Interventions for nausea

and vomiting in early

pregnancy:
a Cochrane Review
Clinical

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Clinical question
What interventions are effective and
safe for treating nausea and vomiting
in early pregnancy?

Source: Matthews A, Dowswell T, Haas DM, Doyle M, OMathna DP.

Interventions for nausea and vomiting in early pregnancy. Cochrane
Database of Systematic Reviews 2010, Issue 9. Art. No.: CD007575.
DOI: 10.1002/14651858.CD007575.pub2.
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Context
Nausea, retching and vomiting are very commonly
experienced by women in early pregnancy.
Symptoms can occur at any time of the day, although
they are often referred to as morning sickness.
Symptoms are mostly experienced in the first 3
months of pregnancy, though they can continue for
some women.
The causes of these symptoms are not known, but
they can have considerable physical and psychological
effects on women.
This builds on a Cochrane review of interventions for
nausea and vomiting in early pregnancy from 2003.
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Methods

The Cochrane Pregnancy and Childbirth Groups Trials

Register was searched by the Trials Search Co-ordinator in
May 2010. This Register contains reports of trials identified
from:
quarterly searches of the Cochrane Central Register of Controlled Trials
(CENTRAL); weekly searches of MEDLINE; hand searches of 30 journals and
the proceedings of major conferences; weekly current awareness alerts for
a further 44 journals; and monthly BioMed Central email alerts.

The search identified 55 studies (in 66 reports). 27 of these

studies were included and 22 were excluded. Four trials are
awaiting further assessment and two trials are ongoing.
Outcomes are described approximately 3 days after the
start of treatment.

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PICO(S) to assess eligible

studies
Participants: Women experiencing nausea, vomiting or retching
in pregnancy, where recruitment to a trial took place up to 20
weeks gestation. (Women with the severe illness, hyperemesis
gravidarum are excluded and covered in another review.)
Intervention: All interventions for nausea, vomiting or retching.
Comparison: Any other intervention, including placebo and
usual care.
Outcomes: Primary outcomes: symptomatic relief (measured
as reduction or cessation of nausea, vomiting or retching), and
adverse maternal and fetal/neonatal outcomes. Secondary
outcomes: quality of life, and costs.
Studies: Randomized trials. (Cross-over and quasi-randomised
studies were excluded.)

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Description of eligible
studies
Twenty-seven trials were included, with a total of 4041

women.
Studies were found of the following comparisons:

Acupressure (P6 point, including acustimulation and auricular)

versus placebo or vitamin B6 (7 studies, 795 women)
Acupuncture versus sham treatment and no treatment (2 studies,
648 women)
Moxibustion (Traditional Chinese Medicine) versus Chinese drugs
(1 study, 302 women)
Ginger versus placebo, vitamin B6 or drugs (9 studies, 1077
women)
Vitamin B6 versus placebo (2 studies, 416 women)
Anti-emetic medications (6) versus placebo (6 studies with 803
women)
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Results: symptom relief

No statistically significant difference between P6

acupressure and placebo or vitamin B6.
Results for auricular acupuncture difficult to interpret, and
no statistically significant differences in the acupuncture
study.
Improvements with both moxibustion and Chinese drugs,
but this study is poorly reported.
Two studies favoured ginger over placebo
Some studies favoured ginger over vitamin B6 and some
favoured vitamin B6 over ginger.
Vitamin B6 was better than placebo.
Of the anti-emetic medications studied, the combination of
dicyclomine, doxylamine and pyridoxine was better than
placebo.
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Results: adverse effects and secondary

outcomes
Adverse effects on the mother or baby
Maternal effects
Side-effects from acupressure bands (both placebo and
treatment groups)
Heartburn from ginger

Fetal/neonatal effects
No studies found significant differences in adverse neonatal
outcomes, but all were too small to detect any likely differences

Secondary outcomes
Quality of life was reported in few studies (and results
were difficult to interpret)
No studies reported on economic costs
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Conclusions: current
evidence

There is little strong or consistent evidence for any intervention,

and it is not possible to be confident in the effectiveness or safety
of any of the interventions.
The methodological quality of studies was mixed, with inadequate
information on randomisation procedures and blinding in many
studies; and the results were difficult to interpret and pool because
of differences in participants, interventions, comparisons and
outcomes.
Some commonly recommended interventions, such as dietary and
other behavioural advice, have not been studied.
No studies had the statistical power to provide convincing evidence
of the effects on relatively rare adverse outcomes.
There was very little information on the psychological, social or
economic effects of nausea and how these were affected by
different interventions.
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Conclusions: future research

There is a need for specific and justified outcomes
in research on interventions for nausea and
vomiting in pregnancy.
Several instruments have been used to measure
outcomes and some of these might help address
this (for example, the Pregnancy Unique
Quantification of Emesis and Nausea (PUQE) scale).
Adherence to dietary and other advice should be
measured consistently, because this may also
affect symptom relief.
Adverse effects, quality of life and cost outcomes
need to be collected and reported.
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10

Useful links
Cochrane Journal Club discussion
points
Interventions for nausea and
vomiting in early pregnancy

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