Eureka Herba Indonesia Vol 3 Issue 1 2022

Eureka Herba Indonesia

Effectiveness of Ginger in Treating Nausea and Vomiting of Pregnancy

A R T I C L E IN F O A B S T R A C T

Keywords: Nausea and vomiting in pregnancy (NVP) is one of the common main complaint in
Nausea pregnancy. NVP can be a significant burden to the patient, make a decrease in quality
Hyperemesis of life, pregnancy threatening or even worse can lead to nutritional loss and death.
Ginger NVP diagnosed when in first trimester of pregnancy and the other possible cause of
Literature Review NVP is excluded. Management of NVP is included maintaining hydration, nutrition,
and lifestyle modification. Also avoiding the smells, food, or activity that can cause
Correspondi ng author: nause are necessary. There are some methods to treat NVP including pharmalogical
Ahmad Ramadha n u or non-pharmalogical. The non-pharmalogical approach is change nutritional habits,
lifestyle and medications. Several pharmalogical agents that can be used to relief the
E-mail address: symptoms of NVP are pyridoxine, anti- histamines, metoclopramide,
ramadhanu.og@gmail.com pyridoxine/doxylamine, promethazine and metoclopramide. Some patients also want
to try more “natural” medications for NVP like ginger. The pharmacological activity is
All authors have reviewed and thought to stand in the pungent principles (gingerols and shogaols) and volatile oils
approved the final version of the (sesquiterpenes and monoterpenes). The true mechanism of action of ginger is
manuscript. probable to be a gastric effect, to increase tone and peristaltic due to anticholinergic
and antiserotonin act. Ginger acts straight to the digestive tract and avoids the CNS
side effects common to centrally acting antiemetics. Ginger is available in capsule or
https://doi.org/10.37275/ehi.v3i1.46 syrup form or in candy, cookies, beer, tinctures, teas, sodas, and jam. Nowadays, true
dosing is available only if one uses standardized extracts; however, women may ch oose
to use another form of ginger.

1. Introduction
Nausea and vomiting or NVP (often referred as Management of hyperemesis gravidarum includes
morning sickness) are common symptoms in maintaining appropriate hydration, electrolytes, and
pregnant women approx. 70 – 85% and 40 –50% of dietary and lifestyle modifications. 4 Women are
pregnant women, respectively. 1 Nausea and vomiting commonly offered advice about the (usually) self-
can be a significant obstacle to the patient, resulting limiting nature of the condition and advised to avoid
in decreased quality of life, furthermore make wide foods, smells, activities or situations that they find
medical complications, malnutrition, and in some nauseating and to eat small frequent meals of dry,
conditions, may result in management disruption bland foodstuffs. Many remedies are suggested for
and stoppage.2 Nausea and vomiting in pregnant nausea and vomiting in early pregnancy, including
women is diagnosed when the first onset of symptoms pharmaceutical and non-pharmaceutical
is in the first trimester of pregnancy and the other interventions. 5
possibilities of causes of NVP have been excluded. The non-pharmacological therapy of Nausea and
There are also risks of recurrence in future pregnancy Vomiting in Pregnancy (NVP) during pregnancy is
(15%–81%). It typically affects pregnant women underpinned by a change of nutritional habits, life-
between the fourth and the seventh gestational week style and medications, which have received scant
and usually resolves by the 20th week. 3 attention in the literature. The drugs widely used to

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treat the mild to moderate cases of NVP are antiserotonin action. Ginger acts straight to the
pyridoxine, anti- histamines, metoclopramide, digestive tract and avoids the CNS side effects
pyridoxine/doxylamine, promethazine and common to centrally acting antiemetics. Ginger is
metoclopramide. In the event of more severe available in capsule or syrup form or in candy,
symptoms, ondansetron and corticosteroids can be cookies, beer, tinctures, teas, sodas, and jam.
pre- scribed. However, there is little on the efficacy of Currently, true dosing is available only if one uses
these drugs. Many mothers feel helpless in dealing standardized extracts; however, women may choose
with this condition, especially out of concern for side to use another form of ginger. 9
effects of these drugs on the unborn foetus. 7 The recommendation of daily dose of ginger for the
Medication options for nausea and vomiting of medication of PNV is 1000 mg. In addition to
pregnancy are limited because of concerns about concerns about dosage, ginger also has the potential
safety. Initially, treatment consists of identifying and to interact with other medications. It is recommended
avoiding nausea triggers, avoidance of spicy and fatty that ginger not be combined with medications such
foods, and cessation of iron supplements. If these as dimenhy- drinate (Dramamine) since the possible
nonpharmacologic approaches do not alleviate interactions are currently unknown. Ginger should
symptoms, other options, including multi- vitamins, also be avoided in patients prescribed oral
vitamin B6, doxylamine, ginger, antihistamines, hypoglycaemic agents or insulin, as some of the
anticholinergics, and corticosteroids, may be tried. constituents of ginger could theoretically potentiate
Many patients prefer to avoid “drugs” during the hypoglycaemic effect of these medications. 10
pregnancy, choos- ing instead “natural” alternatives.
One of these popular op- tions is ginger. The efficacy 2. Methods
and safety of this product is still in question, and it The researcher searched for all studies published
is classified as pregnancy category C. Ginger root is between 01 January 2000 and 01 August 2021, using
commonly used as a flavoring agent in food and the following databases: PubMed. The following
beverages and as a fragrance additive in cosmetic keywords were used in the databases during the
products. The antiemetic constituents of ginger exert literature search: "((ginger) AND (morning sickness))
their effects in the gastrointestinal tract, but the AND (pregnancy)". The research was limited to
specific mecha- nism is unknown. In vitro, it show human study published in the English language.
that to have some ability to antagonize serotonin 5- More studies were identified through a manual
HT3 receptors.8 search of the bibliographic references of the relevant
Ginger rhizome (zingiber officinale), used articles and existing reviews. The inclusion criteria
worldwide as a spice and an herbal remedy, has a was studies that describe the pharmacology of ginger.
long history as a digestive aid and antinausea The exclusion criteria was studies that include other
remedy. It is the herb most commonly used to treat conditions (e.g. comorbid conditions (anxiety,
nausea and vomiting of pregnancy, either socioeconomic status, nutrition level, and number of
recommended by providers or used as self-treatment previous pregnancies), endocrine problems,
by women. The pharmacological activity is thought to neurovascular problems, immunopathological
stand in the pungent principles (gingerols and problems, hematological problems, oncology
shogaols) and volatile oils (sesquiterpenes and problems that could play an important role in the
monoterpenes). The true mechanism of action of nausea and vomitting in pregnancy. Moreover,
ginger is thought to be a gastric effect, to increase because these confounding factors are difficult to
tone and peristaltic due to anticholinergic and account for this study, the adjusted results were used

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and discussed in this article when available. In the ginger provide a significant reduction in NVP;
first step, researcher assess the titles and abstracts however, the clinical relevance of some studies is less
of the studies to exclude articles based on the criteria. certain. Common obstacles within the literature
In the second step, researcher read and evaluated the include the lack of standardized extracts, not very
full-text studies that met the criteria. good controlled or blinded studies, and limited
sample size. Respectively, recent evidence has
3. Results provided further support for 5-HT3 receptor
The PubMed search results identified 62 potensial antagonism as a mechanism by which ginger may
studies, with 50 potential studies remaining after show its potentially beneficial effect on nausea and
duplicates were removed. After a quick review of the vomiting.
titles and abstracts of all 50 studies, 20 studies were Several differences were showed on the different
identified for potential inclusion in the review. After guidelines as the management of NVP. Frequent
deep examination of the full text of the 20 studies snacks and avoidance of iron supplements in NVP are
against the inclusion criteria, a total of 10 trials were recommended for prevention. The intake of ginger,
excluded Reasons for exclusion were: dopamine acustimulations, antihistamines,
studies that include other conditions (e.g. comorbid phenothiazines, and serotonin 5-hydroxytryptamine
conditions (anxiety, socioeconomic status, nutrition type 3 receptor antagonists is routine
level, and number of previous pregnancies), recommendation for use in the community as
endocrine problems, neurovascular problems, treatment.
immunopathological problems, hematological Twenty studies were included in the systematic
problems, oncology problems. See Figure 1 for the review and eight teen in the meta-analysis.
study selection and inclusion process. Acupuncture (OR: 18.9; 95% CI: 2.1, 168),
acupressure (OR: 26.7; 95% CI: 2.5, 283.1) and
4. Discussion methylprednisolone (OR: 6.7; 95% CI: 1.1, 38.8) were
Six double blind RCTs with a total of 675 associated with better control of HG symptoms than
participants and a prospective observational cohort standard of care. Acupressure decreases the
study (n = 187) met all inclusion criteria. The requirement of rescue anti-emetics (OR: 0.06; 95%
methodology quality of 4 of 5 RCTs was high. Four of CI: 0.01, 0.44); ondansetron with reduced hospital
the 6 RCTs (n = 246) show superiority of ginger over stay (WMD: -0.2; 95% CI: -0.31, -0.01) and diazepam
placebo; the other 2 RCTs (n = 429) showed that with reduced risk of hospital admission (OR: 0.11;
ginger was as effective as the reference drug (vitamin 95% CI: 0.01, 0.95). The quality of evidence is very
B6) in relieving the severity of NVP episodes. The low.
observational study obtained and RCTs (including Thirty-seven trials involving 5049 women, met
follow up periods) show the absence of significant the inclusion criteria. These trials covered many
side effects or adverse effects on pregnancy interventions, including acupressure, mint oil,
outcomes. There are no spontaneous or case reports acustimulation, acupuncture, ginger, chamomile,
of adverse events during ginger treatment in lemon oil, vitamin B6 and several antiemetic drugs.
pregnancy. We identified no studies of dietary or other lifestyle
This article identify nine studies and seven interventions. Evidence based the effectiveness of P6
reviews that investigated ginger for morning sickness, acupressure, auricular (ear) acupressure and
postoperative NVP, chemotherapy-induced, and acustimulation of the P6 point was limited.
antiretroviral-induced NVP. All studies reported that Acupuncture (P6 or traditional) showed no significant

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plus to women in pregnancy. The use of ginger finding should be considered in the light of the above
products may be helpful to women, but the evidence limitations.
of effectiveness was low and not consistent, though There is evidence suggesting that ginger is effective
two recent studies support ginger over placebo. There in reducing nausea and vomiting experienced during
was only few evidence from trials to support the use pregnancy. The studies used divided doses ranging
of pharmacological agents including vitamin B6, and between 500 and 1500 mg/day, with no higher
anti-emetic drugs to relieve mild or moderate NVP. incidence of birth defects, miscarriages, or deformities
There was little information on maternal and fetal than in the general population. While most of the
adverse outcomes and on psychological, economic, or studies concluded that there was no increased risk of
social outcomes. We were unable to pool findings birth defects in women taking gin-ger, the inclusion of
from studies for most results due to heterogeneity in those >12 weeks’ gestation means that their data are, in
study participants, interventions, comparison reality, inconclusive.
groups, and outcomes measured or reported. The In all 4 studies reviewed here, no rationale was
methodologic quality of the included study was offered for the choice of dose and length of treatment.
mixed. As with all herbal, prescription, and over-the-counter
In a study of 27 women, 250 mg powdered ginger medications, it is important to know the maximum
root appeared to be superior to a placebo in reducing safe dose and length of treatment with the fewest side
NVP. The placebo was an equivalent dose of lactose, effects, the consequences of overdose, and potential
which may not be an inert ingredient for some drug/herb interactions. In no study was the safety of
subjects. Ginger root, however, is reported to contain ginger consumption during pregnancy explicitly
a thromboxane synthetase inhibitor, which may addressed, nor was any study powered well enough
effect testosterone receptor binding in the fetus. to get statistically significant results concerning
Whether powdered ginger root in quantities of 250 mg safety. The studies were time-limited, yet nausea and
might adversely affect fetal development is not vomiting of pregnancy can last for weeks. Animal
known. studies have report both mutagenic and
All studies showed that ginger had a positive antimutagenic effects of isolated components of
effect on nausea in pregnant women. Unlike others ginger, and human study have conflicting results
studies, one study reported that ginger was not regarding potential inhibition of platelet aggregation
beneficial to the treatment of vomiting. Herbal when ginger is consumed at high doses. One recent
medicines such as matricaria chamomilla, elet- taria study examines pregnancy outcomes in 187 women
cardamomum, pomegranate and spearmint syrup, known to have consumed ginger during the first
lemon provide safe and effective medical alter- natives trimester and found no statistically significant differ-
for treating pregnant women with mild to moderate ence in major malformations, spontaneous abortion,
NVP. The results suggested that ginger was more and stillbirth rates among the ginger and the
effective than vitamin B, but at the dose of 35–500 comparison group. Four RCTs met the inclusion
mg ginger, vitamin B6 and ginger had identical effect. criteria. All trials found orally taken ginger to be
However, over a longer treatment period (60 days), significantly more effective than placebo in reducing
vitamin B6 was proved to be more effective than the frequency of vomiting and intensity of nausea.
ginger. The same effect was showed in the Side events were generally mild and infrequent.
comparison of quince and vitamin B6 as well as
ginger and doxylamine plus pyridoxine. Mentha did 5. Conclusion
not generated a positive effect on NVP. However, this Gingers may be an effective treatment for nausea

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and vomiting in pregnancy. However, more with Ginger. The Annals of
observational studies, with a larger sample size, are Pharmacotherapy. 2005; 39.
needed to confirm the encouraging preliminary data 9. Bryer, E., A Literature Review of the
on ginger safety. The results of study in this article Effectiveness of Ginger in Alleviating Mild-to-
suggest that ginger is a promising treatment for Moderate Nausea and Vomiting of
nausea and vomiting in a variety of clinical settings Pregnancy. Journal of Midwifery & Women’s
and possesses a clinically relevant mechanism. Health. 2005; 50(1).
However, further studies are required to address the 10. Ding, E et al. The effectiveness and safety of
limitations in the current clinical literature before ginger for pregnancy-induced nausea and
firm recommendations for its use can be made. vomiting: A systematic review. Women and
Birth Elesevier. 2013.
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