Can acupuncture help with Nausea and Vomiting in Pregnancy (“Morning Sickness”) and Hyperemesis Gravidarum (“HG”)?

It’s estimated that 70-80% of pregnant people experience some degree of nausea and/or vomiting, and of those women, 1% experience a much more severe form of sickness called Hyperemesis Gravidarum (HG). Nausea and Vomiting can impact someone’s ability to care for younger children, to work, and to perform the usual activities of daily living. Additionally it can greatly impact mood and social functioning.

According to a 2015 Cochrane Review, many types of treatments have been explored for both “typical” nausea and vomiting and HG. The evidence is not conclusive or overwhelming for any of the treatments, including medications (1). This is not to say that none of the treatments are effective, it just means that more research is needed in order to make definitive conclusions.

For this research summary, I will describe the conclusions of two Cochrane Systematic Reviews; one looked at various treatments for nausea and vomiting in early pregnancy (1) and one looked at various treatments for hyperemesis gravidarum (HG) (2). A Cochrane Systematic Review is a high level research review that analyzes available studies on a particular topic.

A note on the safety of acupuncture in early pregnancy:
For more detailed information on this topic, please visit the “safety” page. One study (5) looked at the pregnancy outcomes of 593 women who had acupuncture in early pregnancy. No significant differences were found between those who had acupuncture, sham acupuncture or no acupuncture. This is just one more study which adds to the growing body of research which reassures us that acupuncture is safe during pregnancy (see the Safety page for more information).

Nausea and Vomiting of Early Pregnancy: Findings on Acupuncture and Acupressure

Acupressure Findings:
The 2015 Cochrane Review looked at 12 studies on acupressure point stimulation, most of which used a wrist band for stimulating an acupoint called Pericardium 6, located on the inner wrist. Researchers concluded that there was "some evidence regarding the effectiveness of P6 acupressure. There was also some evidence of the effectiveness of auricular acupressure, though further larger studies are required to confirm this.”

Acupuncture Findings:
Only two studies in the review looked at acupuncture for treating nausea and vomiting- which illustrates how little data the researchers had to work with. Although the Cochrane Review researchers concluded that “acupuncture (P6 or traditional) showed no significant benefit to women with nausea and vomiting in early pregnancy," one of the studies did show some improvements in the acupuncture group. More studies are needed to draw definitive conclusions.

Hyperemesis Gravidarum (HG): Findings on Acupuncture and Acupressure

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 further studies are needed.

The first study (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 (12) compared those getting twice weekly acupuncture and acupressure to those taking medication. Both groups showed improvement, but the group taking medications improved more quickly. By the end of two weeks, the two groups had equal levels of nausea. This study showed that acupuncture and acupressure have potential to be an effective treatment option for people who would like to avoid or can not take anti-nausea medications.
The third study (13) compared three groups: those having acupuncture, taking medication and taking an herbal formula. The group receiving acupuncture treatment had a greater reduction in symptoms than either the medication or herbal medicine group.

Morning Sickness or HG?

Typical nausea and vomiting of pregnancy, often called “morning sickness” can actually occur at any time of day and be constant or come and go. The severity varies greatly from person to person, but it is considered Hyperemesis Gravidarum (HG) when symptoms are much more severe, to the point of being debilitating. In HG, the pregnant person loses 5% or more of their pre-pregnancy weight and experiences severe dehydration (many times to the point of requiring IV hydration in the hospital). If left untreated, HG can pose a risk to the health of the pregnant person. For more information on HG, scroll down to the resources section.

What To Expect From Acupuncture:

A typical course of acupuncture for nausea/vomiting would start with 1-2 sessions per week, continuing until your symptoms have decreased to a level where you feel better more consistently and it is not impacting your work or daily activities to a significant degree. Your acupuncturist may teach you acupressure points to stimulate on yourself. For HG, your acupuncturist will likely recommend more frequent treatments and may be able to come to your home or the hospital. For either condition, your acupuncturist can suggest individualized ideas for changes in diet or lifestyle that may help your symptoms.

Illustration of pressure point

Detailed Research Summary:

For the detailed summaries below, I will describe the conclusions of two Cochrane Systematic Reviews; one looked at various treatments for nausea and vomiting in early pregnancy (1) and one looked at various treatments for hyperemesis gravidarum (HG) (2). A Cochrane Systematic Review is a high level research review that analyzes available studies on a particular topic.

Nausea and Vomiting of Early Pregnancy: Findings on Acupuncture and Acupressure

The Cochrane Review on various treatments for nausea and vomiting of early pregnancy looked at studies investigating medications as well as using ginger, essential oils and acupressure and acupuncture. The overall finding of the review stated the researchers did not find “consistent or strong evidence from trials to support the use of any one pharmacological agent including vitamin B6, antihistamines, and other anti-emetic drugs to relieve mild or moderate nausea and vomiting” (1). They clarify that this is not the same as saying none of the treatments are effective; this just means that the studies performed so far don’t allow us to draw firm conclusions.

One other systematic review concluded that there is some evidence of the benefit of acustimulation for nausea and vomiting during pregnancy, but that more studies are needed (9).

Nausea is included in the list of conditions for which acupuncture has shown a benefit in an evaluation by the International Journal of Obstetrics and Gynecology (6). It is also recommended in the Hutt Hospital Guidelines (NZ) as an indication for which acupuncture treatment may be recommended (7), and acupressure to Pericardium 6 point is listed as a nonpharmacological treatment which appears to be effective in the NICE Clinical Guidelines for Antenatal Care (8) .

Acupressure Findings:

The 2015 Cochrane Review looked at 12 studies on acupressure point stimulation, most of which used a wrist band for stimulating an acupoint called Pericardium 6, located on the inner wrist. Researchers concluded that there was “some evidence regarding the effectiveness of P6 acupressure. There was also some evidence of the effectiveness of auricular acupressure, though further larger studies are required to confirm this.”

Acupuncture Findings:

Only two studies in the review looked at acupuncture for treating nausea and vomiting- which illustrates how little data the researchers had to work with. Although the Cochrane Review researchers concluded that “acupuncture (P6 or traditional) showed no significant benefit to women with nausea and vomiting in early pregnancy,” one of the studies did show some improvements in the acupuncture group. More studies are needed to draw definitive conclusions.

One study by Smith’s research group (3) of 593 women found that after two weeks, women in the traditional acupuncture group had significantly less nausea and dry retching. After 3 weeks, the group of women who were having acupuncture only at the Pericardium 6 inner wrist point started seeing the same benefits. After 4 weeks of the study, both groups of women having acupuncture (both a traditional style and those with pericardium 6 stimulation) continued to see significant improvement, and by this point in the study even women who were having “sham acupuncture” started to see a decrease in nausea. The control group, which did not have any acupuncture, had the least amount of improvement. This rules out spontaneous remission of symptoms as the women moved through their first trimesters. All of the changes mentioned above were considered “statistically significant”- meaning the changes were very unlikely to be due to chance.

The second study which was by Knight’s research group (4) compared 56 women having either acupuncture at Pericardium 6 or “sham” treatment which stimulated the point using a cocktail stick. Although no differences were found between these two groups, this was a much smaller study, so it is possible that if this had been a larger study the researchers would have been able to get a more accurate idea of whether acupuncture had helped or not. Additionally, since this study didn’t include a control group (women getting no acustimulation at all), it’s possible that the results they found were simply due to spontaneous remission of the nausea and vomiting as the women went through their first trimester. Another difference between the Smith study (3) and the Knight study (4) is that Knight only gave acupuncture treatments for 2 weeks, while Smith gave treatments for 4 weeks. It could be that the dosage of acupuncture is an important consideration- would the women have seen more of an improvement if they had continued treatment for 2 more weeks, or had more frequent sessions? We do not know the answers to these questions, therefore more research with larger, well-designed studies will be needed. Furthermore, both of these studies had limitations- a large number of women withdrew from the studies and all results were not clearly reported.

I would also like to briefly mention that the Smith research group wrote a separate paper analyzing the perinatal outcomes, pregnancy complications and infant outcomes of the women in their study (5). They found no statistically significant differences between any of the groups- those having acupuncture, sham acupuncture or no acupuncture during the first trimester. This is just one more study which adds to the growing body of research which reassures us that acupuncture is safe during pregnancy (see the Safety page for more information).

Hyperemesis Gravidarum (HG): Findings on Acupuncture and Acupressure

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.

Resource Links

Reliable Social Media Resources:

Instagram: @pregnancysicknesssupport (pregnancysicknesssupport.org.uk)
Instagram: @hgmoms (hyperemesis.org)

Sources

Matthews A, Haas D, Mathuna D, Dowswell T. Interventions for nausea and vomiting in early pregnancy ( Review ). Cochrane Libr. 2015;(9):1–36.
Boelig RC, Barton SJ, Saccone G, Kelly AJ, Edwards SJ, Berghella V. Interventions for treating hyperemesis gravidarum. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD010607. DOI: 10.1002/14651858.CD010607.pub2.
Smith C, Crowther C, Beilby J. Acupuncture to treat nausea and vomiting in early pregnancy: a randomized controlled trial. Birth 2002;29(1):1-9.

Knight B, Mudge C, Openshaw S, White A, Hart A. Effect of acupuncture on nausea of pregnancy: a randomized, controlled trial. Obstetrics & Gynecology 2001;97:184-8.
Smith C, Crowther C, Beilby J. Pregnancy outcome following women’s participation in a randomised controlled trial of acupuncture to treat nausea and vomiting in early pregnancy. Complement Ther Med. 2002;10:78–83.
Evaluation of outpatient acupuncture for relief of pregnancy related conditions. 2018, International Journal of Obstetrics and Gynecology. https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/ijgo.12446
Hutt Hospital: Hutt Maternity Acupuncture Policy. 2018. Retrieved from http://www.huttmaternity.org.nz/health-professionals/policies-guidelines/
National Institute for Health and Care Excellence. (2008). Antenatal care: routine care for the healthy pregnant woman (NICE Clinical Guideline). Retrieved from https://www.nice.org.uk/guidance/cg62/evidence/full-guideline-pdf-196748323
Van den Heuvel E, Goossens M, Vanderhaegen H, Sun HX, Buntinx F. Effect of acustimulation on nausea and vomiting and on hyperemesis in pregnancy: a systematic review of Western and Chinese literature. BMC Complement Altern Med. 2016 Jan 13;16:13.
Boelig RC, Barton SJ, Saccone G, Kelly AJ, Edwards SJ, Berghella V. Interventions for treating hyperemesis gravidarum. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD010607. DOI: 10.1002/14651858.CD010607.pub2.
Habek D, Barbir A, Habek JC, Janculiak D, Bobic-Vukovic M. Success of acupuncture and acupressure of the pc 6 acupoint in the treatment of hyperemesis gravidarum. Forschende Komplementarmedizin und Klassische Naturheilkunde 2004;11(1):20-3.
Neri I, Allais G, Schiapparelli P, Blasi I, Benedetto C, Facchinetti F. Acupuncture versus pharmacological approach to reduce hyperemesis gravidarum discomfort. Minerva Ginecologica 2005;57(4):471-5.
Mao ZN, Liang CE. Observation on the therapeutic effects of acupuncture on hyperemesis gravidarum. International Journal of Clinical Acupuncture 2010;19(2):60-5.

Can acupuncture help with Nausea and Vomiting in Pregnancy (“Morning Sickness”) and Hyperemesis Gravidarum (“HG”)?

Morning Sickness or HG?

What To Expect From Acupuncture:

Acupressure Findings:

Acupuncture Findings:

Acupressure Findings:

Acupuncture Findings:

Resource Links

Reliable Social Media Resources:

Sources

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