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Interventions for nausea and vomiting in early pregnancy.

BACKGROUND
Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting between 70 and 85% of women. About half of pregnant women experience vomiting.


OBJECTIVES
The objective of this review was to assess the effects of different methods of treating nausea and vomiting in early pregnancy.


SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register.


SELECTION CRITERIA
Randomised trials of any treatment for nausea and/or vomiting in early pregnancy.


DATA COLLECTION AND ANALYSIS
Trial quality was assessed and data were extracted independently by two reviewers.


MAIN RESULTS
Twenty trials were included. These trials were of variable quality. Nausea treatments were different anti-histamine medications, vitamin B6 (pyridoxine), the combination tablet Debendox (Bendectin) and P6 acupressure. For hyperemesis gravidarum two trials were identified using treatments with ginger root and ACTH (adrenocorticotropic hormone) injections. Based on 13 trials, there was an overall reduction in nausea from anti-emetic medication (odds ratio 0.17, 95% confidence interval 0. 13 to 0.21).


REVIEWER'S CONCLUSIONS
Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. The results of the trial using adrenocorticotropic hormone to treat hyperemesis gravidarum show no evidence of benefit. Ginger may be of benefit, but the evidence so far is weak.