Acupuncture for nausea and vomiting during pregnancy: A systematic review and meta-analysis

Pregnant women commonly experience challenging nausea and vomiting, which significantly affect their general well-being and daily life. Although medication is often used for relief, it may not alleviate symptoms completely, emphasizing the need for complementary therapies. Acupuncture is one of the complementary treatments for nausea and vomiting of pregnancy (NVP). Studying the outcomes of acupuncture for NVP can shed light on this issue and inform treatment guidelines. Therefore, we systematically evaluated the effectiveness and safety of acupuncture in managing NVP, considering the traditional meridian and acupoint theories.

PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Periodical Database, ClinicalTrials.gov, and the Chinese Clinical Trial Registry were searched on May 1, 2024. Randomized controlled trials (RCTs) that compared acupuncture for NVP with sham acupuncture, placebo, and Western medicine (WM) or acupuncture plus WM with WM alone were included. The risk of bias was assessed using the Cochrane risk-of-bias tool. A meta-analysis was conducted using RevMan 5.4.1, and the quality of evidence for each outcome was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach.

Twenty-four RCTs (with 26 publications) involving 2390 women were included. Acupuncture plus WM significantly led to a reduction in Pregnancy-Unique Quantification of Emesis (PUQE) scores and ineffective rates compared with WM alone (PUQE: mean difference [MD] -1.95, 95 % confidence interval [CI] -3.08 to -0.81, P = 0.0008, I² = 90 %, six studies; ineffective rates: risk ratio [RR] 0.27, 95 % CI 0.19 to 0.39, P < 0.00001, I² = 7 %, 16 studies). It also resulted in a greater improvement in ketonuria, shorter length of stay, and lower scores on the NVP Quality of Life and Chinese Medicine Syndrome Scale. Acupuncture was superior to WM in terms of reduction in ineffective rates (RR 0.50, 95 % CI 0.30 to 0.81, P = 0.006, I² = 0 %, five studies). Acupuncture and WM had comparable results in improvement in PUQE scores (MD -0.80, 95 % CI -3.06 to 1.46, P = 0.49, I² = 89 %, three studies) and ketonuria negative rates. The evidence is not clear regarding the impact of acupuncture on depression and anxiety compared with that of sham acupuncture. The incidence of severe adverse events was not significantly different between acupuncture and WM or sham acupuncture. Evidence certainty ranged from moderate to very low. Of the 24 RCTs, 19 used the Neiguan (PC6) acupoint, 16 used the Zusanli (ST36) acupoint, and 13 used the Zhongwan (CV12) acupoint.

According to the current systematic review and meta-analysis, acupuncture combined with WM may be a more effective treatment for NVP than WM alone. Furthermore, acupuncture may be as effective as WM. PC6, ST36, and CV12 are the most commonly used acupoints. Although more robust and larger studies are required, the current evidence supports the use of acupuncture in NVP treatment, as it has been demonstrated to be safe.