 15 (50.0) 3 (3.3 acupoint pressure treatment group than in the control
(10.0) Retching group under drug therapy [21]. The average age of the
Initial day 2 6 (20.0) 2 thepatients, onset [22].
placebo group of the
At atreatment,
higher levelfrequency of pyr-
of the value acu-
(6.7) (6.7) pressure exercises, and findings in their study are fully
1st day 8 4 0 (0) consistent with those
amid for studies, in our
Festin’s study.
review Yet in
study [8]another study,
also showed
2nd day (26.7) (13.3) 0 (0)
11 2 (6.7) the result of the intervention on 138 patients at the
(36.7) PC6 acupoint by 30 bands and one acupressure button
3rd day 4 3 (10.0) that pressure at the PC6 acupoint, compared with the
pla-
1 (3.3) showed that pregnancy-related nausea and vomiting were
(13.3) cebo
signif- acupoint,
icantly reduces
reduced in thenausea and vomiting.
acupressure In
group compared
another
with

Data
(%). are presented as n
Discussion
This study was conducted with the aim to
compare the interventions including Neiguan (PC6)
acupoint pres- sure (4 times a day), placebo
(Waiguan, TE5) acupoint pressure, and medication
therapy with vitamin B6 and metoclopramide. The
results showed that the frequency distribution of
vomiting in pregnant women was signifi- cantly
different at the post-intervention phase between the
three groups. In our study, the results showed a de-
crease in the variables including retching complaints,
vomiting, and nausea and vomiting severity and
frequen- cy as well as nausea and retching frequency
in pregnant women at the post-intervention phase
compared with the pre-PC6 pressure intervention.
This is while all the above variables increased in the
placebo group. However, there was no significant
difference in the drug therapy group between the
pre- and post-intervention. The duration of nausea
also decreased significantly in the acupressure group
after the intervention, but this difference was not
significant in the other two groups. Therefore, the
overall results of our study indicate that PC6 pressure
interven- tion could be significantly more effective
than drug ther-
and 6 crossover studies (n = 1,655) were performed
to
determine the effect of PC6 acupoint pressure stimula-
tion on the prevention of nausea and vomiting in
preg- nant women. The results of their study showed
that this type of intervention can reduce the incidence
of nausea
and vomiting by up to 50% [23]. Also, a meta-
analysis performed on six pregnancy-related nausea
and vomiting treatments including 292 acupressure
cases and 288 con- trols showed that acupressure
significantly reduced post- operative nausea and
frequency of vomiting by almost 15% [12].
However, there were also other studies showing,
con- trary to our study, no higher efficacy of PC6
acupoint pressure stimulation in the prevention of
pregnancy-re- lated nausea and vomiting as
compared to drug therapy or placebo. In the group of
studies opposed to our study, Jamigorn et al. [24], in a
comparative study between PC6 acupressure and
vitamin B6, showed that the severity of nausea and
vomiting, based on moderate changes in the Rhodes
Index, was not significant between the two groups. In
another study, it was found that there was no signifi-
cant difference between the duration of admission,
amount of drug received, and amount of fluid
therapy required between the two groups of PC6
acupoint pres- sure and placebo [25]. Norheim et al.
[26] also reported a reduction in both the PC6 and
placebo groups in terms of nausea severity (71 and
63%, respectively) and nausea du- ration (71 and 59%,
respectively).
6 Complement Med Res Tara et al.
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Table 4. Regression analysis of the relationship between job, weight, age, and body mass index with nausea, vomiting, and
retching of pregnant patients

Variables Job Weigh Age Body mass index

t
Beta p Beta p value Beta p value Beta p
value valu
e
Retching severity –0.076 0.490 –0.252 0.247 0.041 0.7 0.151 0.4
18 81
Vomiting severity –0.118 0.278 –0.252 0.342 – 0.7 0.041 0.8
0.03 87 49
0
Nausea severity –0.213 0.034* –0.012 0.954 0.130 0.2 0.006 0.9
49 78
Vomiting times –0.252 0.019* 0.412 0.173 0.011 0.3 –0.020 0.9
09 25
Retching times –0.036 0.744 –0.242 0.265 0.006 0.9 0.320 0.1
59 38
Nausea times 0.203 0.062 –0.170 0.427 – 0.3 0.023 0.9
0.10 37 12
7
Nausea duration –1.750 0.084 0.212 0.321 0.118 0.2 –0.296 0.1
91 63
Vomiting volume 0.151 0.169 –0.056 0.794 – 0.9 0.140 0.5
0.00 65 12
5
* Significant.

However, the difference between the findings of peremesis gravidarum, although it can be a
our study and those of other studies could be complemen- tary therapy with standard
attributed to the difference in the studied age groups, supportive therapy. In a simi- lar vein, the
duration of interven- tion, tools used to measure the majority of health system personnel are
volume and severity of nausea and vomiting, as well skeptical about the benefits of PC6 acupoint
as type of drug therapy. Ac- cording to Werntoft and pressure, al- though it received the US Food and
Dykes [27], the duration of in- tervention required to Drug Administration
exert pressure could be an impor- tant factor. They
report that if the band is used each day for 24 h
compared to the short-term effects of placebo, the
improvement will be enhanced. Moreover, Heazell et
al.
[25] found that the use of acupressure bands for 8 h
per day results in a significant improvement in the
amount of intravenous fluid used or hospitalization
length. Al- though we agree on this issue that the use
of the band is less invasive, the need to use the
band for a long time causes the patients to reduce
compliance and decline the precision of applying
pressure, especially at night. Thus, it is assumed that
the use of acupressure band for only 12 h a day can
lead to desired results and also, assures prop- er
application, noncompliance reduction, and better sat-
isfaction rates [11].
Another point to be noted is that the therapeutic
inter- ventions in complementary medicine, apart
from the therapeutic efficacy issues, require to be
culturally accept- ed in order to be effective; therefore,
the findings of this study, as the first study of its type
in Iran, might be of ut- most importance. Our
findings could be considered as valuable since they
are adding to the number of studies agreeing with the
effectiveness of acupressure treatment in controlling
pregnancy-related nausea and vomiting. However, it
should be noted that we cannot claim the ef- ficacy of
PC6 acupoint pressure in the treatment of hy-
license as a complementary treatment [11]. In addition to
the existing confirmations, the findings of the performed
clinical trials, along with our findings, confirm the lack of
serious complications in this treatment [11, 21].
Limitations
The lack of cooperation of some of the patients in re-
turning the questionnaire to the research team was one of
the limitations of this study. Moreover, the amount of
pressure might differ from patient to patient, as it was
done by the patients themselves. It was another limitation of
the study, which was due to the unavailability of the
standard wrist band. In addition, the duration of the
study might have been very short. We only studied single-
ton pregnancies with low risk and thus, the results may
not be applicable to high-risk or multifetal pregnancies. A
future study that examines multifetal pregnancies with high
risk can be beneficial. Also, more accurate studies could be
conducted if pressure is applied using standard
wristbands or by a doctor.
Conclusions
Based on the study findings, it seems that PC6
acu- point pressure can reduce the severity of nausea,
vomit- ing, and retching. Therefore, due to few
adverse events, low costs, and easy application
compared to other thera- pies, it could be used as an
appropriate therapeutic option in relieving the
symptoms of pregnant women.
Acknowledgments and Funding
This article is derived from the findings of the thesis for
MD degree (code 6385) at the Faculty of Medicine, Mashhad
Univer- sity of Medical Sciences (MUMS). This study was
funded by the Research Deputy of MUMS under a research
proposal approved

Acupressure for Nausea in Pregnancy Complement Med Res 7

with the grant number 86722 and authorized by the Ethics
Com- mittee of MUMS (Ethics Code:
IR.MUMS.REC.1388.100). The protocol was registered in the
Iranian Registry of Clinical Trials with the code No.
IRCT201512187265N6.
We would like to thank the personnel and midwives of
Dane- shamooz and Villashahr Health Centers as well as the
Ommol- banin Hospital, especially Mrs. Farzaneh Hashemi
Bakharzi and Mrs. Nadereh Keshmiri, and also all the patients
who participated in this trial for their sincere cooperation.
DOI: 10.1159/000505637
University of Medical Sciences under the code IR.MUMS.
REC.1388.100. Also, this clinical trial was registered at the
Iranian Registry of Clinical Trials (IRCT) with the code
IRCT201512187265N6.
Disclosure Statement
The authors declare that they have no conflict of interest.

Statement of Ethics
Author Contributions
Written informed consent was received from all the
patients. The patients had the right to withdraw from the Fatemeh Tara, Hoda Azizi, Ziba Zand-Kargar, and Hamidreza
Bahrami-Taghanaki contributed substantially to the
study and a phone number was given to them as a 24-h
conception and design of the study. Masoud Amini
support service in case of any urgent inquiries. According to
Ghalandarabad and Hami- deh Azizi contributed to the
the provisions of the Helsinki Dec- laration, the project
acquisition of data. Habibollah Es- maily and Masoud Amini
executives were required to preserve the con- fidentiality of
Ghalandarabad contributed to the anal- ysis and interpretation.
the patients and conduct the research without men- tioning
Hoda Azizi drafted the article. Fatemeh Tara provided critical
their names. The questionnaires were kept confidential and
revision of the article. Hoda Azizi provided final approval of
the names and characteristics of the patients were disclosed.
the version to publish.
This research was approved by the Ethics Committee of
Mashhad

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22 Steele NM, French J, Gatherer-Boyles J,
New- man S, Leclaire S. Effect of
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ISSN: 1476-7058 (Print) 1476-4954 (Online) Journal homepage: https://www.tandfonline.com/loi/ijmf20

Effect of ginger in the treatment of nausea and

vomiting compared with vitamin B6 and placebo
during pregnancy: a meta-analysis

Youchun Hu, Adwoa N. Amoah, Han Zhang, Rong Fu, Yanfang Qiu, Yuan
Cao, Yafei Sun, Huanan Chen, Yanhua Liu & Quanjun Lyu

To cite this article: Youchun Hu, Adwoa N. Amoah, Han Zhang, Rong Fu, Yanfang Qiu, Yuan
Cao, Yafei Sun, Huanan Chen, Yanhua Liu & Quanjun Lyu (2020): Effect of ginger in the treatment
of nausea and vomiting compared with vitamin B6 and placebo during pregnancy: a meta-analysis,
The Journal of Maternal-Fetal & Neonatal Medicine, DOI: 10.1080/14767058.2020.1712714
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THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE
https://doi.org/10.1080/14767058.2020.1712714

REVIEW ARTICLE

Effect of ginger in the treatment of nausea and vomiting compared with vitamin B6
and placebo during pregnancy: a meta-analysis
Youchun Hua, Adwoa N. Amoaha, Han Zhanga, Rong Fua, Yanfang Qiua, Yuan Caoa, Yafei Suna,
Huanan Chena, Yanhua Liub and Quanjun Lyua,b
a
Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China; bFirst Affiliated
Hospital of Zhengzhou University, Zhengzhou, China

ABSTRACT ARTICLE HISTORY

Introduction: Nausea and vomiting (NV) affect up to 85% of pregnant women, which has mul- tiple Received 6 August 2019
effects on pregnancy outcome. The truth etiology of nausea and vomiting in pregnancy (NVP) is Accepted 5 January 2020
still unknown. Considering the potential teratogenic effect in fetus due to chemical drugs, ginger
KEYWORDS
can be used to treat nausea and vomiting during pregnancy. Reports have shown that ginger can
Ginger; meta-analysis;
reduce the severity of NV, however, these results are controversial. Therefore, this meta-analysis nausea; pregnancy; vitamin
aims to explore the effect of ginger in the treatment of nausea and vomiting during pregnancy B6; vomiting
compared with placebo and vitamin B6.
Methods: The randomized control trials (RCTs) on the association with ginger and pregnancy- related
nausea and vomiting were searched and identified in two databases Web of Science and
PubMed (up to April 2019). Stata software was used to conduct meta-analysis. In addition, the
source of heterogeneity explored by metaregression, sensitivity analysis, subgroup analyses, the
publication bias were assessed by Egger’s tests and Funnel plot, p < .05 was considered to be
significant.
Results: Thirteen studies involving 1174 subjects were included in this meta-analysis. The result
demonstrated that ginger intervention has significant effect in improving general symptom of
2
NVP [OR ¼ 7.475, 95% CI ¼ (4.133, 13.520), I ¼ 30.1%], relieving severity of nausea [SMD ¼ 0.821,
95% CI ¼ (0.585, 1.056), I 2¼ 38.9%], but not significant in reducing vomiting [SMD ¼ 0.549, 95%
CI ¼ (—0.268, 1.365),2I ¼ 91.4%], compared with placebo. Besides, ginger intervention has no sig-
nificant effect on improving general symptom of NVP [OR ¼ 1.239, 95% CI ¼ (0.495, 3.102),
I2¼ 57.3%], relieving severity of nausea [SMD ¼ 0.199, 95% CI ¼ ( 2
—0.102, 0.500), I ¼ 65.7%],
2
reducing vomiting [SMD ¼ 0.331, 95% CI ¼ (—0.145, 0.808), I ¼ 85.9%], compared with vita-
min B6.
Conclusions: Ginger supplementation significantly relieve general NVP symptom and nausea
compared with placebo, but no significant effect on vomiting. Moreover, ginger is more effect- ive
than vitamin B6 in treating NVP, although, there were no significant differences. Further, rigidly
designed RCTs with larger sample sizes are needed to verify the effectiveness of ginger
supplementation for treatment NVP compared with vitamin B6.

Introduction world, and result in a series of complications, for

Nausea and vomiting (NV) during pregnancy (NVP) is a
common condition, however, may be the most preva-
lent and dispirited complications [1], which exclude
pathological causes of NV before the diagnosis of NV
during pregnancy [2]. NV affects up to 85% of women
in their family, social life and profession [3]. Pregnant
women suffer from NV mostly in the first trimester,
from 6 to 12 weeks. In addition, more than 20% of
women experiencing NV continue to the 20th week
[2]. Hyperemesis gravidarum (HG), a severe NVP condi-
tion, the morbidity reported about 1.1% around the
example, malnutrition, dehydration, electrolyte
disturb- ance, and excessive weight loss [4]. There is no
gener- ally accepted point at which NVP becomes HG,
so it is difficult to distinguish between women who
experi- ence NV or HG [5].
NV have multiple effects on pregnancy outcome. A
randomized clinical trial [6] indicated a protective
association of NV in early pregnancy and the risk for
pregnancy loss. However, a prospective cohort study
[7] reported that NV during pregnancy showed little
evidence association with pregnancy outcome. Even

CONTACT Quanjun Lyu lqjnutr@zzu.edu.cn; lvquanjun666@163.com Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou
University, Zhengzhou, China
© 2020 Informa UK Limited, trading as Taylor & Francis Group
2 Y. HU ET AL.
more, there is an increased risk of depressive symp-
toms at 6 weeks postpartum associated with women
who have prolonged nausea [8].
The pathophysiology of NVP/HG is associated with
biological, physiological, psychological and sociocul-
tural factors, but the true etiology is still unknown [9].
Genetic factors increase the risk of NVP incidence [10].
Endocrine factors (especially human chorionic gonado-
tropin) contribute to terrible forms of NVP/HG [11].
Gestational transient thyrotoxicosis has been associ-
ated with the severity of NVP/HG [12]. Additionally,
delayed gastric emptying may correlate with NVP
symptoms [5]. Trace element deficiency is also associ-
ated with HG. HG can be caused by vitamin B6 thia-
min, and vitamin K deficiency, which in turn continues
to aggravate vitamin deficiency.
There are diversified interventions for cure NVP
according to the severity of NVP, which is divided into
three broad groups: first-line treatment be applied in
less severe NVP by women before seeking medical
care, second-line treatment be applied to provide
medical care in hospital in more severe NVP, and third-
line treatment will be applied in even worse con- dition
[5]. When first suffering the bother of NVP, many
pregnant women try more than one interven- tion
which they acquire from the internet or in other ways.
Dietary/lifestyle measures can be used to relieve NVP
(including increasing oral fluid intake, eating small
frequent meals, eating bland foods/protein-pre-
dominant meals and avoiding spicy, odorous and fatty
foods, as well as stopping iron-containing multivita-
mins). Acupressure, hypnotherapy, aromatherapy, and
dietary supplement, including vitamin B6, vitamin B12
and ginger have all been documented to be used in
treating NVP [5].
In the past, chemicals (pyridoxine, doxylamine [13],
thalidomide [14]) and natural plant ingredients were
used to treat NV during pregnancy. Nevertheless, it
has been reported [14,15] that potential teratogenic
effect in fetus results from chemical drugs (particularly
thalidomide [16]). Given these concerns, there has
been an increasing attempt to use functional natural
products as alternatives to the conventional chemical
medicine treatments, which are often more acceptable
to patients [2], one of which is ginger.
Ginger is a perennial herb, rhizome for medicinal,
fresh or dried products can be used as cooking ingre-
dients or made into pickles, sugar ginger [17]. Ginger
has been traditionally used as a folk remedy for
gastrointestinal complaints and has been recom-
mended as a viable adjuvant supplement for NVP [18],
(incomplete outcome data), (6) reporting bias (selec-
as well as NV induced by chemotherapy in cancer
patients [19].
There are many clinical trials [1,20,21] designed in
RCT, exploring the effect of ginger supplement in the
relief of NV. Reports have shown that ginger can
reduce the severity of NVP compared with placebo
and vitamin B6, however, these results are controver-
sial. There is insufficient strong evidence for the effect of
ginger intervention. Hence, the present meta- analysis is
to further evaluate the effect of ginger supplement in
pregnant women suffering from NV compared with
vitamin B6 and placebo.
Materials and methods
Search strategy
A comprehensive literature search of Web of Science
and PubMed was conducted before April 2019. The
following keywords were used: “Ginger” or “Zingiber”
and “pregnancy” and “nausea” or “vomiting”. In add-
ition, the reference lists of primary papers and reviews
were searched manually to identify additional eli-
gible research.
Study selection
Papers included met all the following criteria: (1) The
articles concerning the effect of ginger in treating NV
during pregnancy, (2) Study design: the effects of gin-
ger were compared with a control group (either pla-
cebo, vitamin B6, acupressure, or other comparer) and
the participants were randomly assigned to trials, (3)
Sufficient data for estimating the odds ratios (ORs) or
standardized mean difference (SMD), (4) The outcomes
were about improvement of NVP. Articles were
excluded if: (1) the systematic review, observational
papers, case report, or comments, (2) data were
incomplete or unusable. Two reviewers (Youchun Hu
and Han Zhang) independently screened the titles and
abstracts of the articles to assessment eligibility for
inclusion until consensus was reached.
Quality assessment
Two reviewers (Youchun Hu and Rong Fu) independ-
ently evaluated the methodologic quality of eligible
RCTs using the Cochrane Risk Assessment Tool [22].
The items were for assessment: (1) selection bias (ran-
dom sequence generation), (2) selection bias (alloca-
tion concealment), (3) performance bias (blinding of
participants and personnel), (4) detection bias (blind-
ing of outcome assessment), (5) attrition bias
tion reporting), (7) other biases.
Data extraction THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE 3

The following data from each included study were

extracted independently by two authors (Youchun Hu
and Yanfang Qiu): the first author’s surname, year of
publication, country of original, administrated daily
dose of ginger and control group, number of partici-
pants, study design, duration of treatment period, ges-
tation stage, measure of NV, means and standard
deviations (SDs) of NV at the pretreatment and post-
treatment, and the improvement ratio of NVP.
Discrepancies were resolved by discussion or a third
investigator.

Data analysis
The improvement ratio of NVP was combined using the
Mantel–Haenszel method, and measures of effect were
presented as odds rate (OR) with 95% confidence inter-
vals (CIs). The mean difference (MD) for net change and
95% CI was used to determine the effect of ginger or
control group treatment NVP in this meta-analysis. The
formula applied to calculate the mean difference and
the standard deviations (SDs) for the net changes was:
mean difference ¼ Meanpre-treatment — Meanpost-treatment,
SD ¼ square root [(SDpre-treatment)2 þ (SDpost-treatment) 2 — Figure 1. The process of literature search and selection of
(2 R × SDpre-treatment × SDpost-treatment)], assuming a cor- studies in this meta-analysis.
relation coefficient (R) ¼ 0.5 [23].
Results
The presence of significant heterogeneity was
examined by the I-squared (I2) statistic. If the I2 value Study selection and study characteristics
was less than 50%, fixed-effects models were applied,
Figure 1 summarizes the process of literature search
otherwise, the random effects model was used to cal-
and selection of studies. The search strategy resulted
culate pooled results [24]. Metaregression [25] was
in 195 potentially relevant citations. Papers about
performed to detected the source of heterogeneity.
duplicates, reviews, animal, and in vitro experiments were
Besides, the “leave-one-out” sensitive analysis was
removed. The included studies compared ginger with the
used to access the pivotal contributor which has a
three active ingredients (vitamin B6, acupres- sure,
substantial impact on between-study heterogeneity, in
metoclopramide) and placebo. Only one article compared
case no significant covariates were found to be het-
the ginger with acupressure [28] and another
erogeneous [25]. Subgroup analyses [26] were used to
compared with metoclopramide [29]. Therefore, the
evaluate potential effect modification of variables
effect of ginger compared with acupres- sure and
including country (geographic locations), duration of
metoclopramide can’t be analyzed in this meta-analysis.
intervention, gestation stage, outcome measure
Finally, a total of 13 RCT studies involv- ing 1174
and dose.
The publication bias were assessed by Egger’s tests participants were included in this meta-ana- lysis
[1,20,21,30–39]. The main characteristics of these
and Funnel plots [27], and p < .05 was considered to
be significant. Stata software (version 12.0, StatCorp, included papers are presented in Table 1. The meta-
College Station, TX, USA) was employed for the statis- analysis was divided into two parts: ginger versus pla-
tical analysis. p < .05 was considered as statistically cebo and ginger versus vitamin B6. We extracted all
significant. the available data from eligible papers.

Risk of bias in included studies

The estimate of risk of bias is shown in Figure 2, all tri-
als were designed in randomized control trials, while
only 7 of 13 trials described the detailed information
 4

Y.
HU
ET
AL.

Table 1. Characteristics of included papers about effective of ginger treatment nausea and vomiting during early pregnancy.
St Drop Intervention (ginger Control Group Placebo
First author, year ud Count NPB/NME out dose/day) (control (placebo D of T GS Outcome measure
y ry (treatment) rate dose/day) dose/day) (days) (weeks)
de (%)
sig
n
Sharifzadeh, RCT Iran 77/77 0 Ginger capsule, Vitamin B6 Placebo capsules (not 4 6–16 Rhodes
2018 (28G,26C,23P)
1000 mg/day capsule, 80 mg specified), dose score þ Likert scale
not specified
Saberi, 2014 RCT Iran 120/106 11 Ginger capsule, No intervention Capsules, 3 7 <16 Rhodes
(37G,33C,36P) .6 capsules/day
7
750 mg/day (intervent index þ likert scale,
ion
4 days)
Firouzbakht, RCT Iran 120/97 19 Ginger Vitamin B6 capsule, Sugar 4 <20 VAS þ Likert scale
2014 (24G,35C,28P) .1 capsule, 160 mg/day capsule,
7 1000 mg/day 160 mg/day
2500Haji
mg/day
SeidJavadi, RCT Iran 102/95 6. Ginger capsule, Vitamin B6 tablets, day, dose not specified 4 <17 MPUQE scoring system
(47G,48C) 87
2013 1000 mg/day 80 mg/d
Ozgoli, 2009 RCT Iran 70/67 (32G, 35P) 4. Ginger powder Placebo capsules 4 <20 Nausea analog scale
29 capsules, (lactose), (VAS)
1000 mg/day 1000 mg/day þ frequency of
vomiting
Ensiyeh, 2009 RCT Iran 70/69 (35G, 34C) 1. Ginger powder Vitamin B6 4 ≤17 VAS þ Likert
43 capsules, 1000 capsules, 40 scale (five-
mg/day mg/day point)
Basirat, 2009 RCT Iran 65/62 (32G, 30P) 4. Ginger biscuits, Placebo biscuit, 5 4 <17 VAS þ Likert scale
62 biscuits/
Chittumma, RCT Thaila 126/123 (61G, 62C) 2. Ginger powder Vitamin B6 4 ≤16 Rhodes index
2007 nd 38 capsules; 1950 capsules, 75 (three symptoms)
NPB: number of patients at beginning of trial; NPE: number of patients at end of trial; Control Group: another active ingredients or measure; VAS: visual analog scale; D of T: duration of treatment; GS: gestation
stage; G: patients in ginger group; C: patients in control group; P: patients in placebo.

Figure 2. Risk of bias estimate of included studies in this
meta-analysis.
about random sequence generation, and seven studies
described the methods of allocation concealment,
blinding of participants and personnel (performance
bias) were considered to be low risk in nine trials. The
outcomes recorded by participants in all studies, so
blinding of outcome assessment (detection bias) were
considered to be high risk in all included studies.
To assess the risk of bias for incomplete outcome
data (attrition bias), we calculated the dropout rates
among these 13 included studies, the dropout rates in
4 studies were 11.67, 19.17, 19.23, and 19.24%,
respectively, which may affect the estimation. While
the other nine studies have a dropout rate of less
than 10%. All the trials have almost equal number of
dropout from each intervention group. Only 3 trials of
THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE 5
the included trials reported the ratio of symptom
improvement and the mean score of pre- and post-
treatment about NV. We focused on baseline compar-
ability for other potential sources of bias. The baseline,
such as the age, gestational age, the severity of NV,
were reported to be comparable in all trials among or
between the ginger and control groups.
Ginger group versus placebo group
The ratio of symptom improvement
The effects of ginger treatment NVP compared with
placebo in five studies [31,36–39] are shown in Figure
3(A). We pooled the study-specific ORs using a fixed-
effect model [OR ¼ 7.475, 95% CI ¼ (4.133, 13.520),
p ¼ .000]. No heterogeneity was detected among the
studies (I2 ¼ 30.1%). Ginger was effective in relief NVP
than placebo group. Egger’s test (t ¼ 0.58, p ¼ .600)
and Funnel plot was used to assess publication bias,
presented in Figure 3(B), no obvious publication biases
were observed in Funnel plots.
Change in nausea score
Five studies [1,20,21,37,38] examined the effects of
relief nausea during early pregnancy between ginger
and placebo [Figure 3(C)]. The pooled analysis used a
fixed-effect model which showed that the ginger group
had significantly reduced the nausea score after
treatment [SMD ¼ 0.821, 95% CI ¼ (0.585, 1.056),
p ¼ .000], indicating that ginger group was significant
in reducing the severity of nausea than the placebo
group. No significant heterogeneity was detected
across studies (I2 ¼ 38.9%). Egger’s tests were 0.07
(p ¼ .949). No obvious publication biases were
observed in Funnel plots [Figure 3(D)].
Change in number of vomiting episodes
The forest plots [Figure 3(E)] used five studies
[1,20,21,37,38] to assess the effects of ginger com-
pared with placebo in reducing the number of vomit-
ing episodes during pregnancy, using a random-effect
model. The use of ginger to reduce the frequency of
vomiting episodes was not significant as compared
with placebo [SMD ¼ 0.549, 95% CI ¼ (—0.268,
1.365), p ¼ .188].
There was, however, significant heterogeneity
across studies (I2 ¼ 91.4%). Metaregression with ori- ginal
country, duration of intervention, gestation stage,
outcome measure, and intervention dose showed no
significant impact on between-study
6 Y. HU ET AL.

Figure 3. Forest plot and Funnel plot (of ginger group versus placebo group). (A) Forest plot showing the effect of ginger versus
placebo on the ratio of symptom improvement using a fixed effects model. (B) Funnel plot displaying the publication bias of gin-
ger versus placebo on the ratio of symptom improvement. (C) Forest plot showing the effect of ginger versus placebo on the
change in nausea score using a fixed effects model. (D) Funnel plot displaying the publication bias of ginger versus placebo on
the change in nausea score; change in number of vomiting episodes. (E) Forest plot showing the effect of ginger versus placebo
on the change in number of vomiting episodes using a random effects model. (F) Funnel plot displaying the publication bias of
ginger versus placebo on the change in number of vomiting episodes.

heterogeneity. The leave-one-out analysis demon-

strated that the main contributor to this high hetero-
geneity was one study conducted by Firouzbakht
et al. [21]. After excluding it, the estimate of variance Tau-
squared between-study decreased to 0.377 from 0.792,
and the summary SMD for vomiting episodes was
0.883 [95% CI ¼ (0.225, 1.541), I2 ¼ 83.8%]. This
result implies that ginger was significant in reducing
the number of vomiting episodes than the placebo.
Subgroup analysis conducted by country, duration of
intervention, gestation stage, outcome measure and
dose showed no significant potential effect modifica-
tion of variables between study (p > .05). Publication bias
was performed by Egger’s tests (Egger’s

Figure 4. Forest plot and Funnel plot of ginger versus vitamin B6. Change in nausea score: (A) forest plot for 6 studies using a
random effects model; (B) funnel plot displaying the publication bias of studies. Change in number of vomiting episodes: (C) for-
est plot for 6 studies using a random effects model. SMD: (D) funnel plot displaying the publication bias of studies. CI: confi-
dence interval.
tests ¼ —0.46, p ¼ .675) and the funnel plot is pre-
sented in Figure 3(F).
Ginger group versus vitamin B6 group
The ratio of symptom improvement
Only two studies [32,34] reported the ratio of NVP
symptom improvement between ginger group and
vitamin B6 group. We pooled the study-specific ORs
using a random-effect model [OR ¼ 1.239, 95%
CI ¼ (0.495, 3.102), I2 ¼ 57.3%, p ¼ .647], suggesting
that the effectiveness in treating NVP is unclear
between ginger group and vitamin B6 group. There
was heterogeneity among two studies, however, no
sensitivity analyses and publication bias were per-
formed for insufficient number of studies.
Change in nausea score
Six studies [1,21,30,32,33,35] examined the effects of
nausea relief during early pregnancy between ginger
and vitamin B6 and the result was been presented in
THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE 7
Figure 4(A). The pooled analysis of SMD ¼ 0.199 used
a random-effect model which showed that the ginger
group was more effective than vitamin B6 in reducing
nausea, but there was no significant difference [95%
CI ¼ (—0.102, 0.500), I2 ¼ 65.7%, p ¼ .196].
Metaregression with original country, duration of
intervention, gestation stage, outcome measure and
intervention dose showed no significant impact on
between-study heterogeneity. The leave-one-out ana-
lysis demonstrated that the main contributor to this
high heterogeneity was one study conducted by
Sripramote and Lekhyananda [35]. After excluding it,
the heterogeneity was reduced to I2 ¼ 34.2%, and the
summary SMD was 0.324 (95% CI: 0.126–0.523), which
was reverse to the earlier results. There were no obvi-
ous publication biases observed, Egger’s tests were
0.56 (p ¼ .608). Funnel plots presented in Figure 4(B).
Change in number of vomiting episodes
A total of six studies [1,21,30,32,33,35] assessed the
effects of reduced number of vomiting episodes dur-
ing early pregnancy between ginger and vitamin B6
8 Y. HU ET AL.
[Figure 4(C)] by using a random-effect model. No stat-
istically significant difference was observed in reduced
frequency of vomiting episodes between ginger group
and vitamin B6 group [SMD ¼ 0.331, 95% CI ¼ (—0.145,
0.808), I2 ¼ 85.9%, p ¼ .173].
Metaregression with original country, duration of
intervention, gestation stage, outcome measure and
intervention dose showed no significant impact on
between-study heterogeneity as well. The leave-one-
out analysis demonstrated that the main contributor to
this high heterogeneity was one study conducted by
Firouzbakht et al. [21]. After excluding it, the het-
erogeneity was reduced to I2 ¼ 57.6%, and the sum- mary
SMD was 0.099 (95% CI: —0.186–0.384), which
showed no difference with before (p ¼ .497).
Moreover, a subgroup analysis was conducted by
country, duration of intervention, gestation stage, out-
come measure and dose. It was revealed that there
was no significant potential effect modification of vari-
ables between-study. Additionally, there were no obvi-
ous publication biases observed, Egger’s tests were
1.62 (p ¼ .566), Funnel plots presented in Figure 4(D).
Discussion
Morning sickness is associated with human chorionic
gonadotropin, gastrointestinal function, and olfactory
sensitivity during pregnancy. NVP is caused by multi-
factor, the real mechanism is unclear. The deficiency
of nutrients is also associated with NVP, such as vita-
min B6, so vitamin B6 supplementation can be used
to treat pregnancy NV. Ginger is popular around the
world as a traditional remedy for NV.
In this study, the effect of ginger in the treatment
of NV during pregnancy were investigated, in which
ginger was compared with placebo, vitamin B6. The
pooled effect demonstrated that ginger is effective
than placebo in the treatment of NV during preg-
nancy. However, no significant difference was found
between ginger and vitamin B6. Funnel plots and
Egger’s tests revealed no publication bias in this meta-
analysis.
Effectiveness of ginger in treating general NVP
symptoms during pregnancy were significant than pla-
cebo, which agrees with a previous study [40] based
on six studies conducted in Canada, ginger was signifi-
cantly effective than placebo in relieving nausea. Ginger
was more effective than placebo in treatment vomiting,
but there was no significant difference. In addition, the
effect of ginger on general NVP symp- toms, NV during
early pregnancy were more effective than vitamin B6,
but there was no significant
difference. The results are consistent with previous
research work [1,21,30,35]. Vitamin B6 was as effective
as ginger in alleviating NVP, which contradicted a
study conducted by Chittumma et al. [33] that com-
pared the effectiveness of ginger and vitamin B6 in
treating NVP in early pregnancy in Thailand, in which
ginger was significantly effective than vitamin B6.
Besides, there was a substantial heterogeneity
impact in the reduction of nausea compared between
ginger and vitamin B6. Interestingly, the leave-one-out
analysis demonstrated that after excluding Sripramote
and Lekhyananda [35], the heterogeneity was reduced
to 34.2% from 65.7%, and ginger was more effective
in relieving nausea than vitamin B6. These results con-
cur with Ensiyeh and Sakineh [32]. The trial performed
by Sripramote and Lekhyananda [35] was published in
early year (2003), compared with other five trials,
which may be partly responsible for the
heterogeneity.
Moreover, the study conducted by Firouzbakht
et al. [21] was the main contributor to high hetero-
geneity in reducing vomiting compared with ginger
and vitamin B6 (I2 reduced to 57.6% from 85.9%), as
well as ginger compared with placebo (I2 reduced to
83.8% from 91.4%). By comparing these included stud-
ies, we found that the dropout rate for this study is
19.17%, whereas the dropout rate of the other studies
was less than 12%. Therefore, we deduced that the
heterogeneity may be partly caused by the dropout
rate. When exploring the heterogeneity in ginger ver-
sus placebo (in reducing episode of vomiting), we
failed to find all the heterogeneity among the studies
by metaregression, the leave-one-out analysis, and
subgroup analysis, due to the low quality of included
literature. Further experiments will be necessary to
confirm the effect between ginger and vitamin B6 in
the treatment of pregnancy-related NV.
Because of the insufficient number of studies and
limited quality of evidence, the dose–response was
not conducted in this meta-analysis. Besides, this
paper mainly focused on the effect of ginger in the
relief of NVP, so there was no analysis about the
potential side effects. None of the studies reported
any infant congenital abnormalities, abnormal preg-
nancy and delivery outcome occurring as a result of
the ginger intervention. However, some trials reported
participants suffered dizziness, stomachache and
heartburn after consuming ginger. Stomachache and
heartburn may be avoided by administering ginger
with small frequent meals.
Due to the high prevalence of NV in early preg-
nancy, women and health professionals need clear

guidance about effective and safe interventions. The
result shows that, ginger is effective in treating preg-
nancy-related NV and will be a good alternative choice
to replace chemical drug for NV. Notwithstanding the
limitation of evidence, vitamin B6 could be another
alternative for the treatment of NV during pregnancy
compared with ginger.
Strengths: The most current studies were included
in this meta-analysis. The outcomes, included the ratio
of symptom improved, NV, were pooled and calcu-
lated, respectively. In addition, we also compared the
effectiveness of ginger and vitamin B6 in the treat-
ment of NVP.
Limitations: There are several limitations in this
meta-analysis. Firstly, this meta-analysis focused only
on the literature reported in English, the ones that
were published in other languages may increase het-
erogeneity in the present results. Secondly, subgroup
analyses could not be implemented in each compari-
son because of the limitation of sample size. Thirdly,
there are potential bias in this meta-analysis due to
the low quality of included literature.
Conclusions
This meta-analysis showed that ginger supplementa-
tion significantly relieves general NVP symptoms and
nausea compared with placebo, but not significantly
effective on vomiting. Moreover, ginger is more effect-
ive than vitamin B6 in the treatment of NVP, although,
there were no significant differences. Further rigidly
designed RCTs with larger sample sizes are needed to
verify the effectiveness of ginger supplementation for
the treatment of NVP compared with vitamin B6.
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
This work was supported by the National Natural Science
Foundation of China under grant number [81602852].
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