Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2010 Sep 8:(9):CD007575.
doi: 10.1002/14651858.CD007575.pub2.

Interventions for nausea and vomiting in early pregnancy

Anne Matthews  1 , Therese Dowswell, David M Haas, Mary Doyle, Dónal P O'Mathúna
Affiliations
Review

Interventions for nausea and vomiting in early pregnancy

Anne Matthews et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Nausea, retching and vomiting are very commonly experienced by women in early pregnancy. There are considerable physical and psychological effects on women who experience these symptoms. This is an update of a review of interventions for nausea and vomiting in early pregnancy previously published in 2003.

Objectives: To assess the effectiveness and safety of all interventions for nausea, vomiting and retching in early pregnancy, up to 20 weeks' gestation.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 May 2010).

Selection criteria: All randomised controlled trials of any intervention for nausea, vomiting and retching in early pregnancy. We excluded trials of interventions for hyperemesis gravidarum which are covered by another review. We also excluded quasi-randomised trials and trials using a crossover design.

Data collection and analysis: Four review authors, in pairs, reviewed the eligibility of trials and independently evaluated the risk of bias and extracted the data for included trials.

Main results: Twenty-seven trials, with 4041 women, met the inclusion criteria. These trials covered many interventions, including acupressure, acustimulation, acupuncture, ginger, vitamin B6 and several antiemetic drugs. We identified no studies of dietary or other lifestyle interventions. Evidence regarding the effectiveness of P6 acupressure, auricular (ear) acupressure and acustimulation of the P6 point was limited. Acupuncture (P6 or traditional) showed no significant benefit to women in pregnancy. The use of ginger products may be helpful to women, but the evidence of effectiveness was limited and not consistent. There was only limited evidence from trials to support the use of pharmacological agents including vitamin B6, and anti-emetic drugs to relieve mild or moderate nausea and vomiting. There was little information on maternal and fetal adverse outcomes and on psychological, social or economic outcomes. We were unable to pool findings from studies for most outcomes due to heterogeneity in study participants, interventions, comparison groups, and outcomes measured or reported. The methodological quality of the included studies was mixed.

Authors' conclusions: Given the high prevalence of nausea and vomiting in early pregnancy, health professionals need to provide clear guidance to women, based on systematically reviewed evidence. There is a lack of high-quality evidence to support that advice. The difficulties in interpreting the results of the studies included in this review highlight the need for specific, consistent and clearly justified outcomes and approaches to measurement in research studies.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Methodological quality summary: review authors’ judgements about each methodological quality item for each included study.
Figure 2
Figure 2
Methodological quality graph: review authors’ judgements about each methodological quality item presented as percentages across all included studies.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

    1. Belluomini J, Litt RC, Lee KA, Katz M. Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Obstetrics & Gynecology. 1994;84:245–8. - PubMed
    1. Bsat F, Bayer-Zwirello L, Seubert D, Hoffman D. Randomized study of three common outpatient treatments for nausea and vomiting of pregnancy [abstract] American Journal of Obstetrics and Gynecology. 2001;185(6 Suppl):S181.
    2. Bsat FA, Hoffman DE, Seubert DE. Comparison of three outpatient regimens in the management of nausea and vomiting in pregnancy. Journal of Perinatology. 2003;23:531–5. - PubMed
    1. Chittumma P, Kaewkiattikun K, Wiriyasiriwach B. Comparison of the effectiveness of ginger and vitamin B6 for treatment of nausea and vomiting in early pregnancy: a randomized double-blind controlled trial. Journal of the Medical Association of Thailand. 2007;90(1):15–20. - PubMed
    1. Ensiyeh J, Sakineh MAC. Comparing ginger and vitamin B6 for the treatment of nausea and vomiting in pregnancy: a randomised controlled trial. Midwifery. 2009;25(6):649–53. - PubMed
    1. Erez S, Schifrin BS, Dirim O. Double-blind evaluation of hydroxyzine as an antiemetic in pregnancy. Journal of Reproductive Medicine. 1971;7:57–9. - PubMed

References to studies excluded from this review

    1. Baum G, Boxer EI, Davidson JH, Lawrence N, Lewis JBR, Morgan DJR, et al. Meclozine and pyridoxine in pregnancy sickness. Practitioner. 1963;190:251–3.
    1. Bayreuther J, Lewith GT, Pickering R. A double-blind cross-over study to evaluate the effectiveness of acupressure at pericardium 6 (P6) in the treatment of early morning sickness (EMS) Complementary Therapies in Medicine. 1994;2:70–6.
    1. Can Gurkan O, Arslan H. Effect of acupressure on nausea and vomiting during pregnancy. Complementary Therapies in Clinical Practice. 2008;14(1):46–52. - PubMed
    1. Cartwright EW. Dramamine in nausea and vomiting of pregnancy. Western Journal of Surgery. 1951;59:216–34. - PubMed
    1. Conklin FJ, Nesbitt REL. Buclizine hydrochloride for nausea and vomiting of pregnancy. Obstetrics & Gynecology. 1958;11:214–9. - PubMed

References to studies awaiting assessment

    1. Adamczak J, Kasdaglis J, Rinehart B, Antebi Y, Wolf E, Terrone D. A prospective randomized trial of solumedrol dose pack vs. phenergan for the treatment of symptomatic nausea and vomiting in pregnancy. American Journal of Obstetrics and Gynecology. 2007;197(6 Suppl 1):S88. Abstract no: 277.
    1. Biswas SC, Bal R, Kamilya GS, Mukherjee J, Hazra A, Narender S, et al. A single-masked, randomized, controlled trial of ginger extract in the treatment of nausea and vomiting of pregnancy [abstract]. 49th All India Congress of Obstetrics and Gynaecology; 2006 Jan 6-9; India: Cochin, Kerala State; 2006. p. 53.
    1. Hsu E, Pei V, Shofer FS, Abbuhl SB. A prospective randomized controlled trial of acupressure vs sham for pregnancy-related nausea and vomiting in the emergency department. Academic Emergency Medicine. 2003;10(5):437.
    1. Mamo J, Mamo D, Pace M, Felice D. Evaluation of sea-band acupressure device for early pregnancy nausea and vomiting. 27th British Congress of Obstetrics And Gynaecology; Dublin, Ireland. 1995 July 4-7.1995. p. 283.

References to ongoing studies

    1. Nguyen H. [accessed 20 February 2008];The efficacy of diclectin for nausea and vomiting of pregnancy. ClinicalTrials.gov. http://clinicaltrials.gov/
    1. Wibowo N. [accessed 4 January 2009];B6 treatment for nausea and vomiting in pregnancy. ClinicalTrials.gov. http://clinicaltrials.gov/

Additional references

    1. Aikins Murphy P. Alternative therapies for nausea and vomiting of pregnancy. Obstetrics & Gynecology. 1998;91(1):149–55. - PubMed
    1. Atanackovic G, Wolpin J, Koren G. Determinants of the need for hospital care among women with nausea and vomiting of pregnancy. Clinical & Investigative Medicine. 2001;24(2):90. - PubMed
    1. Attard CL, Kohli MA, Coleman S, Bradley C, Hux M, Atanackovic G, et al. The burden of illness of severe nausea and vomiting of pregnancy in the United States. American Journal of Obstetrics and Gynecology. 2002;186(5 Suppl):S220–S227. - PubMed
    1. Bayles BP. Herbal and other complementary medicine use by Texas midwives. Journal of Midwifery and Women’s Health. 2007;52(5):473–8. - PubMed
    1. Brent R. Medical, social, and legal implications of treating nausea and vomiting of pregnancy. American Journal of Obstetrics and Gynecology. 2002;186(5 Suppl):S262–S266. - PubMed

References to other published versions of this review

    1. Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews. 2003;(Issue 4) [Art. No.: CD000145. DOI: 10.1002/14651858.CD000145.pub2] - PubMed

    1. Indicates the major publication for the study