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This study was undertaken to describe under real-life conditions the effects of acupuncture on symptomatic dyspepsia during pregnancy and to compare this with a group of patients undergoing conventional treatment alone. A total of 42 conventionally treated pregnant women were allocated by chance into two groups to be treated, or not, by acupuncture. They reported the severity of symptoms and the disability these were causing in daily aspects of life such as sleeping and eating, using a numerical rating scale. The study also observed the use of medications. Six women dropped out (one in the acupuncture group and five in the control group). Significant improvements in symptoms were found in the study group. This group also used less medication and had a greater improvement in their disabilities when compared with the control group. This study suggests that acupuncture may alleviate dyspepsia during pregnancy.
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Acupuncture in Medicine 2009; 27:50-53; doi:10.1136/aim.2009.000497
© 2009 BMJ Publishing Group Ltd and the British Medical Acupuncture Society
Original papers
Acupuncture for dyspepsia in pregnancy: a prospective, randomised, controlled study
João Bosco Guerreiro da Silva1, Mary Uchiyama Nakamura2, José Antonio Cordeiro3, Luiz Kulay Jr2 and Rassen
1 Department of Internal Medicine, Rio Preto Medical College, Sao Jose do Rio Preto, Brazil
2 Department of Obstetrics, São Paulo Federal University, São Paulo, Brazil
3 Department of Statistics, Rio Preto Medical College, Sao Jose do Rio Preto, Brazil
Correspondence to:
Professor João Bosco Guerreiro da Silva, Rua Pernambuco 3147, Sao Jose do Rio Preto, Brazil;
Objectives: This study was undertaken to describe under real-life conditions the effects of acupuncture on symptomatic
dyspepsia during pregnancy and to compare this with a group of patients undergoing conventional treatment alone.
Methods: A total of 42 conventionally treated pregnant women were allocated by chance into two groups to be treated,
or not, by acupuncture. They reported the severity of symptoms and the disability these were causing in daily aspects of
life such as sleeping and eating, using a numerical rating scale. The study also observed the use of medications.
Results: Six women dropped out (one in the acupuncture group and five in the control group). Significant improvements
in symptoms were found in the study group. This group also used less medication and had a greater improvement in their
disabilities when compared with the control group.
Conclusions: This study suggests that acupuncture may alleviate dyspepsia during pregnancy.
Digestive disorders constitute one of the most frequent complaints of pregnancy.1 Heartburn, epigastric pain or
discomfort, regurgitation, belching and bloating occurs in approximately 45% to 80% of gravid women and are associated
with symptomatic reflux.2 Effects on the gastrointestinal tract are caused primarily by hormonal changes and not the
physical effects of the gravid uterus.3 Prolongation of gastrointestinal transit times,3 4 enlargement of gallbladder and its
sluggish emptying, and pressure reduction of lower oesophageal sphincter can be the main causes.3 5 They are mediated
by progesterone, with oestrogen probably acting as a primer.3 These symptoms worsen with the progression of gestation
and, although in the majority of cases are not severe, they provoke a considerable drop in the quality of life of the
Several studies have suggested the promise of acupuncture in dyspeptic problems610 although there is a lack of properly
randomised controlled trials. Much evidence exists about the use of acupuncture for nausea and vomiting in pregnancy1
14 but no evidence was found for acupuncture studies into other complaints.
The aim of this study, therefore, was to observe the effects of acupuncture in practice on the treatment of dyspepsia in
pregnancy. We established an acupuncture service in prenatal care and through that we sought to determine the effects
of a policy of "use acupuncture" compared with a policy of "avoid acupuncture" by comparing two groups treated
conventionally, with one group also treated with acupuncture.
The Research Ethics Committee of the Federal University of São Paulo, Brazil approved this study. From January to
December 2003, a study on use of acupuncture on pregnant women attending the prenatal programme of Santa Casa of
São José do Rio Preto, Brazil was initiated with the aim of treating the most common non-obstetrical complaints. This is a
state-funded service that receives pregnant women from the local area who participate in a prenatal programme. This
paper relates an outcome of those patients with dyspepsia. After giving their informed consent, 42 patients that satisfied
the study criteria were selected and randomly allocated into two groups. Randomisation was achieved by a nurse from
the research team selecting from a box a closed piece of paper with a treatment order written on it. Both groups were
counselled by a group of nurses about lifestyle modifications and dietary changes to alleviate dyspepsia. They were also
allowed to receive antacids from their obstetricians. After that, the study group visited the acupuncturists. With the
exception of the acupuncture treatment, there was no difference between the groups.
The inclusion requirements were: aged from 15 to 39 years, at 15–30 weeks of pregnancy and dyspepsia symptoms.
They should not have any underlying disease as a possible cause of the symptoms nor have a history of similar
symptoms prior to pregnancy. They should not belong to a high-risk pregnancy group or have been treated by
acupuncture in the preceding year.
Heartburn is the most typical symptom of dyspepsia and it was considered the primary outcome. It was defined as
burning substernal discomfort with no radiation component and described with common words.15 The women estimated
both the severity and frequency of heartburn using a numerical rating scale (NRS) ranging 0–10, where 0 meant no
symptom and 10 the greatest imaginable. Secondary efficacy variables were antacid consumption (a 600 mg tablet = 1
dose) and the effects of their symptoms in relation to sleeping and eating. Also by means of the NRS, the highest score,
10, indicated the greatest inability to perform these tasks.
At baseline and every 2 weeks until completion of the treatment at 8 weeks, the pregnant women were interviewed by the
research assistant—a medical student who was appropriately trained, and had the minimal contact with the other
members of the study—to collect these values.
At the baseline, all the women were also requested to fill in a questionnaire covering background data, disease history
before the first visit and previous obstetric history. They were then referred to their obstetricians and after that the study
group went to the acupuncturist.
The treatment of acupuncture was performed once a week, occasionally twice when it was deemed necessary, during 8
weeks, making a minimum of eight and a maximum of 12 sessions. Traditional acupuncture was used, respecting the
classical acupuncture points including depth of insertion. Sterilised stainless steel needles of 40 mm in length and 0.2
mm diameter were used. Neither electro-stimulation nor ear acupuncture was used. On average 12 needles were used,
always attempting to achieve the de qi sensation (sensation of soreness, numbness or distension around the point).
Needles were left at place for about 25 minutes.
The acupuncturists in the study (JBGS, RS) have completed 600 hours of postgraduate training in acupuncture, which
included the theory and practice of Traditional Chinese Medicine. For the last 20 years they have run a public service that
has been used to treat at least 50 patients per day. In order to facilitate protocols we decided to use pre-programmed
points. Up to four points were permitted as optional points. The most commonly used points were: LI4 (hands); PC6
(forearms); CV12, ST21, LR13 (abdomen); ST36 (legs) and SP4, ST44 (feet).
Two-sample t tests were used to compare demographic variables, and when recommended, the nonparametric Kruskal-
Wallis test was used. Changes overtime in the NRS assessments of symptoms intensity were analysed by Fisher test.
The differences of mean values between initial and final sessions were analysed by two-sample t test. The questions
about sleeping and eating, measured in medians were analysed by Mood’s test for medians. Before any application of
statistical test, the Anderson-Darling test for normality was performed to confirm the normal distribution of the data. A p
value<0.05 indicates a significant difference.
Six women dropped out. One in each group moved away and four in the control group missed two consecutive
interviews. Thus, 20 patients in the acupuncture group and 16 in the control group completed the treatment and
concluded all the interviews.
No important adverse effects were reported. Just one patient related little ecchymosis in some insertion points.
Acupuncture (3204 g, SD = 466 g) and control patients (3236 g, SD = 297 g) did not differ significantly in respect to the
birth weight of their infants (p = 0.80). The mean value for the one minute Apgar score was 9.0 (interquartile range (IQR)
= 0.0) in the acupuncture group and 9.0 (IQR = 1.0) in the control group (p = 0.24). The median value for 5-minute Apgar
was 10 (IQR = 0.8) for both groups (p = 1.0).
The two groups were similar in respect to age, number of previous pregnancies and body mass index. These data can be
seen in table 1.
*Means, standard deviation and t test; medians, interquartile range and Mood’s test.
BMI, body mass index; GA, gestational age.
During the study period, the average heartburn intensity decreased by at least a half in 15/20 (75%) of patients in the
study group and in 7/16 (44%) of those in the control group (p = 0.044). During treatment a diminishing trend of NRS
values could be seen in both groups (p<0.001), however this effect was greater in the study group (p = 0.001),
notwithstanding control group global mean being significantly greater than that of study group (p = 0.001) as can be seen
in fig 1 and table 2, despite that, at initial evaluation, there was no significant difference between them (p = 0.15).
All scores are in means of NRS (SD); p value (differences of NRS) = 0.001
NRS, numerical rating scale; SD, standard deviation!
After treatment, the NRS differences in the acupuncture group were significantly higher in comparison with the control
group (NRS 5.1 (SD = 3.7) versus 0.9 (SD = 2.9) (p = 0.001).
Only 14 patients, seven in each group, took antacids. The study group had a mean reduction in the use of medications of
6.3 doses (SD = –6.9) whereas the control group had an increased use of 4.4 doses (SD = 5.5).
After treatment 15/20 (75%) of the members of the study group reported an improvement of at least 50% in respect to
eating compared to only 5/16 (31%) of the control group (p value = 0.008). In respect to sleeping, 14/20 in the study
group and 4/16 in the control group also reported improvements of 50% (p value = 0.009).
In our cohort, acupuncture proved to exert a great influence in minimising the heartburn in pregnancy (table 2) during
treatment. This can be seen by the significant difference between groups, that is, although in both groups the symptoms
dropped, the mean of the symptoms in the study group is lower than that of the control group at the end of treatment.
We had some difficulties in our study. It is not easy to evaluate upper dyspepsia. There are few published systematic
reviews of the best approaches to symptom evaluation in upper dyspepsia.16 17 It is said that predominant heartburn is
the feature that best identifies it, and both the severity and frequency seem to be important characteristics.18 They have
been the focus of treatment trials and are the primary concern in everyday practice.15
Measurement of symptoms status among patients with upper dyspepsia has, to date, been conducted in a variety of
ways and uncertainty remains on the best methods for measuring the symptoms.19 Although there are several
drawbacks, visual analogue scale or NRS formats yield theoretically continuous response data which simplifies
computations and analyses of these data.19 20 In order to minimise those drawbacks, we outlined, in interviewer training,
four cognitive steps that respondents must traverse when answering questionnaire items:
1. Interpret what is being asked
2. Retrieve relevant information
3. Make a summary judgement
4. Convey that judgement to examiner
Our aim was to observe the result of treating dyspeptic complaints with acupuncture under real-life conditions, compared
with a group that were not treated in this way. We used a fifth category as described by Hammerschlag:21 "acupuncture
plus standard care versus standard care only". This may be the most ethical option in that there is no attempt to deny
subjects effective standard treatment.22 Patients in the trial were not blinded, but the interviewer was, or at least it was an
Dyspeptic complaints are very often seen in prenatal programmes. Thus, we observed in our cohort an incidence of 41%.
These complaints, as well as their intensity, during pregnancy may be associated to certain variables such as age,
gestational age, previous pregnancies, parity, previous miscarriages and body mass index. Hence these were analysed
in the study and control groups so that they could be excluded as a cause of differences in the results.
Although just a small part of the women took antacids, if we analyse these subgroups we can see that the control group
used more medication than the study subgroup, which suggests that the difference in the symptoms’ intensity between
the two groups would have been even greater with time.
We could also see, in the case group, an increase in the capacity to sleep and eat, some aspects that usually deteriorate
during the evolution of the gestation. A situation that is worse when a gravida suffers from dyspeptic disorders.
Summary points
We could find no previous published research on acupuncture for dyspepsia in pregnant women.
In this RCT, acupuncture was compared with usual care in 36 pregnant women.
The acupuncture group had significantly reduced symptoms as well as improved sleeping and eating.
One important point of our work is its originality. Although there is proof of the positive effects of acupuncture on the
digestive tract, both in animals23 24 and humans,7 8 25 there are practically no prospective randomised clinical studies
relating to this subject. The exceptions are the varying well-conducted studies about anti-emesis.1114 Because of the
proven effects of acupuncture in modulating gastric motor activity and in the motility of the oesophagus and lower
oesophageal sphincter,10 improvements in our patients were expected. Clinical studies in the literature are exclusively
case reports.2629 While these papers describe clinical experience, prospective randomised clinical data are lacking.
Many acupuncturists fear the use of acupuncture in pregnant women, as they believe that some points might trigger
uterine contractions. We did not find in scientific literature or even in interviewing many obstetric acupuncturists in Brazil
and China any real evidence that some distant points could be harmful to pregnancy. However, until more research is
done, we do not recommend sacral or low abdominal points. In this work no important adverse effects were seen during
the study. We could not see any significant differences between infants from one group compared to the other. These
data are congruent with results reported by other authors as no maternal or obstetric side-effects have been found during
or after more than 3300 acupuncture stimulations in 573 pregnant women.12 14 23 3034
Dyspepsia in pregnancy is a very common problem. The use of medication is always a concern. Acupuncture, as was
demonstrated in this study, seems to be an effective means of reducing the symptoms and improving the quality of life for
gravidas. This technique should be further studied in prospective randomised studies of large populations to confirm our
findings in effectiveness and the absence of adverse effects. It is simple to apply and if used in an appropriate manner
can reduce the need for medication.
Competing interests: None.
Ethics approval: This study has been approved by the Research Ethics Committee of the Federal University of São
Paulo, São Paulo, Brazil.
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... In 2 studies, 39,40 the researchers reported that ''no important adverse events occurred''; however there were 5 withdrawals from the 2009 study 40 (1 from the acupuncture group, 4 from the usual-care group), and outcomes were not included in the final analysis. ...
... Kvorning et al. reported acupuncture with stimulation verses no acupuncture 38 but no theoretical framework was provided. Two studies 39,40 reported using TCM theory according to the classics and TCM theory and trigger-point locations. ...
... This item describes practitioners' backgrounds, including qualifications, affiliations, and information provided to participants. In the 2 studies by Guerreiro da Silva et al., 39,40 the practitioner received 600 postgraduate hours of training in acupuncture; however, no qualifications were provided. Two studies 22,38 reported that the practitioners were midwives trained in acupuncture, and 1 study had a physiotherapist trained in acupuncture. ...
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Objective: Pregnancy is a complex physical and hormonal condition. Many women experience back and pelvic pain, reflux, and headaches during pregnancy. There has been a significant rise in the popularity of acupuncture for pain conditions in pregnancy, wherein nonpharmacologic options are important. Concerns have been raised by both traditional and medical acupuncturists about using "forbidden points" during pregnancy and the risk of preterm contractions (PTC), as this could limit women's and practitioners' willingness to continue treatment during pregnancy. There is also a risk of bias introduced into clinical trials when participants are highly selected or they drop out of studies due to adverse outcomes. This review examined randomized controlled trials (RCTs) of acupuncture using forbidden points prior to 37 weeks of pregnancy to treat pain conditions, with the primary outcome of PTC. Methods: A database search identified RCTs, including trials of penetrating acupuncture that used forbidden points in their protocols to treat pregnancy-related pain conditions. STRICTA [Standards for Reporting Interventions in Clinical Trials of Acupuncture] and GRADE [Grades of Recommendation, Assessment, Development, and Evaluation] criteria were used to assess the quality of evidence. This review includes 8 RCTs reporting on 713 women. Results: Only 2 studies reported on the primary outcome of PTC, and there were insufficient data to perform a primary analysis. In these 2 studies, 6 participants withdrew due to PTC. No study was at a low risk of bias for all GRADE domains, and 3 studies were at high or unclear risk of bias in all domains. Conclusions: PTC is an important clinical outcome and should be reported routinely. The strength of evidence to date is insufficient to recommend using forbidden points prior to 37 weeks of pregnancy. Highly selected patient populations, risk of bias in study design, and participant withdrawal rates, suggest that high-quality trials are required.
... 32 Two papers focused on the need to identify women who experienced intimate partner violence during pregnancy. 33,34 Obstetric and medical disorders The need to recognise and provide support for common symptoms in pregnancy was highlighted, including for dyspepsia, 35 nausea and vomiting, 36,37 and management of varicose veins and leg oedema. 38 Of 11 papers on obstetric problems and five on medical disorders in pregnancy, nine focused on gestational diabetes, including risk factors and determinants, the effect of dietary and medical advice and treatment in reducing perinatal complications. ...
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Background: Antenatal Care (ANC) is one of the key care-packages required to reduce global maternal and perinatal mortality and morbidity OBJECTIVES: To identify the essential components of ANC and develop signal functions SEARCH STRATEGY: MESH headings for databases including Cinahl, Cochrane, Global Health, Medline, PubMed, and Web of Science SELECTION CRITERIA: Papers and reports on content of ANC published from 2000-2020 DATA COLLECTION AND ANALYSIS: Narrative synthesis of data and development of signal function through 7 consensus-building workshops with 184 stakeholders MAIN RESULTS: A total of 221 papers and reports are included from which 28 essential components of ANC were extracted and used to develop 15 signal functions with the equipment, medication and consumables required for implementation of each. Signal functions for the prevention and management of infectious diseases (malaria, HIV, tuberculosis, syphilis and tetanus) can be applied depending on population disease burden. Screening and management of pre-eclampsia, gestational diabetes, anaemia, mental and social health (including intimate partner violence) are recommended universally. Three signal functions adress monitoring of foetal growth and wellbeing and identification and management of obstetric complications. Promotion of health and wellbeing via education and support for nutrition, cessation of substance abuse, uptake of family planning, recognition of danger signs and birth preparedness are included as essential components of ANC. Conclusions: New signal functions have been developed which can be used for monitoring and evaluation of content and quality of ANC. Country adaptation and validation is recommended.
... In one small trial of acupuncture versus placebo, acupuncture showed improved quality of life, in terms of ability to sleep and eat, with no increased rate of side effects. 9,10 In those with persistent symptoms, pharmacologic therapy should be considered, in a "step-up" algorithm ( Figure 1). At this stage, common patient questions will likely include: "Is this a safe medication to take while pregnant?" ...
Full-text available
Background: Gestational reflux is common, affecting up to 80% of pregnant women. Most symptoms will abate during lactation. During both of these periods, interventions used to relieve symptoms focus on a "step-up" methodology with progressive intensification of treatment. This begins with lifestyle modifications. Aim: To provide guidance in the treatment of reflux in pregnancy and lactation, as well as briefly summarising the pathogenesis, clinical presentation and diagnostic workup. Methods: A comprehensive search, using online databases PubMed and MEDLINE, along with relevant manuscripts published in English between 1966 and 2019 was used. All abstracts were screened, potentially relevant articles were researched, and bibliographies were reviewed. Results: Only a small percentage of relevant drugs are contraindicated for use in pregnancy or while breastfeeding. However, not all drug agents have been extensively evaluated in pregnant women or during the breastfeeding period. Antacids, alginates, and sucralfate are the first-line therapeutic agents. If symptoms persist, any of the H2 RAs can be used except for nizatidine (due to foetal teratogenicity or harm in animal studies). PPIs are reserved for women with intractable symptoms or complicated GERD; all are FDA category B drugs, except for omeprazole, which is a class C drug. Conclusions: The management of heartburn during pregnancy and lactation begins with lifestyle modifications. In situations where disease severity increases, medical providers must discuss risks and benefits of these medicines with the patient in detail.
Full-text available
Objective: The aim of the current study is to evaluate the efficacy and safety of acupuncture on sleep quality and overnight melatonin secretion, measured as urinary 6-sulfatoxymelatonin, in pregnant women. Patients and methods: This randomized, parallel, single-blinded (participant), controlled trial was conducted on 72 pregnant women with insomnia. Study participants were randomly assigned to either the intervention, 10 sessions of acupuncture treatment over a 3-week period, or control group by block randomization (1:1). Patients in both groups were evaluated at baseline and post-treatment (third week) using the Pittsburgh Sleep Quality Index (PSQI) score (as the primary outcome) and urinary 6-sulfatoxymelatonin. Results: Fifty-five of 72 participants completed the study. There was no statistically significant difference regarding PSQI score and 6-sulfatoxymelatonin level between intervention and control groups at the baseline (P=0.169 and P=0.496). At the end of the study period, treatment with acupuncture significantly improved the PSQI score (P<0.001) with a large effect size of 3.7, as well as 6-sulfatoxymelatonin level (P=0.020) with a medium effect size of 0.6 as compared to the control group. No adverse effects were noted during acupuncture sessions and follow-up visits. Conclusion: Acupuncture was shown to significantly improve the sleep quality in pregnant women, possibly through increasing melatonin secretion, and could be recommended as a low-cost and low-risk alternative treatment to pharmacological therapies.
Background: Acupuncture is a non-pharmacological option to relieve pregnancy-related complaints. Objectives: To critically appraise the best available evidence for the use of acupuncture in outpatient care. Search strategy: The MEDLINE, Cochrane Library, and Centre for Reviews and Dissemination databases were searched for English-language and German-language papers published from January 1980 to March 2017 using search terms related to pregnancy combined with 'acupuncture'. Selection criteria: Systematic reviews and randomized controlled trials (RCTs) comparing non-pharmacological treatments in unselected or low-risk pregnant women. Data collection and analysis: Quality was assessed using a checklist (A Measurement Tool to Assess Systematic Reviews) and the Cochrane risk of bias tool. Meta-analyses were also performed. Main results: High-quality systematic reviews (n=5) and RCTs with low risk of bias (n=3) were identified. The systematic reviews were based on single studies, with small sample sizes, that showed a benefit of acupuncture for evening pelvic pain; pelvic and low-back pain; nausea; functional disability; and sleep quality. Contradictory results were found in the RCTs regarding cesarean delivery; time to delivery; spontaneous labor; fetal distress; and Apgar score. Data pooling emphasized the heterogeneity of results. Conclusions: Evidence to support the use of acupuncture for relief of pregnancy-related conditions was limited. This article is protected by copyright. All rights reserved.
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Chinese medicine is a relatively new concept or rather an alternative medicine to the west [1]. Chinese medicine is considered to be an assimilation of philosophical and scientific thoughts and ideas that influence us in our daily lives. Chinese medicine believes in Yin Yang which metaphors the idea to a dualist reality that prevails in our society today. Like Ayurveda, Chinese medicine also represents the different elements of nature like wood, fire, metal, water and earth. Qi another concept in traditional Chinese medicine (TCM) is regarded as the main force of life filled with energy [2]. It is compared to the hot steam that comes out from cooking rice and consists of the wind, cold, heat and damp. In modern civilization Chinese medicine is slowly becoming the main stream of medicine in many east and Far East nations and is often regarded as an alternative source of treatment [3]. Since 5000 years and beyond Chinese medicine has offered many therapeutic potentials in pregnancy related indications ranging from infertility issues to threatened miscarriages [4, 5]. Chinese herbal medicine, diet and acupressure/acupuncture are some of the widely evolved and accepted Chinese method of practicing medicine. Although Chinese medicine is considered safe and gentle by some health care practitioners, public health workers and therapists, major concerns pertaining to its safety and therapeutic potency remains a big question till date.
There has been no published indepth systematic evaluation of the best approaches to symptom evaluation in gastro-oesophageal reflux disease (GORD). A two day international multidisciplinary workshop was therefore held in Marrakech, Morocco, in September 2002 to address these issues. The aim of the workshop was to critically review the data regarding the reliability, processes, and priorities for symptom evaluation in GORD patients. The workshop was designed to give outputs that could be readily reported and to arrive at specific recommendations on best practice in symptom evaluation in reflux disease.
Purpose: To review the pathophysiology of gastrointestinal motility disorders during pregnancy, their clinical manifestations, and their management. Data Sources: Studies published from 1963 to 1992 identified by computerized literature searches of Index Medicus and MEDLINE; hand searches; contact with pharmaceutical representatives for information on drug therapy during pregnancy; and selected texts on drugs and obstetrics. Study Selection: Selected studies were those involving controlled design of physiology related to pregnancy or to hormonal effects on the gastrointestinal tract or both, and clinical studies or previous reviews that contributed to the understanding of the gastrointestinal effects of pregnancy
Hyperemesis gravidarum, severe vomiting, develops in about 1–2% of all pregnancies. Acupuncture on the point PC6 above the wrist on the palmar side has been found to prevent some types of nausea and vomiting. The purpose of the present study was to see if acupuncture, in addition to standard treatment, could hasten the improvement of hyperemesis gravidarum. Thirty-three women with hyperemesis were evaluated in a randomized, single-blind, crossover comparison of two methods of acupuncture, active (deep) PC6 acupuncture or placebo (superficial) acupuncture. The women estimated their degree of nausea on a visual analogue scale (VAS). The daily number of emesis episodes were documented. Crossover analyses showed that there was a significantly faster reduction of nausea VAS and more women who stopped vomiting after active acupuncture than after placebo acupuncture. This study suggests that active PC6 acupuncture, in combination with standard treatment, could make women with hyperemesis gravidarum better faster than placebo acupuncture.
Background: Nausea and vomiting in early pregnancy are troublesome symptoms for some women. We undertook a single blind randomized controlled trial to determine whether acupuncture reduced nausea, dry retching, and vomiting, and improved the health status of women in pregnancy. Methods: The trial was undertaken at a maternity teaching hospital in Adelaide, Australia, where 593 women less than 14 weeks' pregnant with symptoms of nausea or vomiting were randomized into 4 groups: traditional acupuncture, pericardium 6 (p6) acupuncture, sham acupuncture, or no acupuncture (control). Treatment was administered weekly for 4 weeks. The primary outcomes were nausea, dry retching, vomiting, and health status. Comparisons were made between groups over 4 consecutive weeks. Results: Women receiving traditional acupuncture reported less nausea (p < 0.01) throughout the trial and less dry retching (p < 0.01) from the second week compared with women in the no acupuncture control group. Women who received p6 acupuncture (p < 0.05) reported less nausea from the second week of the trial, and less dry retching (p < 0.001) from the third week compared with women in the no acupuncture control group. Women in the sham acupuncture group (p < 0.01) reported less nausea and dry retching (p < 0.001) from the third week compared with women in the no acupuncture group. No differences in vomiting were found among the groups at any time. Conclusion: Acupuncture is an effective treatment for women who experience nausea and dry retching in early pregnancy. A time-related placebo effect was found for some women.
Six randomized, placebo controlled studies were performed to investigate the effect of electroacupuncture on gastric acid output in 38 healthy males. Electroacupuncture decreased basal acid output when compared to placebo acupuncture [from 3.50±0.59 mmol/hr to 2.54±0.56 mmol/hr (P<0.05)] as well as sham feeding-stimulated acid output [from 18.52±2.25 mmol/hr to 5.38±2.11 mmol/hr (P<0.005)], but had no effect on the pentagastrin stimulated acid output. The inhibitory effect of acupuncture on sham feeding-stimulated acid output was not affected by local anesthesia of the acupoint, but was prevented by a prior intravenous naloxone injection. Acupuncture did not alter plasma gastrin levels (20.7±7.6 μg/liter, vs control 21.2±7.2 μg/liter) but naloxone increased it (26.1±14.5 μg/liter) (P<0.05). We conclude that the antisecretory effects of electroacupuncture do not result from decreased gastrin release or decreased parietal cell sensitivity to gastrin, but are mediated through naloxone-sensitive opioid neural pathways and vagal efferent pathways.
Acupuncture has been used empirically in clinical practice in China for several millenia and has recently drawn interest as a mode of anesthesia. Despite extensive investigation, the exact mechanisms of its analgesic action are unknown, but are thought to involve endogenous opioid peptides. Only recently have studies attempted to evaluate the effect of acupuncture on gastrointestinal function and disease. A review of studies from both the Chinese and Western literature supports the efficacy of acupuncture in the regulation of gastrointestinal motor activity and secretion through opioid and other neural pathways. However, no firm conclusion can be drawn about the effectiveness of acupuncture in the treatment of specific gastrointestinal disorders because of the lack of properly randomized controlled trials.
The gallbladder and gut should be viewed as hormonally responsive organs the normal physiology of which may be altered by the hormones of pregnancy. The gallbladder enlarges and empties sluggishly in response to meals during pregnancy. Small bowel transit is slowed, and the resting pressure of the lower esophageal sphincter is reduced. All these effects are reversed by delivery; motility reverts toward normal in the postpartum period. The rapid return of normal motility suggests that the effects of pregnancy are hormonally related. Most studies have demonstrated that progesterone, not estrogen, may be the hormone responsible. Although incompletely defined, one mechanism of the effects of pregnancy on motility may be progesterone-induced inhibition of the mobilization of intracellular calcium within smooth muscle cells.
Gastrointestinal disorders constitute one of the most frequent complaints of pregnancy. An understanding of the mode of presentation and the incidence of the various gastrointestinal disorders will optimize care in obstetric patients. Disorders of the esophagus, stomach, duodenum, ilium, jejunum, colon, rectum, and appendix are individually discussed with reference to physiologic changes in pregnancy, infectious diseases, autoimmune disease, and ulcer formation.