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Evidence summaries

Interventions for Nausea and Vomiting in Early Pregnancy

Vitamin B6, antiemeticdrugs and ginger may be effective for nausea and vomiting in early pregnancy compared with placebo. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 41 trials involving a total of 5 449 women. Ginger, vitamin B6, and several antiemetic drugs were studied. There was a trend favouring ginger compared to placebo, but the results were nonsignificant and not consistent. There was no difference in nausea in studies comparing ginger with vitamin B6. In 2 trials comparing vitamin B6 with placebo the reduction in nausea score was nonsignificant (RR 0.92, 95% CI 0.40 to 1.44; n=393 ). The evidence about anti-emetic drugs was very limited. Information on maternal and fetal adverse outcomes was sparce.

Another Cochrane review [Abstract] 2 included 25 trials involving a total of 2 052 women, but the majority of 18 different comparisons included data from single studies with small numbers of participants. In a study with 92 participants, women taking vitamin B6 had a slightly longer hospital stay compared with placebo (mean difference (MD) 0.80 days, 95% CI 0.08 to 1.52). There was insufficient evidence to demonstrate a difference in other outcomes including mean number of episodes of emesis (MD 0.50, 95% CI -0.40 to 1.40) or side effects.

A systematic review 3 included 78 studies (n=8930). Evidence of 35 RCTs with low risk of bias showed that ginger, vitamin B6, antihistamines, metoclopramide (for mild symptoms), pyridoxine-doxylamine, and ondansetron (for moderate symptoms) were associated with improved symptoms compared with placebo.

A multicenter, randomized, double-blind, placebo-controlled trial 4 in China included 352 women with moderate to severe nausea and vomiting. Participants receiving acupuncture 30 minutes per day (mean difference [MD] -0.7, 95% CI -1.3 to -0.1), doxylamine-pyridoxine (MD -1.0, 95% CI -1.6 to -0.4), and the combination of both (MD -1.6, 95% CI -2.2 to -0.9) for 14 days had a larger reduction in PUQE score than their respective control groups (sham acupuncture, placebo, and sham acupuncture plus placebo).

Comment: The quality of evidence is downgraded by shortcomings in study quality and by inconsistency.

    References

    • Matthews A, Haas DM, O'Mathúna DP et al. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev 2015;(9):CD007575. [PubMed]
    • Boelig RC, Barton SJ, Saccone G et al. Interventions for treating hyperemesis gravidarum. Cochrane Database Syst Rev 2016;(5):CD010607. [PubMed]
    • McParlin C, O'Donnell A, Robson SC et al. Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy: A Systematic Review. JAMA 2016;316(13):1392-1401. [PubMed]
    • Wu XK, Gao JS, Ma HL, et al. Acupuncture and Doxylamine-Pyridoxine for Nausea and Vomiting in Pregnancy : A Randomized, Controlled, 2 × 2 Factorial Trial. Ann Intern Med 2023;176(7):922-933 [PubMed]

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