A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting

Estelle Viljoen, Janicke Visser, Nelene Koen, Alfred Musekiwa, Estelle Viljoen, Janicke Visser, Nelene Koen, Alfred Musekiwa

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.

Methods: 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.

Results: 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.

Conclusions: 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.

Figures

Figure 1
Figure 1
Diagrammatic representation of the process followed in the selection of studies.
Figure 2
Figure 2
Methodological quality graph: judgments about each methodological quality item presented as percentages for all included studies (n = 12).
Figure 3
Figure 3
Forest plot of the improvement in nausea symptoms measured by change in VAS scores (ginger versus placebo).
Figure 4
Figure 4
Forest plot of the improvement in nausea symptoms as measured by the change in VAS scores (ginger versus Vitamin B6): subgroup analysis regarding dose (≥1500 mg versus < 1500 mg).

References

    1. Ebrahimi N, Maltepe C, Einarson A. Optimal management of nausea and vomiting of pregnancy. Int J Women’s Health. 2010;2:241–248.
    1. Badell ML, Ramin SM, Smith JA. Treatment options for nausea and vomiting during pregnancy. Pharmacotherapy. 2006;26(9):1273–1287. doi: 10.1592/phco.26.9.1273.
    1. Martin EA. The Oxford concise medical dictionary. 6. Oxford: Oxford University Press; 2002.
    1. Fagen C. In: Nutrition and Diagnosis-Related Care. 5. Escott-Stump S, editor. Philadelphia: Lippincott Williams & Wilkins; 2002. Pregnancy and Lactation; pp. 4–11.
    1. Mathai K. In: Krause’s Food, Nutrition and Diet Therapy. 10. Mahan KL, Escott-Stump S, editor. Philadelphia: W.B. Saunders Company; 2000. Integrative Medicine and Herbal Therapy; pp. 415–425.
    1. Quinlan JD, Hill DA. Nausea and vomiting of pregnancy. Am Fam Physician. 2003;68(1):121–128.
    1. Parboosingh J. The effects of medication during pregnancy. Can Fam Physician. 1981;27:1013–1015.
    1. Natural Standard Research Collaboration. 2009. (Ginger (Zingiber Officinale Roscoe)). [ ]
    1. Al-Achi A. A current look at ginger use. [ ] 21 July 2009.
    1. Ernst E, Pittler MH. Efficacy of Ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth. 2000;84(3):367–371. doi: 10.1093/oxfordjournals.bja.a013442.
    1. White B. Ginger: an overview. Am Fam Physician. 2007;75(11):1689–1691.
    1. Ladas EJ, Post-White J, Hawks R, Taromina K. Evidence for symptom management in the child with cancer. J Pediatr Hematol Oncol. 2006;28:601–615. doi: 10.1097/01.mph.0000212989.26317.52.
    1. Cassileth BR, Deng G. Complementary and alternative therapies for cancer. Oncologist. 2004;9:80–89. doi: 10.1634/theoncologist.9-1-80.
    1. Betz O, Kranke P, Geldner G, Wulf H, Eberhart LH. Is ginger a clinically relevant antiemetic? A systematic review of randomized controlled trials. Forsch Komplementarmed Klass Naturheilkd. 2005;12(1):14–23. doi: 10.1159/000082536.
    1. Chrubasik S, Pittler MH, Roufogalis BD, Zingiberis R. A comprehensive review on the ginger effect and efficacy profiles. Phytomedicine. 2005;12:684–701. doi: 10.1016/j.phymed.2004.07.009.
    1. Borrelli F, Capasso R, Aviello G, Pittler MH, Izzo AA. Effectiveness and safety of ginger in the treatment of pregnancy-induced nausea and vomiting. Obstet Gynecol. 2005;105(4):849–856. doi: 10.1097/01.AOG.0000154890.47642.23.
    1. Jewell D, Young G. Nausea and vomiting in early pregnancy. Am Fam Physician. 2003;68(1):143–4.
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration; 2011. (version 5.1.0 [updated March 2011]). Available from .
    1. Basirat Z, Moghadamnia AA, Kashifard M, Sarifi-Razavi A. The effect of ginger biscuit on nausea and vomiting in early pregnancy. Acta Med Iran. 2009;4(1):51–56.
    1. Chittumma P, Kaewkiattikun K, Wiriyasiriwach B. Comparison of the effectiveness of ginger and vitamin B6 for treatment of nausea and vomiting in early pregnancy: a randomized double-blind controlled trial. J Med Assoc Thai. 2007;90(1):15–20.
    1. Ensiyeh J, Sakineh MA. Comparing ginger and vitamin B6 for the treatment of nausea and vomiting in pregnancy: a randomised controlled trial. Midwifery. 2005;25(6):649–653.
    1. Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping U. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol. 1991;38(1):19–24. doi: 10.1016/0028-2243(91)90202-V.
    1. Keating A, Chez RA. Ginger syrup as an antiemetic in early pregnancy. Altern Ther Health Med. 2002;8(5):89–91.
    1. Mohammadbeigi R, Shahgeibi S, Soufizadeh N, Rezaiie M, Farhadifar F. Comparing the effects of ginger and metoclopramide on the treatment of Pregnancy nausea. Pak J Biol Sci. 2011;14(16):817–820.
    1. Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea, and vomiting. J Altern Complement Med. 2009;15(3):243–246. doi: 10.1089/acm.2008.0406.
    1. Pongrojpaw D, Somprasit C, Chanthasenanont MD. A randomized comparison of ginger and dimenhydrinate in the treatment of nausea and vomiting in pregnancy. J Med Assoc Thai. 2007;90(9):1703–1709.
    1. Smith C, Crowther C, Willson K, Hotham N, McMillian V. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol. 2004;103(4):639–645. doi: 10.1097/.
    1. Sripramote M, Lekhyananda N. A randomized comparison of ginger and vitamin B6 in the treatment of nausea and vomiting of pregnancy. J Med Assoc Thai. 2003;86(9):846–853.
    1. Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol. 2001;97(4):577–582. doi: 10.1016/S0029-7844(00)01228-X.
    1. Willetts KE, Ekangaki A, Eden JA. Effect of a ginger extract on pregnancy-induced nausea: a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2003;43(2):139–144. doi: 10.1046/j.0004-8666.2003.00039.x.
    1. Modares M, Besharat S, Kian FR, Besharat S, Mahmoudi M, Sourmaghi HS. Effect of Ginger and Chamomile capsules on nausea and vomiting in pregnancy. J Gorgan Uni Med Sci. 2012;14(1):46–50.
    1. Narenji F, Delavar M, Rafiei M. Comparison the effects of the ginger fresh root and vitamin B6 on the nausea and vomiting in pregnancy. Iran J Obstet Gynecol Infert. 2012;15(2):39–43.
    1. Qualitymetric: disease specific health surveys. [ ] 27 November 2011.
    1. Matthews A, Dowsell T, Haas DM, Doyle M, O’Mathuna DP. Interventions for nausea and vomiting in early pregnancy. (Cochrane Review) Cochrane Database Syst Rev. 2010;8(9):CD007575.
    1. Ding M, Leach M, Bradley H. The effectiveness and safety of ginger for pregnancy-induced nausea and vomiting: a systematic review. Women Birth. 2013;26(1):e26–e30. doi: 10.1016/j.wombi.2012.08.001.
    1. Thomson M, Corbin R, Leung L. Effects of ginger for nausea and vomiting in early pregnancy: a meta-analysis. J Am Board Fam Med. 2014;27(1):115–122. doi: 10.3122/jabfm.2014.01.130167.
    1. Fugh-Berman A, Kronenberg F. Complementary and alternative medicine (CAM) in reproductive-age women: a review of randomized controlled trials. Reprod Toxicol. 2003;17(2):137. doi: 10.1016/S0890-6238(02)00128-4.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir