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A comparison between the effects of ginger, pyridoxine (vitamin B6) and placebo for the treatment of the first trimester nausea and vomiting of pregnancy (NVP).

Sharifzadeh F, Kashanian M, Koohpayehzadeh J, Rezaian F, Sheikhansari N, Eshraghi N. A comparison between the effects of ginger, pyridoxine (vitamin B6) and placebo for the treatment of the first trimester nausea and vomiting of pregnancy (NVP). J Matern Fetal Neonatal Med 2018;31(19), 2509-2514.

Sixty to eighty per cent of women experience nausea and vomiting of pregnancy (NVP) or morning sickness in the first half of pregnancy. Although NVP has been linked to better pregnancy outcomes, it can have significant impacts on the social and daily functioning of women, and 10% of pregnant women require medication. The cause of NVP is still unknown but the relationship between human chorionic gonadotropin (HCG) and oestrogen has been proposed and pregnant women's preferences for natural medicines have been reported. Accordingly, interest is high for natural therapies that provide relief for NVP and are safe and well tolerated. Two natural interventions previously explored include vitamin B6 and ginger. Ginger is a competitive antagonist for H3 receptors and it has clinical effect a few days after treatment for approximately 80% of women. The aim of the current study was to compare the effects of ginger to vitamin B6 and placebo for the treatment of NVP.

The study was a triple-blind random and consecutive control trial including women who were 6-16 weeks' pregnant, had mild to moderate NVP and presenting to casualty from September 2012 to January 2015 to the Akbarabadi Teaching Hospital, Tehran, Iran. Exclusion criteria included NVP needing hospitalisation, lack of acceptance of herbal medicine, gastrointestinal or other pathological disorders, or allergy to ginger or vitamin B6. Subjects were allocated to one of three groups: ginger (500 mg), B6 (40 mg) or placebo twice daily for four days. The primary endpoint was changes in the Rhodes Score at four days.

In total, 77 women completed the study (28 in the ginger group, 26 in the Vitamin B6 group and 23 in the placebo group). At the beginning of the trial, the women did not show significant difference in age, parity, gestational age, level of education or severity of symptoms. An endpoint, a statistically significant improvement, was found for both B6 and ginger compared to placebo for reducing intensity frequency and distress of nausea, vomiting and retching. In a per group analysis of change over time, ginger was more effective for reducing severity of nausea and amount of vomiting, and B6 was more effective for reducing retching and distress of vomiting. A limitation of this study was that the method of allocating participants to the intervention groups (B6, ginger and placebo) was not clearly explained. The researchers state group allocation was conducted using a mixture of consecutive assignment and randomisation. Consecutive assignment means that the confounding characteristics of the participants, such as parity, term of pregnancy, age, reproductive history were not controlled and that the outcomes may not be explained by the treatments alone.

In previous systematic reviews, ginger has been found to be an effective and safe medication to reduce the frequency and severity of nausea and vomiting in NVP. However, it is important to note that a maximum safe dose in pregnancy is not clear, and while the current and previous research indicates it is as effective as B6 in reducing symptoms of NVP, more studies are required. Future research is required to assess optimal dose for each symptom of NVP.

These abstracts are brief summaries of articles which have appeared in recent issues of herbal medicine journals, some of which may be held in the NHAA library.
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Article Details
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Author:McLean, Wendy
Publication:Australian Journal of Herbal Medicine
Article Type:Author abstract
Geographic Code:7IRAN
Date:Dec 1, 2018
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