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Effects of Ginger for Nausea and Vomiting in Early Pregnancy: A Meta-Analysis

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Nausea and vomiting in early pregnancy (NVEP) is commonly encountered in family medicine. Ginger (Zingiber officinale) is a popular nonpharmacological treatment but consensus of its use is lacking. We conducted a meta-analysis of clinical trials using ginger for NVEP as published in PubMed and EMBASE, CINAHL, Cochrane Library, and all EBM reviews. Studies satisfying 3 criteria were selected: (1) randomized placebo-controlled design; (2) use of ginger or Z. officinale; and (3) extractable data on improvement in NVEP. Data were synthesized into pooled odd ratios based on the random effects model, and results were tabulated with the aid of Forest plots. We identified 135 potentially relevant records; only 6 studies met the final criteria. Of the total 508 subjects, 256 and 252 subjects were randomly assigned to receive ginger and placebo, respectively. The use of ginger (∼1 g daily) for at least 4 days is associated with a 5-fold likelihood of improvement in NVEP. Heterogeneity among the clinical studies were acknowledged in the final interpretation of results. Despite the widespread use of ginger in the diet, its clinic value and safety profile in treating NVEP is still unknown. Our meta-analysis suggests that ginger is an effective nonpharmacological treatment for NVEP.
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ORIGINAL RESEARCH
Effects of Ginger for Nausea and Vomiting in Early
Pregnancy: A Meta-Analysis
Maggie Thomson, MD, Renee Corbin, MSc, and Lawrence Leung, MBBChir, MFM(Clin)
Background: Nausea and vomiting in early pregnancy (NVEP) is commonly encountered in family medi-
cine. Ginger (Zingiber officinale) is a popular nonpharmacological treatment but consensus of its use
is lacking.
Methods: We conducted a meta-analysis of clinical trials using ginger for NVEP as published in
PubMed and EMBASE, CINAHL, Cochrane Library, and all EBM reviews. Studies satisfying 3 criteria were
selected: (1) randomized placebo-controlled design; (2) use of ginger or Z. officinale; and (3) extract-
able data on improvement in NVEP. Data were synthesized into pooled odd ratios based on the random
effects model, and results were tabulated with the aid of Forest plots.
Results: We identified 135 potentially relevant records; only 6 studies met the final criteria. Of the
total 508 subjects, 256 and 252 subjects were randomly assigned to receive ginger and placebo, respec-
tively. The use of ginger (1 g daily) for at least 4 days is associated with a 5-fold likelihood of im-
provement in NVEP. Heterogeneity among the clinical studies were acknowledged in the final interpreta-
tion of results.
Conclusions: Despite the widespread use of ginger in the diet, its clinic value and safety profile in
treating NVEP is still unknown. Our meta-analysis suggests that ginger is an effective nonpharmacologi-
cal treatment for NVEP. (J Am Board Fam Med 2014;27:115–122.)
Keywords: Alternative Medicine, Complementary Medicine, Pregnancy, Prenatal Care, Primary Health Care
Pregnancy-induced nausea and vomiting is com-
monly seen in family medicine, and 50% to 90% of
pregnancies are affected by nausea with or without
vomiting. According to a recent study, up to 63%
of women experience nausea and vomiting up to 24
weeks’ gestation.
1
While only 0.3% to 2% of these
cases are considered severe (called hyperemesis
gravidarum, leading to a loss of 5% of prepreg-
nancy body weight), all forms of pregnancy-related
nausea can affect quality of life.
2
Compared with
the volume of literature regarding the pathogenesis
and treatment of pregnancy-induced nausea and
vomiting in general, few studies look at nausea and
vomiting in early pregnancy (NVEP).
Epidemiology, Risk Factors, and Pathogenesis
of NVEP
Nausea and vomiting during pregnancy is known to
be more common in younger primigravid women,
as well as in Western countries and urban areas.
2
Risk factors for its development include history of
estrogen-based medication causing nausea and mo-
tion or migraine causing nausea. Multiple gestation
pregnancies,
3
women who did not take multivita-
mins before conception,
4
those with acid reflux,
5
and those with a hydatidiform mole
6
also are known
be at increased risk. There seems to be a genetic
component to developing hyperemesis gravidarum;
several studies demonstrate that daughters of women
who experienced the condition are at increased
risks.
7,8
It is interesting that alcohol consumption
and cigarette smoking have both been demon-
strated to be protective.
9
The exact pathogenesis of
NVEP remains unclear; however, hormonal changes
including elevated serum human chorionic gonado-
This article was externally peer reviewed.
Submitted 29 May 2013; revised 17 July 2013; accepted 22
July 2013.
From the Department of Family Medicine (MT, LL) and
the Centre of Studies in Primary Care (RC, LL), Queen’s
University, Kingston, Ontario, Canada.
Funding: none.
Conflict of interest: none declared.
Corresponding author: Lawrence Leung, MBBChir,
MFM(Clin), Department of Family Medicine, Queen’s
University, 220 Bagot St, PO Bag 8888, Kingston ON
K7L 5E9, Canada (E-mail: leungl@queensu.ca).
doi: 10.3122/jabfm.2014.01.130167 Ginger for Nausea and Vomiting in Early Pregnancy 115
tropin have been implicated,
2
as have psychological
factors and stress response.
10
Delayed or dysrhythmic
gastric motility also has been postulated as a likely
cause of NVEP.
2
Diagnosis and Treatment of NVEP
Diagnosis of NVEP is purely clinical. There exists
no defined diagnostic criteria for the condition.
Mean onset is known to be between 5 to 6 weeks of
gestation, with the majority of symptoms resolving
by 20 weeks.
2
Approximately 20% of women con-
tinue to have symptoms into their second and third
trimesters.
2
Contrary to popular belief, symptoms
occur throughout the day and are often not limited
to the morning as the term morning sickness would
imply.
2
Goals of treatment include reducing maternal
symptoms and complications and mitigating any
effects on the fetus. Antiemetics for NVEP that
have been studied include Diclectin (Duchesnay
Inc., Blainville, QC, Canada), ondansetron, ginger,
various antihistamines, vitamin B
6
, metoclopra-
mide, and phenothiazines.
2
A recent randomized,
double-blind, placebo-controlled trial
11
demon-
strated that Diclectin was effective for nausea and
vomiting during pregnancy, and this drug is cur-
rently recommended as first-line pharmacological
treatment for NVEP in Canada. Ondansetron is
commonly used as an antiemetic during chemo-
therapy, with good evidence.
12
However, it has
been used for some time in the United States as
a first-line (albeit off-label) treatment for preg-
nancy-related nausea and vomiting.
13
While ev-
idence exists for other pharmacological and nonphar-
macological treatments (eg, dietary adjustments,
acupressure, and acupuncture), they are beyond
the scope of this article. Our study aimed to
critically examine the efficacy of ginger in the
treatment of NVEP through meta-analysis of
published clinical trials.
Ginger and Its Medicinal Effects
The antinausea effect of ginger was first described
in one of the canons of traditional Chinese medi-
cine—the Synopsis of the Prescriptions of Golden
Chamber
14
—in 200 AD. Ginger is the under-
ground stem (or rhizome) of the perennial plant
Zingiber officinale, which is indigenous to China and
India but is cultivated all over the world. From the
body of ginger sprouts the peudostems, which
branch off to leaves that can reach 2 feet in
height.
15
Analysis of ginger reveals 2 major classes
of phytochemicals: volatile oils, which give ginger
its pleasant smell,
16
and the nonvolatile compounds
(eg, gingerols and zingerones), which account for
its piquant taste and its pharmacological effects.
17
Many studies of the antiemetic nature of ginger for
various conditions have been published but with
mixed results. While evidence supports benefits of
ginger for seasickness,
18
motion sickness,
19
and
postoperative nausea and vomiting,
20
its use in pre-
venting chemotherapy-induced nausea and vomit-
ing is still conflicting.
21,22
Ginger also has been
demonstrated to be effective in treating nausea and
vomiting in pregnancy to the extent that it is as
effective as vitamin B
6
alone.
23–27
The exact anti-
emetic mechanisms of ginger are still unknown, but
in vitro studies revealed antagonistic effects of gin-
gerols on serotonergic 5-HT
328,29
and cholinergic
M receptors.
29
So far, no direct adverse effects on
human fetuses or the course of pregnancy have
been demonstrated.
24–27
However, there had been
concerns about interfering with fetal development,
which led to the issuance within Finland and Den-
mark of warning labels for all supplements contain-
ing ginger.
30
It is also recognized that ginger has
potent anticoagulant effects, which may enhance
bleeding and miscarriages and interact with other
medications.
30
At present, there are no large-scale
studies ascertaining the safety of ginger. That said,
in Europe and North America the current consen-
sus for the maximum safe dose of ginger is 2 g/day
in divided doses of 250 mg, even during preg-
nancy.
30
Methods
Study Aim
NVEP is a commonly encountered condition in
family medicine, and ginger has been used as a
nonpharmacological remedy. Our meta-analysis
aimed to critically examine and synthesize available
data from good-quality randomized clinical trials to
evaluate the efficacy of ginger in treating NVEP.
Eligibility Criteria
Our primary interest was the treatment of NVEP
using ginger as the therapeutic intervention. To
minimize heterogeneity, we limited our scope to
randomized, placebo-controlled trials with a satis-
116 JABFM January–February 2014 Vol. 27 No. 1 http://www.jabfm.org
factory score on the Cochrane Risk of Bias assess-
ment tool.
Search Strategy
A literature search of published medical reports
was performed in all languages using PubMed,
EMBASE, CINAHL, the Cochrane Library, and
all evidence-based medicine reviews using the
OVID Portal of Queen’s University, Kingston,
Ontario. Abstracts were initially obtained using
MeSH keywords of early pregnancy,nausea,vomit-
ing, and ginger. Manual searches of references and
review articles supplemented the computerized
search.
Study Selection, Data Extraction, and Quality
Assessment
Two reviewers (MT and RC) went through the
initial abstracts. A simple form was adopted to
select trials that satisfied the eligibility criteria
stated above. Selected studies were evaluated ac-
cording to the Cochrane Risk of Bias tool with
regard to quality of the study, randomization pro-
tocol, adequacy of concealment and blinding, and
rigor of follow-up for drop-outs. Information re-
garding the demography of the study population,
duration of the study, the number of affected sub-
jects who improved with treatment and placebo,
and finally a numeric score for the Cochrane risk of
bias was extracted and tabulated in spreadsheets. Of
note, we found only 6 randomized, placebo-con-
trolled trials of ginger that displayed data required
for our meta-analysis (see Table 1). The primary
outcome was improvement of pregnancy-related
nausea and vomiting.
Statistical Analysis
All data from the 6 appropriate studies of ginger
were synthesized in a meta-analysis, and odds ratios
(ORs) were calculated with appropriate confidence
intervals (CIs) based on the number of subjects
reporting improvement in both the intervention
and control groups. Where necessary, the value of
1 was added to any arm with zero outcome events
according to the Sheele 1 rule. To assess heter-
ogeneity, we used the Cochrane Q-statistic with
95% confidence CIs. We assumed a Pvalue of
.05 for the Cochran Q-statistic. Forest plots were
generated with ORs for each ginger study. Statis-
tical advice was provided by our data analyst at our
Centre of Studies in Primary Care.
Results
We initially identified 135 records using the MeSH
keywords of early pregnancy,ginger,nausea, and
vomiting. After removing duplicates and further
screening, 8 full articles were retrieved. Two of
them were excluded because of irrelevance. Con-
sensus was reached among the reviewers to include
the final 6 studies. The 2009 PRISMA checklist was
used; the PRISMA flow diagram is given in the
Appendix.
In our meta-analysis, a total of 256 patients were
randomly assigned to receive ginger, and 252 pa-
tients were randomly assigned to receive placebo.
Total sample size per study ranged from 23 to 235.
The period of intervention lasted from 4 days to 3
weeks. Dose and method of administration of gin-
ger also varied among studies: Basirat et al
31
used 5
biscuits per day, each containing 500 mg of ginger,
Table 1. Brief Description of the 6 Studies Included in the Meta-Analysis
Study Intervention Placebo
Duration of
Study
Gestation
Stage
Outcome Measure (Nausea
and Vomiting)
Basirat et al.
31
500-mg ginger powder in
biscuit, 5 biscuits/day
Placebo biscuit 4 days 17 weeks Nausea scale (VAS)
frequency of vomiting
Ozgoli et al.
35
250-mg ginger capsules QID Lactose capsules 4 days 20 weeks Nausea scale (VAS)
frequency of vomiting
Smith et al.
26
350-mg ginger capsules TID Vitamin B
6
(25-
mg capsules)
3 weeks 16 weeks Nausea and vomiting scales
(Rhodes Index)
Keating et al.
32
250-mg ginger syrup QID Plain syrup 2 weeks 12 weeks 4-point nausea scale
frequency of vomiting
Vutyavanich et al.
34
250-mg ginger capsules QID Placebo capsules 4 days 17 weeks VAS Likert scale
Fischer-Rasmussen
et al.
33
250-mg ginger capsules QID Lactose capsules 4 days 20 weeks Unique scoring system
QID, four times per day; TID, three times per day; VAS, visual analogue scale.
doi: 10.3122/jabfm.2014.01.130167 Ginger for Nausea and Vomiting in Early Pregnancy 117
whereas the others used either capsules or syrup
containing approximately1gofginger daily
26,32–35
(Table 1).
We applied the Cochrane Risk of Bias assessment
to the 6 studies; they achieved a score of at least 3 of
6 and were deemed to be of satisfactory quality.
Our primary outcome was the improvement of
pregnancy-related nausea and vomiting, which was
reported in all 6 studies: 180 of the 256 subjects in the
ginger group and 126 of the 252 subjects in the
placebo group reported improvement in symptoms of
nausea and vomiting. In view of the interstudy varia-
tion in the duration and form of intervention, a ran-
dom effects model was adopted. The pooled OR was
4.89, with a 95% CI of 1.88 to 12.73 (see Table 2).
The Cochrane Q-statistic was significant at 33.72,
with a degree of freedom of 5 (P.0001) (Table 3).
A synthesis Forest plot was generated (Figure 1), and
the corresponding funnel plot is included for refer-
ence (Figure 2). Relative risk was calculated at 1.76
(95% CI, 1.18–2.65), and the number needed to treat
for a positive effect was calculated to be 5.
Discussion
Our meta-analysis demonstrated that ginger (Z.
officinale) is better than placebo in improving
NVEP when administered at a dosage of approxi-
mately 1 g/day for a duration of at least 4 days.
Despite the common intake of ginger in our
diet, no large-scale studies have directly assessed
the safety profile of ginger during human preg-
nancy. In the early 1990s, Backon
36
commented on
a theoretical possibility of ginger affecting testos-
terone receptor binding and sex steroid differenti-
ation in the fetal brain. An antiplatelet effect of
ginger through inhibition of thromboxane synthe-
tase has been reported in vitro.
37
However, there
have been no reports of increased risk of antenatal
or postpartum hemorrhage with ginger use during
pregnancy. Increased levels of early embryonic loss
due to ginger intake
38
were reported in rats; how-
ever, the dosage was far greater than those rou-
tinely used in humans. Subsequent study of rats
using human-compatible doses of ginger showed
no similar adverse effects.
39
A commonly observed side effect of ginger is
reflux. In a study by Willets et al,
24
4 of the 120
subjects withdrew because of symptoms consistent
with reflux. Reflux has been commonly reported
with ginger use outside pregnancy. In a study of the
prevention of postoperative nausea and vomiting,
8% of subjects had heartburn after taking 1 g gin-
ger.
40
Another study of photopheresis-induced
nausea demonstrated that 27% of subjects has re-
flux as a result of ginger use.
41
Apart from gastric
discomfort, the side effect of reflux poses no long-
term harm or damage, and patients should be
warned of this side effect before beginning ginger
therapy.
There are a few limitations to our meta-analysis.
First, there is variability in the dosage and formu-
lation of ginger. While 4 studies administered gin-
ger in capsules,
26,33–35
one study administered gin-
ger in syrup
32
and the other in the form of
biscuits.
31
Moreover, the durations of intervention
also differed. Four studies administered interven-
tion for 4 days,
31,33–35
while Keating and Chez
32
gave ginger for 2 weeks and Smith et al
26
for 3
Table 2. Results from Meta-Analysis Comparing Ginger to Placebo in Improvement of Nausea and Vomiting in
Early Pregnancy
Study Intervention Group Control Group Odds Ratio 95% CI
Basirat et al.
31
28/32 21/30 3.00 0.81–11.1
Fischer-Rasmussen et al.
33
19/27 4/27 13.66 3.56–52.43
Keating et al.
32
10/13 2/10 13.33 1.78–100.14
Vutyavanich et al.
34
28/32 10/35 17.50 4.87–62.87
Ozgoli et al.
35
27/32 20/35 4.05 1.26–12.99
Smith et al.
26
68/120 69/115 0.87 0.52–1.47
Total (random effects) 180/256 126/252 4.89 1.88–12.73
CI, confidence interval.
Table 3. Test for Heterogeneity of Studies
Q-statistic 33.72
Degree of freedom 5
Significance level P.0001
118 JABFM January–February 2014 Vol. 27 No. 1 http://www.jabfm.org
weeks. There was also variation in the combined
sample size in the studies, which ranged from 23 to
235 (see Table 2). All these translated to a level of
heterogeneity that was reflected in the Cochrane
Q-statistic, with a significance of P.0001. A final
limitation of our study is the variability of scores
Figure 1. Forest plot for 6 studies using a random effects model. CI, confidence interval.
Figure 2. Funnel plot displaying the heterogeneity of studies. OR, odds ratio.
doi: 10.3122/jabfm.2014.01.130167 Ginger for Nausea and Vomiting in Early Pregnancy 119
used to qualify and quantify outcome measures in
NVEP. Vutyavanich et al,
34
Ozgoli et al,
35
and
Basirat et al
31
used a visual analog scale, whereas
Fischer-Rasmussen et al
33
developed a unique scor-
ing system. Keating and Chez used a symptoms
diary and a 4-point scale and Smith et al used the
Rhode’s index. While this does add heterogeneity
to our meta-analysis, the primary endpoint chosen
remained the same (ie, improvement of NVEP).
Given its limitations, our meta-analysis demon-
strated that ginger is better than placebo in improv-
ing NVEP, with an approximate number needed to
treat of 5. Further large-scale, multicenter trials
should be undertaken to further examine the effi-
cacies of ginger and detail its safety profiles when
treating NVEP.
Conclusions
Ginger is commonly consumed in our diet as an
additive in cooking. In traditional Chinese medi-
cine, ginger is indicated specifically as a remedy for
NVEP. Based on our meta-analysis, we conclude
that ginger is an effective nonpharmacological op-
tion for treating NVEP with respect to the inher-
ent heterogeneity of the available studies. Family
physicians and other medical professionals should
be cognizant of the value of ginger as they contem-
plate pharmacological options for suitable patients
with NVEP.
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Appendix: PRISMA Flow Diagram
133 records idenfied through
database searching
(
n =133
)
ScreeningIncluded Eligibility Idenficaon
17 addional records idenfied
through other sources
(
n=17
)
135 records aer duplicates removed
(n = 135 )
135 records screened
(n =135 )
129 records excluded
(n = 129 )
8 full-text arcles assessed
for eligibility
(
n=8
)
2 full-text arcles excluded due
to irrelevance
(
n=2
)
6 studies included in
quantave synthesis
(meta-analysis)
(n = 6 )
122 JABFM January–February 2014 Vol. 27 No. 1 http://www.jabfm.org
... A summary table of the individual characteristics of all interventional studies cited by MAs in the umbrella review is available in Supplemental Table 5. The results of the umbrella review are presented descriptively in a table of study characteristics ( Table 2) and a summary table of the results including effect estimates of the outcomes (Table 3) [20,[26][27][28][29][30][31]. ...
... There were no MAs conducted on the effect of ginger preparation use on gestational diabetes-related outcomes such as control of blood glucose concentrations. There were 6 MAs [20,26,27,[29][30][31] and 1 network MA [28] of oral ginger use focused on the outcome of maternal NVP ( Figure 2). Table 2 summarizes the key characteristics of the included MAs. ...
... Three existing umbrella reviews on human health outcomes of ginger use were identified in the evidence scan; however, none were focused exclusively on a pregnant population, or maternal nausea and vomiting specifically of pregnancy [63][64][65]. The umbrella review by Zhang et al. [65] focused broadly on human health outcomes and discussed 3 MAs included in this review, which focused on ginger for treating NVP [27,30,31]. The umbrella review by Crichton et al. [63] also focused broadly on oral ginger consumption and human health outcomes, but included 5 systematic reviews, a narrative review, an MA, and an umbrella review [1,5,6,9,27,47,66]. ...
Article
Ginger is a commonly used nonpharmacological treatment of pregnancy-related symptoms including nausea and vomiting, inflammation, and gastrointestinal dysfunction. Determining the efficacy of ginger is particularly important during pregnancy and lactation when maternal and neonatal detrimental effects may be a concern. This evidence scan and umbrella review aimed to assess the extent and quality of the evidence regarding the effectiveness and safety of using dietary preparations of ginger during pregnancy and lactation. We searched MEDLINE, Embase, CAB Abstracts, and International Pharmaceutical Abstracts up to 20 December, 2023, to identify maternal and neonatal outcomes associated with ginger use during pregnancy or lactation compared to placebo or conventional medicines. Outcomes for which a meta-analysis (MA) of intervention studies was identified were synthesized in an umbrella review. The AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews-2) tool was used to critically appraise the reviews. The percent overlap in primary studies was calculated overall and pairwise for each included MA. Data extracted from each MA included the summary estimate of the effect of ginger, the formulation of the ginger treatment, gestational timepoint at intervention, population enrolled in the study, type of intervention, comparator intervention, and number of study participants. The evidence scan identified 90 articles relevant to ginger use during pregnancy and lactation. Seven MAs of ginger use for treating nausea and vomiting of pregnancy reported 22 independent studies with a 49% study overlap overall. The majority of the MAs found a significant positive effect of ginger on the improvement of nausea in pregnancy compared with placebo, or equivalence to conventional treatments, and no evidence of significant adverse effects. The quality of the MAs ranged from critically low to low. The evidence suggests that ginger is effective at reducing nausea in pregnancy; however, the included studies contained substantial heterogeneity and were of low quality.
... Ginger tea and vitamin E can effectively reduce dysmenorrhea symptoms and pain. Whereas all pharmaceuticals have the disadvantage of not being prescribed or ingested during pregnancy due to serious fetal side effects, herbal medicine has a competitive advantage, as ginger is effective in treating nausea and vomiting during pregnancy with no side effects (Thomson et al., 2014;Viljoen et al., 2014). ...
... Nausea, vomiting and morning sickness is the common complaint in pregnancy due to hormonal changes mainly estrogen and progesterone in first trimester of pregnant women, using of sweeteners like chocolate, candy help to reduce morning sickness but using of chemically sweeteners may be harmful for both fetus as well as mother that's why using of herbal drug like herbal candy is more suitable or more safer than the chemical candy and using of Level or also maintains electrolyte balance and reduces nauseous effect or frequency of vomiting. Sensory evaluation parameters revealed that brown in color, with a sweet in taste [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. ...
... In addition, ginger is a promising treatment for nausea associated with a variety of stimuli including post-operative nausea and vomiting, motion sickness, morning sickness, and chemotherapy-induced nausea and vomiting [56][57][58] . Even though Ayurveda discusses the benefits of ginger (Zingiber officinale) for hepatoprotective, anti-inflammatory, antioxidant, and other disorders, it nevertheless suggests using ginger to treat a variety of medical ailments. ...
Article
Full-text available
Background-Ginger (Zingiber officinale), a perennial herb in the Zingiberaceae family, is one of the foods and herbal spices that people consume the most nowadays. For millennia, ginger has been a vital component of traditional Chinese, Ayurvedic, and Unani medicine due to its favorable scent and biological and pharmacological properties. The ginger rhizome, which is indigenous to SouthEast Asia, is widely used to treat a variety of ailments, such as cough, nausea, vomiting, diarrhea, and other ailments, in nations like China, India, and the USA.
... Two out of three meta-analyses in pregnancy-related nausea and vomiting demonstrated that ginger has a statistically significant effect in reducing nausea, but not vomiting [20,21]. Another showed that ginger can reduce both nausea and vomiting [22]. These results indicate that ginger has good potential for reducing nausea and vomiting. ...
Article
Full-text available
Chemotherapy-induced nausea and vomiting (CINV) affects over 50% of pediatric patients undergoing chemotherapy, a higher proportion than in adults. CINV often occurs despite adequate antiemetic prophylaxis, hampering patients' willingness to continue the chemotherapy regimen. As an ayurvedic medicine, ginger (Zingiber officinale) has an antiemetic effect by inhibiting serotonin in gastrointestinal nerves and as an NK1 antagonist. Therefore, we aimed to review oral ginger supplementation in children with CINV systematically. Systematic searching was performed in June 2023 from Pubmed, Embase, CINAHL, Cochrane, and hand searching. The search consisted of PICO “children chemotherapy”, “ginger”, and “CINV incidence”. We limited the search to only human studies. Studies that meet inclusion and exclusion criteria were included for analysis. Out of 116 studies found with our selection criteria, four were compatible with inclusion and exclusion criteria. Two studies had a small Risk of Bias (RoB), while the others had a high RoB. All studies statistically significantly reduced acute and delayed CINV with the number needed to treat (NNT) 2–4. No adverse effects were reported. However, these studies still had high heterogeneity based on cancer treatment, chemotherapy regimen, ginger dosing, and ginger processing. Ginger has the potential to reduce both the acute and delayed phases of CINV in children. Additional research employing standardized methodologies is recommended to validate this effect.
... These components show antiinflammatory and anti-oxidative activities, as confirmed in in vitro and in vivo animal models and in cancer patients [1][2][3]. Several systematic reviews have shown that consuming ginger can alleviate nausea and vomiting during pregnancy [4][5][6][7][8][9][10] and improve metabolic syndrome [4,[10][11][12][13][14][15][16][17] and pain [4,[18][19][20][21][22]. Nevertheless, further research is needed to elucidate the differences among clinical trial conditions, including ginger form, dosage, consumption period, and evaluation outcomes. ...
Article
Full-text available
This study aimed to assess ginger extract’s impact on ocular and peripheral blood flow and its potential to alleviate eye fatigue and shoulder stiffness. This study included 100 healthy individuals aged 20–73 years with eye fatigue and shoulder stiffness. Participants were randomly assigned to receive either placebo capsules or ginger extract capsules daily for eight weeks. Ocular blood flow, peripheral blood flow, eye fatigue (visual analog scale [VAS]), shoulder stiffness (VAS), body warmth (VAS), and shoulder muscle stiffness were assessed at weeks 0, 4, and 8, respectively. No improvement in ocular blood flow was observed under the study conditions. Conversely, peripheral blood flow in deep areas was enhanced in females (p = 0.033). Subgroup analysis by age (≥51 or <51 years) revealed that ginger’s effect on enhancing peripheral blood flow in deep vessels was restricted in females under 51 (p = 0.017). Similarly, subjective complaints of eye fatigue and shoulder stiffness were improved by ginger consumption in females under 51. Body warmth was favorably changed significantly in males ≥51 years due to ginger consumption. The muscle stiffness showed no statistically significant changes. In conclusion, ginger consumption reduces eye fatigue and shoulder stiffness by enhancing peripheral blood flow in relatively young females.
... Penelitian ini sejalan dengan hasil metaanalisis dari penelitian (Thomson et al., 2014) yang menyatakan bahwa jahe merupakan pilihan non farmakologis yang efektif untuk mengobati mual muntah pada ibu hamil. Manfaat seduhan jahe untuk mengatasi mual dan muntah juga terdapat dalam penelitian (Ningsih et al., 2020) yang menyatakan terdapat perbedaan rata-rata frekuensi mual muntah pada ibu hamil trimester I sebelum dan sesudah intervensi seduhan jahe dengan nilai Z=-4,123 dan p value = 0,000. ...
Article
Full-text available
The incidence of nausea and vomiting affects almost 50% to 80% of pregnant women and approximately 5% of pregnant women require treatment in the form of hospitalisation for fluid replacement and correction of electrolyte imbalances. Non-pharmacological therapy is needed as an alternative or complementary treatment if pharmacological therapy causes side effects. in some cases nausea, vomiting, and hyperemesis gravidarum. This literature review aims to identify non-pharmacological therapies to help mothers overcome nausea, vomiting, and hyperemesis gravidarum in pregnancy. Five electronic databases were used for literature review research: PubMed, ProQuest, Google Scholar, Wiley Online Library, and Science Direct between 2014 and 2024. Of the 3,070 articles, 12 articles met the inclusion criteria and were analysed. This literature review provides evidence of non-pharmacological therapy methods that can be used as an alternative to treat nausea, vomiting, and hyperemesis gravidarum in pregnant women, namely oral therapy (ginger, mint leaves, and dates), inhalation therapy (lemon aromatherapy, lavender aromatherapy, and ginger aromatherapy) and therapy through massage (P6 acupressure and ST36 acupressure). The most frequently used and effective therapeutic methods for treating nausea, vomiting, and hyperemesis gravidarum in pregnant women are ginger therapy, lemon aromatherapy, and P6 acupressure.
... Originating in Southeast Asia and later spreading to Europe, ginger has a rich history of traditional use as herbal medicine for various purposes (Biniaz 2013). It has been employed to treat multiple ailments, including nausea and vomiting, pain relief, indigestion, and symptoms associated with cold-induced syndromes (Vasala 2012;Thomson et al. 2014). The versatile nature of ginger has contributed to its widespread use and recognition as a valuable herbal remedy throughout different cultures and periods. ...
Chapter
Ayurveda is an ancient Indian system of medicine that has been used for thousands of years. In recent years, there has been growing interest in using Ayurvedic principles and natural products to discover new drugs. Reverse pharmacology, an approach that involves using traditional knowledge to guide drug discovery, has been gaining attention in this field. In this chapter, an overview of Ayurvedic principles and the concept of reverse pharmacology in drug discovery is provided. Some of the drugs developed through this approach are discussed here as case studies. While there are challenges and limitations to this approach, deriving novel therapeutic applications from the existing formulation and developing safer drugs from natural sources represent crucial benefits.
Article
Gastrointestinal (GI) symptoms occur frequently in pregnant women, resulting in poor quality of life. These patients frequently require co-management with the obstetrician and a physician/GI specialist. The causation is complex and multifactorial. It is a result of a combination of maternal changes in pregnancy and feto-placental hormonal effects on the GI tract (the feto-placental-gut axis). Additional factors such as the gut-brain interaction, genetics, immune response and effects of maternal supplements during pregnancy also contribute to the causation of symptoms. The most common of these symptoms include nausea and vomiting followed by heartburn. The common lower GI symptoms include constipation and hemorrhoids. Irritable bowel syndrome (IBS) is also common in a pregnant patient. But there is a paucity of literature and high-quality studies concerning the management of IBS. This review addresses the pathophysiology and clinical and laboratory evaluation of the common upper GI and lower GI symptoms and their management. A majority of symptoms are mild and lifestyle modifications with non-pharmacological measures should be the first-line management, whereas drugs should be used judiciously in case of non-response or severe symptoms. The nutritional status of the mother and the fetus needs close monitoring. Drugs that are routinely used in pregnancy are discussed with regard to the safety of the mother and the fetus. GI endoscopy may be needed in select patients and the indications for endoscopy and colonoscopy in pregnancy along with special pregnancy-related precautions are discussed. Most symptoms improve to pre-pregnancy state after delivery.
Article
Full-text available
The research describes a clinical case involving the onset of Wernicke's encephalopathy as a complication due to excessive vomiting in pregnant women (hyperemesis gravidarum). The condition arises from a deficiency of thiamine (vitamin B1). Diagnosing it accurately is challenging due to its similarity to several other conditions. Early diagnosis and prompt treatment can mitigate the risk of severe illness and irreversible complications with potential life-threatening consequences. A notable aspect of this case is the occurrence of the classic triad of symptoms in a 32-year-old pregnant woman with excessive vomiting, which is observed in only 16% of patients with Wernicke's encephalopathy. Initially, symptoms of ataxia and nystagmus manifested, followed by memory impairment and confabulations. Brain magnetic resonance imaging revealed symmetrical bilateral areas with heightened MR signal in T2 (SE and FLAIR) pulse sequences in the dorso-medial nucleus of the thalami, subependymal parts of the third ventricle, and the periaqueductal gray matter. Immediate treatment for Wernicke's encephalopathy was initiated with intravenous thiamine at a dosage of 200 mg three times a day. Encouraging progress was observed during the course of therapy. The pregnancy progressed without complications, culminating in the birth of a healthy, full-term baby girl. In the postpartum period, the patient continued to experience instability while walking, worsened upon closing her eyes, and nonspecific dizziness.
Article
Full-text available
Nausea and vomiting of pregnancy (NVP) are often alleviated by eating dried biscuits or foods. Natural products such as ginger have been suggested as herbal remedies for its treatment. The purpose of this study was to determine the effectiveness of ginger in biscuit form for the treatment. Sixty-five women with NVP at or before 17 weeks of gestation, who attended the antenatal clinic of Yahyanejad hospital in Babol town, Northern Iran, during 2005-2006 were included in the study. The subjects were randomized in a dou-ble-blind design and divided into two groups to take biscuits. 0.5g of ginger as fine powder was incorporated in each biscuit. Subjects received 5 ginger biscuits per day or an identical placebo biscuit for 4 days. They graded their severity of nausea using visual analog scales (VAS) and recorded the number of vomiting epi-sodes in the previous 24 hours and again during 4 consecutive days. Five-item Likert scales were used to as-sess the severity of their symptoms. The average VAS scores of day 1 to 4 of post-therapy minus baseline nausea was decreased significantly in ginger (2.6±1.77) compared with the placebo group (1.4±1.62) (P=0.01). The number of vomiting episodes was also decreased in ginger (0.96±0.21) and placebo (0.62±0.19), the difference being insignificant. A significant difference was seen in inter-group variations per day in both groups. Likert scale showed an improvement in symptoms in both groups (P=0.43). Therefore, ginger in biscuit form is effective for relieving the severity of nausea and, to some extent, of vomiting in pregnancy.
Article
Full-text available
The herbal drug ginger (Zingiber officinale Roscoe) may be effective for treating nausea, vomiting, and gastric hypomotility. In these conditions, cholinergic M (3) receptors and serotonergic 5-HT (3) and 5-HT (4) receptors are involved. The major chemical constituents of ginger are [6]-gingerol, [8]-gingerol, [10]-gingerol, and [6]-shogaol. We studied the interaction of [6]-gingerol, [8]-gingerol, [10]-gingerol (racemates), and [6]-shogaol with guinea pig M (3) receptors, guinea pig 5-HT (3) receptors, and rat 5-HT (4) receptors. In whole segments of guinea pig ileum (bioassay for contractile M (3) receptors), [6]-gingerol, [8]-gingerol, [10]-gingerol, and [6]-shogaol slightly but significantly depressed the maximal carbachol response at an antagonist concentration of 10 µM. In the guinea pig myenteric plexus preparation (bioassay for contractile 5-HT (3) receptors), 5-HT maximal responses were depressed by [10]-gingerol from 93 ± 3 % to 65 ± 6 % at an antagonist concentration of 3 µM and to 48 ± 3 % at an antagonist concentration of 5 µM following desensitization of 5-HT (4) receptors and blockade of 5-HT (1) and 5-HT (2) receptors. [6]-Shogaol (3 µM) induced depression to 61 ± 3 %. In rat esophageal tunica muscularis mucosae (bioassay for relaxant 5-HT (4) receptors), [6]-gingerol, [8]-gingerol, [10]-gingerol, and [6]-shogaol (2-6.3 µM) showed no agonist effects. The maximal 5-HT response remained unaffected in the presence of the compounds. It is concluded that the efficiency of ginger in reducing nausea and vomiting may be based on a weak inhibitory effect of gingerols and shogaols at M (3) and 5-HT (3) receptors. 5-HT (4) receptors, which play a role in gastroduodenal motility, appear not to be involved in the action of these compounds.
Article
Full-text available
This study was undertaken to determine whether there is familial aggregation of hyperemesis gravidarum (HG), making it a disease amenable to genetic study. Cases with severe nausea and vomiting in a singleton pregnancy treated with intravenous hydration and unaffected friend controls completed a survey regarding family history. Sisters of women with HG have a significantly increased risk of having HG themselves (odds ratio, 17.3; P = .005). Cases have a significantly increased risk of having a mother with severe nausea and vomiting; 33% of cases reported an affected mother compared to 7.7% of controls (P < .0001). Cases reported a similar frequency of affected second-degree maternal and paternal relatives (18% maternal lineage, 23% paternal lineage). There is familial aggregation of HG. This study provides strong evidence for a genetic component to HG. Identification of the predisposing gene(s) may determine the cause of this poorly understood disease of pregnancy.
Article
Chemotherapy-induced nausea and vomiting (CINV) is a common side-effect of cytotoxic treatment. It continues to affect a significant proportion of patients despite the widespread use of antiemetic medication. In traditional medicine, ginger (Zingiber officinale) has been used to prevent and treat nausea in many cultures for thousands of years. However, its use has not been confirmed in the chemotherapy context. To determine the potential use of ginger as a prophylactic or treatment for CINV, a systematic literature review was conducted. Reviewed studies comprised randomized controlled trials or crossover trials that investigated the anti-CINV effect of ginger as the sole independent variable in chemotherapy patients. Seven studies met the inclusion criteria. All studies were assessed on methodological quality and their limitations were identified. Studies were mixed in their support of ginger as an anti-CINV treatment in patients receiving chemotherapy, with three demonstrating a positive effect, two in favor but with caveats, and two showing no effect on measures of CINV. Future studies are required to address the limitations identified before clinical use can be recommended.
Article
PURPOSE:: Symptoms of nausea and vomiting are commonly experienced during early pregnancy (nausea and vomiting of pregnancy or NVP) and have been associated with stress, anxiety, and depression in pregnancy. However, nausea and vomiting in late pregnancy is a little-studied phenomenon. The purpose of our study was to examine the prevalence, severity, and psychosocial determinants of NVP during early and late pregnancy. STUDY DESIGN AND METHODS:: Data were originally from a longitudinal and epidemiological study of depression in pregnancy and postpartum in a cohort of 648 Canadian women conducted from 2005 to 2008. Measures included the Nausea and Vomiting in Pregnancy Instrument (NVPI), the Cambridge Worry Scale (CWS), and the Edinburgh Postnatal Depression Scale (EPDS). Demographic, maternal/obstetrical, psychological, and behavioral variables related to NVP were also examined. Odds ratios and 95% confidence intervals were calculated for all risk factors investigated using multiple logistic regression, controlling for potential confounders. RESULTS:: The prevalence of NVP was 63.3% (n = 551) at Time 1 (early pregnancy) and 45.4% (n = 575) at Time 2 (late pregnancy). Severity of symptoms was associated with earlier gestation, antiemetic medication use, employment status, and symptoms of major depression. Maternal smoking and having the support of three or more persons were protective for NVP. CLINICAL IMPLICATIONS:: This study suggests that screening for NVP should be ongoing throughout pregnancy and measures that address NVP, poor social support, and depression are warranted. Further research is needed in regard to effective management of this very common and distressing condition.
Article
Despite significant advances and development of novel anti-emetics, nausea and vomiting (emesis) is a major side-effect of cancer chemotherapy. At times, severe nausea and vomiting may also lead to reduction in adherence to the treatment regimen, and this will concomitantly affect the patient's survival. The rhizome of Zingiber officinale, commonly known as ginger, is globally an important spice. It has been used for centuries in the Indian, Chinese, Arabic, Tibetan, Unani, and Siddha systems of traditional medicine to treat nausea and vomiting induced by different stimuli. Preclinical studies with experimental animals (dogs and rats) have shown that the various extracts of ginger and the ginger juice possess anti-emetic effects against chemotherapy-induced nausea and vomiting. Gingerol, the active principle, is also shown to possess anti-emetic effects in minks. However, with regard to humans, while most studies have been supportive of the preclinical observations, a few have been contradictory. The exact mechanism responsible for the anti-emetic effects of ginger is unknown; however, the ginger phytochemicals, especially 6-gingerol, 8-gingerol, 10-gingerol, and 6-shogaol, may function as a 5-hydroxytryptamine (5-HT3) antagonist, NK1 antagonist, antihistaminic, and possess prokinetic effects. The present review for the first time attempts to address the anti-emetic observations and the variability in response of the anti-emetic effects of ginger in cancer chemotherapy. An attempt is also made to address the lacunae in the published studies and emphasize aspects that need further investigations for ginger to be of use in clinics as an anti-emetic agent in the future.
Article
Ginger is a common traditional remedy taken by numerous women experiencing nausea and vomiting in pregnancy (NVP). There is considerable evidence to support its effectiveness as an anti-emetic, but also increasing concern over its safety. Ginger is a powerful herbal medicine which acts pharmacologically and thus has specific indications, contraindications, precautions and side-effects, the most notable of which is an anticoagulant action. Midwives and other professionals advising women in early pregnancy about strategies for coping with NVP should be aware of the risks and benefits of ginger in order to provide comprehensive and safe information to expectant mothers. This paper reviews some of the contemporary research evidence which demonstrates that ginger is not a universally appropriate or safe choice for women with NVP and offers a checklist for professionals advising expectant mothers.
Article
Nausea and vomiting are common experiences in pregnancy, affecting 70% to 80% of all pregnant women. Various metabolic and neuromuscular factors have been implicated in the pathogenesis of nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum (HG), an entity distinct from NVP. However, their exact cause is unknown. Consequently, treatment of NVP and HG can be difficult, as neither the optimal targets for treatment nor the full effects of potential treatments on the developing fetus are known. This article reviews the epidemiology, pathology, diagnosis, outcomes, and treatment of NVP and HG.