Acupuncture, doxylamine-pyridoxine alone both reduce severe nausea, vomiting in pregnancy

Key takeaways:

• Both acupuncture and doxylamine-pyridoxine alone reduced morning sickness symptoms.
• Doxylamine-pyridoxine was associated with a higher risk small-for-gestational-age offspring compared with placebo.

Acupuncture and doxylamine-pyridoxine alone and the combination of the two were effective in reducing morning sickness symptoms during pregnancy, researchers reported in Annals of Internal Medicine.

Currently, severe nausea and vomiting of pregnancy is primarily managed with antiemetics, such as doxylamine-pyridoxine, and even hospitalization. Combining antiemetics with other treatment methods may be more effective than using each sequentially,” Xiao-Ke Wu, MD, PhD, of the department of gynecology at the First Affiliated Hospital at the Heilongjiang University of Chinese Medicine and the Centre for Reproductive Medicine at Heilongjiang Provincial Hospital, China, and colleagues wrote. “However, evidence is still lacking to properly justify the addition of acupuncture as complementary therapy in the context of antiemetics.”

Wu and colleagues conducted a multicenter, randomized, double-blind, placebo-controlled trial including 352 women in early pregnancy with moderate to severe nausea and vomiting of pregnancy from 13 tertiary hospitals in China from June 2020 to February 2022. All women were randomly assigned to daily active acupuncture for 30 minutes plus doxylamine-pyridoxine for 14 days (n = 88), sham acupuncture plus doxylamine-pyridoxine (n = 88), active acupuncture plus placebo (n = 88) or sham acupuncture plus placebo (n = 88).

The primary outcome was the reduction in Pregnancy-Unique Quantification of Emesis score on day 15. Secondary outcomes included quality of life, adverse events and maternal and perinatal complications.

Researchers observed no significant interaction in the four interventions. The mean change in Pregnancy-Unique Quantification of Emesis score was –5.7 for women who received active acupuncture plus doxylamine-pyridoxine, –5 for sham acupuncture plus doxylamine-pyridoxine, –4.7 for active acupuncture plus placebo and –4 for sham acupuncture plus placebo.

Active acupuncture (mean difference, –0.6; 95% CI, –1.1 to –0.1) and doxylamine-pyridoxine (mean difference, –1.2; 95% CI, –1.7 to –0.7) resulted in greater VAS score reductions compared with controls. Doxylamine-pyridoxine also resulted in greater reductions in nausea and vomiting of pregnancy quality of life score (mean difference, –17.4; 95% CI, –27.1 to –7.8), Zung Self-Rating Depression Scale score (mean difference, –3.5; 95% CI, –6 to –1) and Zung Self-Rating Anxiety Scale score (mean difference, –2.8; 95% CI, –5.1 to –0.4) compared with controls.

In addition, researchers observed a higher risk for births with small-for-gestational-age offspring among women who received doxylamine-pyridoxine compared with women who received placebo (OR = 3.8; 95% CI, 1-14.1).

“The combination of both treatments showed numerically larger and potentially more clinically meaningful benefit than either treatment alone,” the researchers wrote. “This finding is especially significant because there is a pressing need to establish a pregnancy-safe treatment regimen and an integrative guideline for managing severe nausea and vomiting of pregnancy.”