Morning sickness is a prevalent condition that affects a significant percentage of pregnant women in Atlanta and can have debilitating effects. While the majority of women experience mild symptoms that resolve naturally, a small portion develops a severe form called hyperemesis gravidarum (HG), which can lead to dehydration, weight loss, and even hospitalization.
Conventional medical treatments for morning sickness often prove ineffective or come with notable side effects. As a result, there has been a growing interest in exploring acupuncture as an alternative treatment option. Scientific evidence supporting the effectiveness of acupuncture for morning sickness is steadily accumulating. Numerous randomized controlled trials have demonstrated that acupuncture can effectively reduce the severity of nausea and vomiting in pregnant women. Moreover, acupuncture is considered generally well-tolerated and associated with minimal side effects.
This article aims to provide an overview of the scientific literature concerning acupuncture for morning sickness. We will examine the effectiveness of acupuncture, explore its mechanisms of action, and discuss why it may be a preferable choice compared to conventional medical treatments.
Morning sickness, its mechanism and why it should be dealt with
Hyperemesis gravidarum (HG) is a severe and distressing condition characterized by persistent nausea and vomiting during pregnancy that goes beyond the typical morning sickness experienced by many expectant mothers. HG affects less than 3% of pregnant individuals, with estimates ranging from 0.3% to 2% (1). However, this condition can cause significant discomfort and potential complications.
The exact cause of HG is not fully understood, but it is believed to arise from a complex interplay of hormonal, genetic, and environmental factors. Hormones such as human chorionic gonadotropin (hCG), estrogen, and progesterone are thought to play a role in the development of HG. Additionally, having a family history of HG increases the likelihood of experiencing the condition (1).
One theory states that the involvement of the central nervous system (CNS) in the response to emetic stimuli is a key aspect of HG. Animal studies have shown a complex reflex arc involving specific brain regions and neurohormonal receptors that respond to emetogenic substances. Abnormal EEG findings have also been observed in some women with HG, indicating possible cerebral cortical involvement(2).
Elsewhere, the placenta, with its production of cytokines and hormones, is another area of interest. Studies have shown correlations between increased production of certain cytokines, elevated hormone levels, and the occurrence of HG(2).
Also, hormonal factors, including hCG, estrogen, and progesterone, have been implicated in the pathogenesis of HG. While the exact threshold values for the development of Nausea and Vomiting during Pregnancy (NVP) have not been established, their levels and proportions have been associated with HG(2).
Finally, gastrointestinal factors may contribute to the development of HG, as women with HG often experience relief from vomiting when they abstain from eating. Psychological factors and the overactivity of the hypothalamic-pituitary-adrenal (HPA) axis have also been explored in relation to HG(2).
The implications of HG extend beyond the immediate discomfort it causes. Women experiencing HG are at risk of severe dehydration, electrolyte imbalances, and weight loss, and may require hospitalization for supportive care. The condition can significantly impact the woman’s quality of life, making it challenging to carry out daily activities, fulfill work responsibilities, and care for her family.
Hyperemesis Gravidarum – Gynecology and Obstetrics – Merck Manuals Professional Edition
Additionally, several studies have revealed that HG can have perinatal effects. One study assessed the association between HG, psychological morbidity, and infant bonding and found that women with HG experienced long-lasting psychological morbidity, with a high prevalence of probable depression during the antenatal and postnatal periods. However, HG did not directly affect infant bonding. Women with HG also required extended periods of sick leave, highlighting the socioeconomic impact of the condition(3).
Elsewhere, another study focused on perinatal outcomes of infants born to mothers with HG. Meta-analyses of multiple studies revealed that HG was associated with increased risks of preterm birth, low birth weight, neonatal resuscitation, neonatal intensive care unit admission, and placental abruption. On the other hand, HG was associated with a reduced risk of macrosomia (birth weight > 4000 g) and stillbirth. However, the underlying mechanisms behind these associations were not investigated(4).
Finally, another study examined the long-term health outcomes of children born in Atlanta to mothers with HG. Meta-analyses showed that HG was associated with an increased risk of anxiety disorders and sleep problems in offspring. There was also a potential association with testicular cancer in male offspring.
Additionally, studies reported increased rates of attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and cognitive and motor problems among children of mothers with HG. One study even found differences in brain structure, with smaller cortical volumes and areas in children from HG-affected pregnancies. However, findings on anthropometry and cardiometabolic disease risk were inconsistent(5).
Overall, HG can have a significant impact on the psychological well-being of women, leading to long-lasting psychological morbidity. It is also associated with adverse perinatal outcomes, such as preterm birth and low birth weight. Offspring of mothers with HG may face an increased risk of neurodevelopmental disorders, mental health disorders, and possibly testicular cancer. However, further research is needed to better understand the underlying mechanisms and establish the long-term effects of HG on offspring health. Therefore, this calls for effective intervention that will not only relieve the symptoms but also act prophylactically.
Mechanism of action of acupuncture in treating morning sickness
Acupuncture is a treatment in Atlanta modality that has shown promise in alleviating symptoms of hyperemesis gravidarum (HG), a condition characterized by persistent nausea and vomiting during pregnancy. While the exact mechanisms underlying the effectiveness of acupuncture in HG are not yet fully understood, several proposed mechanisms have been studied in both animal models and human trials.
One possible mechanism is the stimulation of endorphin release through acupuncture. Endorphins are natural pain-relieving substances produced by the body, and they are known to have anti-nausea and anti-vomiting effects. Acupuncture may stimulate the release of endorphins, which can help reduce the severity and frequency of nausea and vomiting in individuals with HG. Animal studies have shown that acupuncture can increase endorphin levels in the brain, supporting this proposed mechanism(6).
Another suggested mechanism involves the regulation of the autonomic nervous system by acupuncture. The autonomic nervous system controls various involuntary functions, including digestion. By targeting specific acupuncture points, acupuncture may influence the autonomic nervous system, leading to improved regulation of digestive processes and a reduction in nausea and vomiting(7).
The gut microbiome has also been implicated in the pathophysiology of HG, and acupuncture may influence its balance. Research has shown that acupuncture can modulate the gut microbiome, the community of bacteria that reside in the gastrointestinal tract. By promoting a healthier balance of gut bacteria, acupuncture may contribute to a decrease in symptoms associated with HG(8).
It is more likely that acupuncture works through a combination of these mechanisms, rather than a single pathway. Studies in both animal and human subjects have provided supporting evidence for these proposed mechanisms though this area would benefit from more research.
Effectiveness of acupuncture for morning sickness
In terms of effectiveness, acupuncture and acupressure have been investigated as potential therapeutic approaches for managing hyperemesis gravidarum (HG). In recent years, several systematic reviews and meta-analyses have shed light on the clinical efficacy of these interventions. Here, we summarize the key findings and implications of three relevant studies, providing a comprehensive perspective on the effectiveness of acupuncture and acupressure in treating HG.
The first study, conducted by Lu et al. (2021), aimed to evaluate the clinical efficacy of acupuncture in treating HG. Through a comprehensive search of various databases, they included a total of 16 randomized controlled trials involving 1043 pregnant women with HG. The meta-analysis demonstrated that acupuncture was associated with a significantly higher effective rate compared to conventional treatment. Acupuncture also showed positive effects on urine ketone conversion rate, improvement of nausea and vomiting, and food intake. Additionally, acupuncture was associated with shorter hospitalization times, lower pregnancy termination rates, and fewer adverse events. Overall, these studies demonstrated that acupuncture and acupressure are much more effective in treating HG(9).
In another network meta-analysis by Sridharan and Sivaramakrishnan (2018), a variety of interventions for treating HG were compared. The analysis included 20 studies and demonstrated that acupuncture and acupressure were associated with better control of HG symptoms compared to the standard of care. Specifically, acupuncture and acupressure showed superior therapeutic benefits compared to other interventions. These findings were consistent with other studies and affirmed that indeed acupuncture was more effective in treating HG than standard care(10).
Finally, Tara et al. (2020) conducted a randomized controlled trial specifically investigating the efficacy of acupressure on the severity of nausea, vomiting, and retching in pregnant women. The study included 90 participants and compared PC6 acupoint pressure stimulation, sham acupressure, and medication with vitamin B6 and metoclopramide. The results indicated that PC6 acupoint pressure significantly reduced the severity of nausea, vomiting, and retching compared to the other two groups. Therefore, this evidence leads us to one conclusion- that acupoint pressure is superior to routine HG treatment(11).
Collectively, these studies provide valuable insights into the potential effectiveness of acupuncture and acupressure in the management of HG. They highlight the positive effects of these interventions on symptom control, urine ketone conversion, food intake, and overall well-being. However, it is important to acknowledge there might be limitations of the current evidence, such as publication bias, lower quality studies, and the need for further research to establish the safety and long-term effectiveness of these interventions.
In conclusion, acupuncture and acupressure in Atlanta show promise as adjunctive therapies for HG. While the available evidence suggests their potential benefits, additional well-designed randomized controlled trials are warranted to provide more robust and reliable conclusions. These studies will help refine our understanding of the mechanisms underlying the effectiveness of acupuncture and acupressure and guide their implementation as safe and effective treatment options for pregnant women suffering from HG.
Adverse effects of acupuncture for morning sickness
Understanding the potential adverse effects of acupuncture is crucial for ensuring patient safety and making informed decisions regarding its use as a treatment for morning sickness, specifically hyperemesis gravidarum (HG). Though specific side effects as pertains to the specific treatment of HG are not well researched, there are studies on general side effects of acupuncture.
Several studies have investigated the adverse effects of acupuncture and reported relatively low rates of negative reactions. In a study examining short-term reactions and adverse events, researchers found that adverse events associated with acupuncture treatment were infrequent, and no significant adverse events were reported(12, 13). Another study involving routine acupuncture treatment observed adverse effects in 11.4% of the treatments, which included slight bleeding, hematoma, dizziness, and other systemic symptoms.
However, it is important to note that these adverse effects were generally mild and transient(14). Another study investigating adverse reactions associated with acupuncture reported mild and transient systemic reactions such as tiredness, drowsiness, aggravation of preexisting symptoms, and localized reactions like minor bleeding and pain on insertion. Severe adverse events were rare in standard practice(15).
The most commonly reported adverse events in the reviewed studies were minor bleeding, hematoma, tiredness, dizziness, and localized discomfort. These side effects were generally mild, transient, and infrequent. Severe adverse events, such as pneumothorax or infection, were rare occurrences. It is crucial to emphasize that these studies were conducted by trained practitioners who followed established safety guidelines, contributing to the minimization of adverse events.
The findings highlight the significance of practitioners adhering to safety guidelines and receiving appropriate training in acupuncture techniques. By following established safety guidelines and receiving comprehensive training, practitioners can further minimize the risk of adverse events associated with acupuncture. Consequently, acupuncture can be considered a safe therapeutic option for the management of morning sickness, particularly when administered by well-trained practitioners who prioritize patient safety.
Based on the available evidence, acupuncture has shown a favourable safety profile for the treatment of morning sickness, including HG. The reported adverse events are generally mild, transient, and infrequent. Common side effects include minor bleeding, hematoma, tiredness, dizziness, and localized discomfort. Severe adverse events are rare when practitioners adhere to safety guidelines and receive appropriate training. Patients and practitioners need to have open discussions about the potential adverse effects of acupuncture, enabling informed decision-making and promoting safe and effective treatment.
In conclusion, acupuncture shows promise as a safe and effective treatment for morning sickness, specifically hyperemesis gravidarum (HG). Overwhelming evidence has been found to support that acupuncture indeed reduces the severity of nausea and vomiting and improves symptoms such as urine ketone conversion and food intake in pregnant patients at risk of developing HG. Additionally, adverse events associated with acupuncture are generally mild, transient, and infrequent, with common side effects including minor bleeding, hematoma, tiredness, dizziness, and localized discomfort which are minute compared to the benefits that acupuncture provides. What is more, is that when practitioners follow safety guidelines and receive appropriate training the risk of adverse events can be minimized.
Further high-quality research is needed to establish the long-term effectiveness and safety of acupuncture in HG but overall, acupuncture offers a potentially beneficial option for managing morning sickness when administered by well-trained practitioners. Book your appointment today.
- Jennings LK, Mahdy H. Hyperemesis Gravidarum. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Heba Mahdy declares no relevant financial relationships with ineligible companies.: StatPearls Publishing
Copyright © 2023, StatPearls Publishing LLC.; 2023.
- Sanu O, Lamont RF. Hyperemesis gravidarum: pathogenesis and the use of antiemetic agents. Expert opinion on pharmacotherapy. 2011;12(5):737-48.
- Mitchell-Jones N, Lawson K, Bobdiwala S, Farren JA, Tobias A, Bourne T, et al. Association between hyperemesis gravidarum and psychological symptoms, psychosocial outcomes and infant bonding: a two-point prospective case-control multicentre survey study in an inner city setting. BMJ open. 2020;10(10):e039715.
- Jansen LAW, Nijsten K, Limpens J, van Eekelen R, Koot MH, Grooten IJ, et al. Perinatal outcomes of infants born to mothers with hyperemesis gravidarum: A systematic review and meta-analysis. European Journal of obstetrics, gynecology, and reproductive biology. 2023;284:30-51.
- Nijsten K, Jansen LAW, Limpens J, Finken MJJ, Koot MH, Grooten IJ, et al. Long-term health outcomes of children born to mothers with hyperemesis gravidarum: a systematic review and meta-analysis. American journal of obstetrics and gynecology. 2022;227(3):414-29.e17.
- Han JS. Acupuncture and endorphins. Neuroscience letters. 2004;361(1-3):258-61.
- Shin HH, Choi W-S, Yoo J, Kwon KM, Kim MS, Kim SJ, et al. Effect of Magnetic Acupuncture Attachment on PC6 (Neiguan) on Autonomic Nervous System. 2018;8(4):499-503.
- Li X, Liu S, Liu H, Zhu JjJTAR. Acupuncture for gastrointestinal diseases. 2022.
- Lu H, Zheng C, Zhong Y, Cheng L, Zhou Y. Effectiveness of Acupuncture in the Treatment of Hyperemesis Gravidarum: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM. 2021;2021:2731446.
- Sridharan K, Sivaramakrishnan G. Interventions for treating hyperemesis gravidarum: a network meta-analysis of randomized clinical trials. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2020;33(8):1405-11.
- Tara F, Bahrami-Taghanaki H, Amini Ghalandarabad M, Zand-Kargar Z, Azizi H, Esmaily H, et al. The Effect of Acupressure on the Severity of Nausea, Vomiting, and Retching in Pregnant Women: A Randomized Controlled Trial. Complementary medicine research. 2020;27(4):252-9.
- Enblom A, Johnsson A. Type and frequency of side effects during PC6 acupuncture: observations from therapists and patients participating in clinical efficacy trials of acupuncture. Acupuncture in medicine : journal of the British Medical Acupuncture Society. 2017;35(6):421-9.
- Park SU, Ko CN, Bae HS, Jung WS, Moon SK, Cho KH, et al. Short-term reactions to acupuncture treatment and adverse events following acupuncture: a cross-sectional survey of patient reports in Korea. Journal of alternative and complementary medicine (New York, NY). 2009;15(12):1275-83.
- Ernst G, Strzyz H, Hagmeister H. Incidence of adverse effects during acupuncture therapy-a multicentre survey. Complementary therapies in medicine. 2003;11(2):93-7.
- Yamashita H, Tsukayama H, Hori N, Kimura T, Tanno Y. Incidence of adverse reactions associated with acupuncture. Journal of alternative and complementary medicine (New York, NY). 2000;6(4):345-50.