In 2016 researchers completed a Cochrane Systematic Review which looked at various treatments for managing Hyperemesis Gravidarum symptoms. These symptoms are much more severe than “typical morning sickness”- including near constant nausea, frequent vomiting, dehydration and significant and rapid weight loss because the women are unable to eat. This Systematic Review looked at treatments including various combinations of medications, comparing who the lead care provider was and the style of assessment, muscle relaxation, Chinese Medicine Herbs, and finally acupuncture and acupressure. For all of these treatments, the researchers found “there is little high quality and consistent evidence supporting one intervention” and that a majority of evidence was rated as low or very low, and only a small amount of evidence was rated as moderate quality (10). This leaves healthcare providers to make their care decisions based on what evidence we do have as well as their own clinical judgement and experience to help their patients.
Acupressure Findings:
This Cochrane review included 4 studies which examined acupressure on Pericardium 6 (a point on the inner wrist which is commonly used to address nausea). The studies utilized a variety of ways of stimulating this point, from an acupressure wrist band, to manually applied pressure, to a nerve-stimulating device. After analyzing the studies, the researchers concluded that there may be some benefit to acupressure at Pericardium 6 compared to placebo treatments. However, more studies of good quality are needed.
Acupuncture Findings:
This Cochrane review included 3 studies looking at acupuncture for treating HG symptoms. These three studies were all fairly small (ranging from 37 to 90 participants) and each study showed some significant issues in terms of the study design. The conclusions we do have are promising but will require further studies.
- The first study which is from Habek’s research group (11) found that participants in the group receiving true acupuncture or acupressure to Pericardium 6 required fewer additional antiemetic (anti-vomiting) medications compared to the placebo group.
- The second study which is from Neri’s group (12) compared two groups: those getting twice weekly acupuncture plus acupressure between sessions and those taking metoclopramide (anti-nausea and vomiting medication) and Vitamin B12. The results of this study were quite interesting; both groups showed decreased nausea and vomiting and improved ability to eat. The group taking the medication noticed a difference almost immediately but the acupuncture and acupressure group showed a more gradual, progressive improvement. By the end of the two week study, the groups were doing equally well. While it’s important for women to have relief from symptoms as quickly as possible, for those who may be averse or allergic to medications, this study shows that acupuncture and acupressure has the potential to be an effective treatment.
- The third study by Mao’s group (13) compared three groups: those getting acupuncture treatments, those taking phenobarbital* and those taking an individualized herbal formula based on Traditional Chinese Medicine principles. All three groups also received “standard care” (IV fluids and electrolytes). The group receiving acupuncture treatment had a greater reduction in symptoms than either the medication or herbal medicine group. *Of note is that this is not a valid comparison since phenobarbital is no longer a medication used for management of HG in western settings.