Interventions for nausea and vomiting in early pregnancy
Abstract
Background
Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting between 70 and 85% of women. About half of pregnant women experience vomiting.
Objectives
To assess the effects of different methods of treating nausea and vomiting in early pregnancy.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group trials register (December 2002) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002).
Selection criteria
Randomised trials of any treatment for nausea and/or vomiting in early pregnancy.
Data collection and analysis
Two reviewers assessed the trial quality and extracted the data independently.
Main results
Twenty‐eight trials met the inclusion criteria. For milder degrees of nausea and vomiting, 21 trials were included. These trials were of variable quality. Nausea treatments were: different antihistamine medications, vitamin B6 (pyridoxine), the combination tablet Debendox (Bendectin), P6 acupressure and ginger. For hyperemesis gravidarum, seven trials were identified testing treatments with oral ginger root extract, oral or injected corticosteroids or injected adrenocorticotropic hormone (ACTH), intravenous diazepam and acupuncture. Based on 12 trials, there was an overall reduction in nausea from anti‐emetic medication (odds ratio 0.16, 95% confidence interval 0.08 to 0.33).
Authors' conclusions
Anti‐emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes from randomised controlled trials. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. No trials of treatments for hyperemesis gravidarum show any evidence of benefit. Evidence from observational studies suggests no evidence of teratogenicity from any of these treatments.
PICO
Plain language summary
Interventions for nausea and vomiting in early pregnancy
Drugs do help sickness in early pregnancy, but acupressure and ginger may work with no side effects.
Many women have sickness and vomiting in early pregnancy. Women with persistent vomiting may need to be given extra fluids. Many drugs have been tried. Antihistamines work well but are likely to make women feel sleepy. One widely used pill (Debendox/Bendectin) using an antihistamine combined with vitamin B6 was withdrawn after its use was linked to limb defects in babies; but this was not confirmed by later research. Vitamin B6 (pyridoxine) on its own may work but the evidence is not very strong. Acupressure (sea bands) could help, so may ginger, and more research is now being done.
