Interventions for nausea and vomiting in early pregnancy

David Jewell; Gavin Young

doi:10.1002/14651858.CD000145

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Analysis 1.1

Comparison 1 All antiemetic medication compared with placebo, Outcome 1 Effect on nausea.

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Analysis 1.2

Comparison 1 All antiemetic medication compared with placebo, Outcome 2 Effect on drowsiness or sleepiness.

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Analysis 1.3

Comparison 1 All antiemetic medication compared with placebo, Outcome 3 Effect on miscarriage or neonatal loss.

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Analysis 1.4

Comparison 1 All antiemetic medication compared with placebo, Outcome 4 Effect on fetal abnormality.

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Analysis 2.1

Comparison 2 Bendectin (Debendox) compared with placebo, Outcome 1 Effect on nausea.

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Analysis 3.1

Comparison 3 Antihistamines compared with placebo, Outcome 1 Effect on nausea.

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Analysis 4.1

Comparison 4 Phenothiazines compared with placebo, Outcome 1 Effect on nausea.

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Analysis 5.1

Comparison 5 Vitamin B6 compared with placebo, Outcome 1 Effect on vomiting.

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Analysis 5.2

Comparison 5 Vitamin B6 compared with placebo, Outcome 2 Improvement in nausea score.

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Analysis 6.1

Comparison 6 Ginger compared with placebo, Outcome 1 Effect on vomiting.

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Analysis 6.2

Comparison 6 Ginger compared with placebo, Outcome 2 Effect on nausea.

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Analysis 6.3

Comparison 6 Ginger compared with placebo, Outcome 3 Effect on miscarriage.

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Analysis 7.1

Comparison 7 Acupuncture or acupressure, compared with sham or dummy acupuncture or acupressure, Outcome 1 Effect on morning sickness.

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Analysis 7.2

Comparison 7 Acupuncture or acupressure, compared with sham or dummy acupuncture or acupressure, Outcome 2 Effect on vomiting score.

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Analysis 7.3

Comparison 7 Acupuncture or acupressure, compared with sham or dummy acupuncture or acupressure, Outcome 3 Effect on nausea score.

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Analysis 8.1

Comparison 8 Acupuncture or acupressure compared with no treatment, Outcome 1 Effect on morning sickness.

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Analysis 8.2

Comparison 8 Acupuncture or acupressure compared with no treatment, Outcome 2 Effect on vomiting score.

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Analysis 8.3

Comparison 8 Acupuncture or acupressure compared with no treatment, Outcome 3 Effect on nausea score.

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Analysis 9.1

Comparison 9 Adrenocorticotropic hormone or steroids versus placebo for hyperemesis gravidarum, Outcome 1 Effect on persistent vomiting within 4 days of treatment.

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Analysis 9.2

Comparison 9 Adrenocorticotropic hormone or steroids versus placebo for hyperemesis gravidarum, Outcome 2 Effect on subsequent readmission to hospital.

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Analysis 9.3

Comparison 9 Adrenocorticotropic hormone or steroids versus placebo for hyperemesis gravidarum, Outcome 3 Effect on spontaneous abortion.

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Analysis 10.1

Comparison 10 Ginger versus placebo for hyperemesis gravidarum, Outcome 1 Improvement in hyperemesis symptom score.

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Analysis 11.1

Comparison 11 Diazepam versus placebo for hyperemesis gravidarum, Outcome 1 Effect on persistence of vomiting.

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Analysis 11.2

Comparison 11 Diazepam versus placebo for hyperemesis gravidarum, Outcome 2 Effect on readmission with recurrent symptoms.

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Analysis 11.3

Comparison 11 Diazepam versus placebo for hyperemesis gravidarum, Outcome 3 Effect on length of stay in hospital.

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Analysis 12.1

Comparison 12 Methylprednisolone versus promethazine for hyperemesis gravidarum, Outcome 1 Effect on persistence of vomiting.

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Analysis 12.2

Comparison 12 Methylprednisolone versus promethazine for hyperemesis gravidarum, Outcome 2 Effect on subsequent readmission to hospital.

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Analysis 13.1

Comparison 13 Ondansetron versus promethazine for hyperemesis gravidarum, Outcome 1 Effect on persistence of vomiting.

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Analysis 14.1

Comparison 14 Acupuncture or acupressure for hyperemesis gravidarum, Outcome 1 Effect on persistent vomiting.

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Comparison 1. All antiemetic medication compared with placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on nausea Show forest plot	12	1505	Odds Ratio (M‐H, Random, 95% CI)	0.16 [0.08, 0.33]

2 Effect on drowsiness or sleepiness Show forest plot	4	343	Odds Ratio (M‐H, Random, 95% CI)	2.24 [1.05, 4.75]

3 Effect on miscarriage or neonatal loss Show forest plot	1	161	Odds Ratio (M‐H, Random, 95% CI)	0.96 [0.32, 2.87]

4 Effect on fetal abnormality Show forest plot	1	161	Odds Ratio (M‐H, Random, 95% CI)	0.31 [0.03, 3.07]

Comparison 1. All antiemetic medication compared with placebo

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Comparison 2. Bendectin (Debendox) compared with placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on nausea Show forest plot	3	240	Odds Ratio (M‐H, Random, 95% CI)	0.23 [0.07, 0.70]

Comparison 2. Bendectin (Debendox) compared with placebo

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Comparison 3. Antihistamines compared with placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on nausea Show forest plot	6	571	Odds Ratio (M‐H, Random, 95% CI)	0.20 [0.06, 0.63]

Comparison 3. Antihistamines compared with placebo

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Comparison 4. Phenothiazines compared with placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on nausea Show forest plot	2	300	Odds Ratio (M‐H, Random, 95% CI)	0.09 [0.00, 1.88]

Comparison 4. Phenothiazines compared with placebo

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Comparison 5. Vitamin B6 compared with placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on vomiting Show forest plot	2	392	Odds Ratio (M‐H, Random, 95% CI)	0.64 [0.18, 2.26]

2 Improvement in nausea score Show forest plot	2	395	Mean Difference (IV, Random, 95% CI)	‐0.99 [‐1.47, ‐0.51]

Comparison 5. Vitamin B6 compared with placebo

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Comparison 6. Ginger compared with placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on vomiting Show forest plot	1	67	Odds Ratio (M‐H, Random, 95% CI)	0.31 [0.12, 0.85]

2 Effect on nausea Show forest plot	1	67	Odds Ratio (M‐H, Random, 95% CI)	0.06 [0.02, 0.21]

3 Effect on miscarriage Show forest plot	1	67	Odds Ratio (M‐H, Random, 95% CI)	0.34 [0.03, 3.49]

Comparison 6. Ginger compared with placebo

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Comparison 7. Acupuncture or acupressure, compared with sham or dummy acupuncture or acupressure

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on morning sickness Show forest plot	2	285	Odds Ratio (M‐H, Random, 95% CI)	0.35 [0.12, 1.06]

2 Effect on vomiting score Show forest plot	2	332	Mean Difference (IV, Random, 95% CI)	‐0.31 [‐0.76, 0.14]

3 Effect on nausea score Show forest plot	2	332	Mean Difference (IV, Random, 95% CI)	‐0.57 [‐1.41, 0.26]

Comparison 7. Acupuncture or acupressure, compared with sham or dummy acupuncture or acupressure

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Comparison 8. Acupuncture or acupressure compared with no treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on morning sickness Show forest plot	1	238	Odds Ratio (M‐H, Random, 95% CI)	0.25 [0.14, 0.43]

2 Effect on vomiting score Show forest plot	1	265	Mean Difference (IV, Random, 95% CI)	‐0.30 [‐0.79, 0.19]

3 Effect on nausea score Show forest plot	1	265	Mean Difference (IV, Random, 95% CI)	‐0.70 [‐1.45, 0.05]

Comparison 8. Acupuncture or acupressure compared with no treatment

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Comparison 9. Adrenocorticotropic hormone or steroids versus placebo for hyperemesis gravidarum

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on persistent vomiting within 4 days of treatment Show forest plot	2	56	Odds Ratio (M‐H, Random, 95% CI)	1.96 [0.39, 9.93]

2 Effect on subsequent readmission to hospital Show forest plot	2	56	Odds Ratio (M‐H, Random, 95% CI)	0.53 [0.14, 1.95]

3 Effect on spontaneous abortion Show forest plot	1	32	Odds Ratio (M‐H, Random, 95% CI)	1.0 [0.06, 17.51]

Comparison 9. Adrenocorticotropic hormone or steroids versus placebo for hyperemesis gravidarum

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Comparison 10. Ginger versus placebo for hyperemesis gravidarum

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement in hyperemesis symptom score Show forest plot	1	27	Mean Difference (IV, Random, 95% CI)	‐3.15 [‐7.22, 0.92]

Comparison 10. Ginger versus placebo for hyperemesis gravidarum

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Comparison 11. Diazepam versus placebo for hyperemesis gravidarum

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on persistence of vomiting Show forest plot	1	50	Odds Ratio (M‐H, Random, 95% CI)	0.64 [0.10, 4.19]

2 Effect on readmission with recurrent symptoms Show forest plot	1	50	Odds Ratio (M‐H, Random, 95% CI)	0.13 [0.01, 1.19]

3 Effect on length of stay in hospital Show forest plot	1	50	Mean Difference (IV, Random, 95% CI)	‐1.10 [‐2.07, ‐0.13]

Comparison 11. Diazepam versus placebo for hyperemesis gravidarum

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Comparison 12. Methylprednisolone versus promethazine for hyperemesis gravidarum

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on persistence of vomiting Show forest plot	1	40	Odds Ratio (M‐H, Random, 95% CI)	1.59 [0.24, 10.70]

2 Effect on subsequent readmission to hospital Show forest plot	1	35	Odds Ratio (M‐H, Random, 95% CI)	0.07 [0.00, 1.38]

Comparison 12. Methylprednisolone versus promethazine for hyperemesis gravidarum

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Comparison 13. Ondansetron versus promethazine for hyperemesis gravidarum

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on persistence of vomiting Show forest plot	1	30	Odds Ratio (M‐H, Random, 95% CI)	0.29 [0.03, 3.12]

Comparison 13. Ondansetron versus promethazine for hyperemesis gravidarum

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Comparison 14. Acupuncture or acupressure for hyperemesis gravidarum

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Effect on persistent vomiting Show forest plot	1	33	Odds Ratio (M‐H, Random, 95% CI)	0.23 [0.05, 1.03]

Comparison 14. Acupuncture or acupressure for hyperemesis gravidarum

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