Effectiveness and Safety of Ginger in the Treatment of Pregnancy-Induced Nausea and Vomiting

Department of Experimental Pharmacology, University of Naples Federico II, Naples, Italy.
Obstetrics and Gynecology (Impact Factor: 5.18). 05/2005; 105(4):849-56. DOI: 10.1097/01.AOG.0000154890.47642.23
Source: PubMed

ABSTRACT Conventional antiemetics are burdened with the potential of teratogenic effects during the critical embryogenic period of pregnancy. Thus, a safe and effective medication would be a welcome addition to the therapeutic repertoire. This systematic review was aimed at assessing the evidence for or against the efficacy and safety of ginger (Zingiber officinale) therapy for nausea and vomiting during pregnancy.
Systematic literature searches were conducted in 3 computerized databases (MEDLINE, EMBASE, and Cochrane Library), and the reference lists of all papers located were checked for further relevant publications.
For the evaluation of efficacy, only double-blind, randomized controlled trials (RCTs) were included. All retrieved clinical data, including uncontrolled trials, case reports, observational studies, and RCTs, were included in the review of safety.
Six double-blind RCTs with a total of 675 participants and a prospective observational cohort study (n = 187) met all inclusion criteria. The methodological quality of 4 of 5 RCTs was high. Four of the 6 RCTs (n = 246) showed superiority of ginger over placebo; the other 2 RCTs (n = 429) indicated that ginger was as effective as the reference drug (vitamin B6) in relieving the severity of nausea and vomiting episodes. The observational study retrieved and RCTs (including follow-up periods) showed the absence of significant side effects or adverse effects on pregnancy outcomes. There were no spontaneous or case reports of adverse events during ginger treatment in pregnancy.
Ginger may be an effective treatment for nausea and vomiting in pregnancy. However, more observational studies, with a larger sample size, are needed to confirm the encouraging preliminary data on ginger safety.

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Available from: Francesca Borrelli, Oct 13, 2014
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    • "Currently no clear guidelines are available for ginger’s use in the treatment of NVP, despite some literature available on the subject [10,16,17]. A systematic review of the available literature (also focusing on safety aspects) can provide the best current evidence regarding possible benefits or risks for the clinical use of ginger to treat NVP. "
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    ABSTRACT: Background and objectives: Nausea and vomiting during pregnancy (NVP) occur commonly. Possible harmful side-effects of conventional medicine to the fetus create the need for alternative options to relieve NVP. This systematic review (SR) investigated current evidence regarding orally administered ginger for the treatment of NVP. The primary objective was to assess the effectiveness of ginger in treating NVP. The secondary objective was to assess the safety of ginger during pregnancy. A comprehensive electronic bibliographic database search was carried out. Randomized controlled trials (RCTs) of the efficacy of orally administered ginger, as treatment for NVP in pregnant women at any stage of pregnancy, published in English, were included. Two researchers independently extracted data and assessed trial quality. RevMan5 software (Cochrane Collaboration) was used for data analysis. p < 0.05 was considered statistically significant. Twelve RCTs involving 1278 pregnant women were included. Ginger significantly improved the symptoms of nausea when compared to placebo (MD 1.20, 95% CI 0.56-1.84, p = 0.0002, I2 = 0%). Ginger did not significantly reduce the number of vomiting episodes during NVP, when compared to placebo, although there was a trend towards improvement (MD 0.72, 95% CI -0.03-1.46, p = 0.06, I2 = 71%). Subgroup analyses seemed to favor the lower daily dosage of <1500 mg ginger for nausea relief. Ginger did not pose a significant risk for spontaneous abortion compared to placebo (RR 3.14, 95% CI 0.65-15.11, p = 0.15; I2 = 0%), or to vitamin B6 (RR 0.49, 95% CI 0.17-1.42, p = 0.19, I2 = 40%). Similarly, ginger did not pose a significant risk for the side-effects of heartburn or drowsiness. This review suggests potential benefits of ginger in reducing nausea symptoms in pregnancy (bearing in mind the limited number of studies, variable outcome reporting and low quality of evidence). Ginger did not significantly affect vomiting episodes, nor pose a risk for side-effects or adverse events during pregnancy. Based on evidence from this SR, ginger could be considered a harmless and possibly effective alternative option for women suffering from NVP.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42011001237.
    Nutrition Journal 03/2014; 13(1):20. DOI:10.1186/1475-2891-13-20 · 2.60 Impact Factor
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    • "Although this symptom gets spontaneously recovered with the time passing, it can place a great stress on the pregnant woman and those around her and disturb her work so that, in 25% of cases, the employed pregnant women often require a leave. This symptom can even lead to depression [4]. "
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    ABSTRACT: Objective. Comparing the effectiveness of vitamin B6 (40 mg twice daily) and ginger (250 mg four times daily) in treatment of pregnancy nausea. Methods. In a clinical trial in health centers of Qazvin University of Medical Sciences from November 2010 to February 2011 on pregnant mothers, the effects of vitamin B6 (40 mg twice daily) and ginger (250 mg four times daily) were evaluated in treatment of pregnancy nausea. Results. In both groups, treatments with vitamin B6 or ginger led to significant reduction in MPUQE score. Scores of symptoms at the day before treatment in vitamin B6 and ginger groups were 9.35 ± 1.97 and 9.80 ± 2.03, respectively, and reduced to 5.98 ± 1.45 and 6.28 ± 1.63, respectively, in the fourth day of treatment; however, mean changes in the two groups were not significantly different. Mean changes of MPUQE score in ginger and vitamin B6 groups were 8.32 ± 2.19 and 7.77 ± 1.80, respectively, showing no significant difference (P = 0.172). Conclusion. Vomiting was more reduced in vitamin B6 group; however, this reduction was not statistically significant. There was no significant difference between the two groups in nausea occurrences and their duration. No side effect was observed in either group.
    Obstetrics and Gynecology International 10/2013; 2013:927834. DOI:10.1155/2013/927834
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    • "Following Bendectin's removal from the market in 1982 after allegations that it caused fetal damage (Brent, 1995), there has been limited information on what women in the United States are using to treat NVP. There is existing literature on the optimal management of NVP and the risk of some of these medications (Arsenault et al., 2002; Portnoi et al., 2003; American College of Obstetrics and Gynecology, 2004; Asker et al., 2005; Borrelli et al., 2005; Einarson et al., 2007; Gill and Einarson, 2007; Ebrahimi et al., 2010; Koren et al., 2010), but a number of these medications have not been tested adequately for safety in pregnancy. "
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    ABSTRACT: Nausea and vomiting of pregnancy (NVP) occurs in up to 80% of pregnant women, but its association with birth outcomes is not clear. Several medications are used for the treatment of NVP; however, data are limited on their possible associations with birth defects. Using data from the National Birth Defects Prevention Study (NBDPS)-a multi-site, population-based, case-control study-we examined whether NVP or its treatment was associated with the most common noncardiac defects in the NBDPS (nonsyndromic cleft lip with or without cleft palate [CL/P], cleft palate alone [CP], neural tube defects, and hypospadias) compared with randomly selected nonmalformed live births. Among the 4524 cases and 5859 controls included in this study, 67.1% reported first-trimester NVP, and 15.4% of them reported using at least one agent for NVP. Nausea and vomiting of pregnancy was not associated with CP or neural tube defects, but modest risk reductions were observed for CL/P (adjusted odds ratio [aOR] = 0.87; 95% confidence interval [CI], 0.77-0.98) and hypospadias (aOR = 0.84; 95% CI, 0.72-0.98). Regarding treatments for NVP in the first trimester, the following adjusted associations were observed with an increased risk: proton pump inhibitors and hypospadias (aOR = 4.36; 95% CI, 1.21-15.81), steroids and hypospadias (aOR = 2.87; 95% CI, 1.03-7.97), and ondansetron and CP (aOR = 2.37; 95% CI, 1.18-4.76), whereas antacids were associated with a reduced risk for CL/P (aOR = 0.58; 95% CI, 0.38-0.89). NVP was not observed to be associated with an increased risk of birth defects; however, possible risks related to three treatments (i.e., proton pump inhibitors, steroids and ondansetron), which could be chance findings, warrant further investigation.
    Birth Defects Research Part A Clinical and Molecular Teratology 01/2012; 94(1):22-30. DOI:10.1002/bdra.22865 · 2.09 Impact Factor
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