Ginger for Nausea in Pregnancy

Sources: Keating A, Chez RA. Ginger syrup as an antiemetic in early pregnancy. Altern Ther Health Med 2002;8:89-91.

Abstract: Ginger (Zingiber officinale) has been used to ameliorate symptoms of nausea. A beverage containing ginger in a syrup may be easier to consume than a capsule or solid food. The objective of this double-blind, placebo-controlled, randomized clinical trial was to determine if ginger syrup mixed in water is an effective remedy for the relief of nausea and vomiting in the first trimester of pregnancy. Twenty-six subjects in the first trimester of pregnancy were enrolled from the University of South Florida department of obstetrics and gynecology private practice office. The authors concluded that the ingestion of 1 g of ginger in syrup in a divided dose daily may be useful in some patients experiencing nausea and vomiting in the first trimester of pregnancy.

Blumenthal M. Ginger as an antiemetic during pregnancy [letter]. Altern Ther Health Med 2003;9:9-20.

Source: Vutyavanich T, et al. Ginger for nausea and vomiting in pregnancy: Randomized, double-masked, placebo-controlled trial. Obstet Gynecol 2001;97:577-582.

Abstract: The authors in this trial sought to determine the effectiveness of ginger for the treatment of nausea and vomiting of pregnancy. Women with nausea and vomiting of pregnancy, who first attended an antenatal clinic at or before 17 weeks’ gestation, were invited to participate in the study. During a five-month period, 70 eligible women gave consent and were randomized in a double-masked design to receive either oral ginger 1 g per day or an identical placebo for 4 days. Subjects graded the severity of their nausea using visual analog scales and recorded the number of vomiting episodes in the previous 24 hours before treatment, and again during four consecutive days while taking treatment. At a follow-up visit seven days later, five-item Likert scales were used to assess the severity of their symptoms. The authors concluded that ginger is effective for relieving the severity of nausea and vomiting of pregnancy.

Comments by Mary L. Hardy, MD

Morning sickness can be a difficult illness to treat in Western medicine. Therapy is limited by fear of inducing harm to the developing fetus. As a result, many women have sought relief from natural remedies. Of 70 women who called the Mother Risk Helpline for nausea, 61% reported using complementary and alternative therapies.1 Vitamin B6, ginger, and acupuncture were the therapies most commonly reported. Only 8% of the women told their doctors or pharmacists what they were using. Thus, it is very important that medical professionals who see pregnant patients be prepared to discuss the use of ginger by having a sense of the efficacy and safety of ginger for nausea and vomiting of pregnancy.

Ginger is an herb that has been used medicinally by virtually every culture. Traditionally, it has been given to treat upper gastrointestinal complaints like nausea or indigestion. Clinical trials have shown that ginger is effective in reducing nausea associated with motion sickness and chemotherapy or following surgery.2 To date, three clinical trials have looked at the effect of ginger on morning sickness.

The first trial showed a decrease in nausea and vomiting after 10 days of treatment with ginger, but this trial was not ideal for several reasons.3 The number of women studied was small (n = 30) and they were hospitalized with relatively severe symptoms. The dosage used—250 mg dried powder twice a day—was smaller than was customarily used.

Following this trial, a group in Thailand, where ginger is used extensively as a folk treatment and dietary spice, conducted a trial to address these issues.4 Seventy women complaining of first trimester nausea at an outpatient obstetrical visit were enrolled in this study. They were given a dried ginger powder (250 mg four times a day for four days), which had been prepared by the investigators from fresh ginger root. Nausea as assessed by a visual analog scale was significantly lower in the treatment group by day 2 and continued to decrease for the next two days. Subjectively, 28 of 32 treated women also reported an improvement in symptoms compared with only 10 of 35 placebo patients. Ginger apparently was effective after a short treatment time, but it is a weakness of this trial that women were not followed for a longer time. Thus, this trial does not tell us anything about the durability of a response to ginger.

Most recently, Keating and Chez tested a commercially available ginger syrup for first trimester nausea.5 This was a small pilot study and no statistical analysis was performed. However, the trend was consistent with the two previous studies. A syrup that contained the equivalent of 250 mg of ginger root was consumed four times a day for two weeks. By the tenth day, the treatment group reported a better clinical response than the placebo group. This more unusual formulation was well accepted by the patients.

Given the limited but positive data for efficacy of ginger, attention should be paid to safety. Questions have been raised about the safety of ginger for pregnant women. Several authorities permit the use of fresh ginger, but consider dried ginger a risk to the baby. However, this view is not held universally. Ginger as a food is widely consumed in Asia in amounts much larger than the amounts tested in these trials without reports of increased risk to fetus. No adverse events to the fetus were reported in the clinical trials reported here, although they were not long enough or large enough to represent definitive safety studies. It is fair to say that with ginger doses of 1 g/d, the evidence of benefit outweighs the evidence of risk. However, additional caution would be recommended to any patient with a history of first trimester fetal loss.

Dr. Hardy is Medical Director, Cedars-Sinai Integrative Medicine Medical Group, Los Angeles, CA.

References

1. Hollyer T, et al. The use of CAM by women suffering from nausea and vomiting during pregnancy. BMC Complement Altern Med 2002;2:5-10.

2. Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: A systematic review of randomized clinical trials. Br J Anaesthesia 2000;84:367-371.

3. Fischer-Rasmussen W, et al. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 1990;38:19-24.

4. Vutyavanich T, et al. Ginger for nausea and vomiting in pregnancy: Randomized, double-masked, placebo-controlled trial. Obstet Gynecol 2001;97:577-582.

5. Keating A, Chez RA. Ginger syrup as an antiemetic in early pregnancy. Altern Ther Health Med 2002;8:89-91.