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For What 'Ales' You: Ginger, N/V, and Pregnancy
Abstract & Commentary
By Russell H. Greenfield, MD
Synopsis: A brief intervention of an extract of ginger administered four times daily was effective in ameliorating nausea and vomiting of pregnancy in this small single-blind trial.
Source: Ozgoli G, et al. Effects of ginger capsules on pregnancy, nausea, and vomiting. J Altern Complement Med 2009;15:243-246.
In an attempt to determine the efficacy of an extract of ginger on nausea and vomiting of pregnancy (NVP), researchers from Iran employed a single-blind clinical trial design to study subjects (n = 67 pregnant women) with mild-to-moderate nausea with or without vomiting. Prior to randomization, participants were asked to complete a visual analog scale (VAS, scale 0-10) to document severity of nausea and vomiting over the previous 24 hours. They were then randomized in blinded fashion to either an experimental group taking ginger 1,000 mg/d (250 mg capsules taken in the morning, at noon, in the afternoon, and at nighttime with water) or a placebo group taking capsules containing lactose at the same time periods for four days. They were asked not to use prescription aids during the trial and were counseled to avoid fatty foods, as well as to eat less food at each meal, but were also advised to increase the number of meals consumed each day. The effects of the interventions on nausea severity were to be evaluated twice (noon and bedtime) for four days using a treatment questionnaire and the VAS. After four days the questionnaires were given to a researcher who, based on their responses to questions about intensity of nausea and vomiting, interviewed each of the participants with a special emphasis on adherence to the dietary recommendations.
Mean gestational age and parity of the participants was 13 ± 3 weeks and 1.6, respectively. At baseline, nausea severity was rated as moderate in 54% and 56% of the control and experimental samples, respectively, mild in 25.7% and 18.7%, and severe in 7% and 8%. Subjects who received ginger experienced greater relief from nausea than did those in the placebo group (84% vs 56%) and had fewer vomiting episodes (50% decrease vs 9%). After treatment, 26% of ginger users no longer had nausea, whereas only 10% of the control group experienced complete relief. There were no changes in nausea intensity for 22% of the women in the control group and 9% in experimental group. Roughly 54% in the control group and 44% in the experimental group did not pay strict attention to dietary recommendations. The authors conclude that a standardized extract of ginger in a divided dose of 1,000 mg/d is effective in the treatment of NVP.
Up to 90% of pregnant women experience NVP, a condition that typically resolves spontaneously by the 20th week of gestation. While discomfiting and having a negative impact on quality of life, NVP is generally mild. At the other end of the spectrum, however, is hyperemesis gravidarum, where nausea and vomiting are severe and can result in significant metabolic derangements that endanger both mother and unborn child. The focus of the paper at hand was on the mild form of NVP.
A small number of studies have previously been published that support a possible role for ginger in the treatment of NVP, but dosage and duration of treatment have remained unsettled issues. This trial employed a commonly used divided dosage of 1,000 mg daily and showed significant clinical benefit, but the intervention was offered for only four days. Being that NVP can develop early in pregnancy and continue through the first part of the second trimester, a four-day intervention may not be clinically relevant, although more than one-quarter of women in the active group had complete resolution of their symptoms by trial's end. More research is needed to better determine safety parameters around duration of administration. As a side noteginger ale is not therapeutic in this regard because it is such a dilute preparation, and often contains a large amount of sugar.
Issues with the current study include the possibility of bias, being that the researcher who interviewed subjects after four days of therapy was not blind to treatment assignment, and unequal numbers of assessments in the two study arms. It is worthwhile to note there was a significant response in the placebo group (56%). These considerations stated, ginger has a long and rich tradition of use across cultures and appears to be safe; still, the discussion centers around the health of mother and baby, and further studies fully evaluating safety for both can only be welcomed. While ginger may be a reasonable option for some women with NVP, other tried-and-true interventions include vitamin B6, dietary manipulation, and acupressure.