Ginger in Nausea and Vomiting of Pregnancy: A Meta-Analysis

Abstract
Nausea and vomiting of pregnancy (NVP) or morning sickness is one of the
most common complaints of pregnant women.

Persistent and severe nausea and

vomiting can lead to feelings of anxiety and worry about the negative impact it can bring
to the fetus.

Ginger (Zingiber officinale), being a common food condiment and

beverage, is widely available in our country. It has several effects on the gastrointestinal
tract, including antiemetic properties. Despite the many studies using ginger for
treatment of NVP, there is no agreed upon treatment for NVP here in the Philippines.
This meta-analysis showed that ginger was better than placebo in reducing the severity
of nausea and frequency of vomiting episodes. The risk of no relief from nausea and
vomiting using ginger was only 0.29 (95% CI 0.17, 0.50, p < 0.001). Furthermore, this
paper has shown that the risk of cumulative side effects was only 0.32 (95% CI, 0.21,
0.47, p < 0.001), clearly favoring the ginger treatment arm. One study has reported that
fetal outcomes are within the normal range in the ginger group.

Therefore, this meta-

analysis has shown that ginger may be used as an alternative choice of treatment for the
management of the aforementioned symptoms.

KEYWORDS: nausea, vomiting, pregnancy, hyperemesis gravidarum, ginger, Zingiber

officinale, meta-analysis

Introduction

Nausea and vomiting of pregnancy (NVP), more commonly known as morning

sickness, is one of the most common complaints of pregnant women. Symptoms
usually begin between the fourth and sixth week of pregnancy and improve by the 15th to
20th week of gestation. The nausea of pregnancy ranges from mild and disturbing to
severe and unremitting, with associated severe vomiting, dehydration, and weight loss.1
Hyperemesis gravidarum is defined as severe nausea and vomiting that cause weight
loss greater than 5% of pre-pregnancy weight with associated electrolyte imbalance and
ketonuria.2 These noxious symptoms may lead to depression, poor nutrition,
absenteeism, and hospitalization.1 Failure to treat these derangements promptly may
lead to renal and hepatic damage.

The etiology of NVP is poorly understood. Several hormones were suggested to be

the cause of NVP and hyperemesis gravidarum. Among these are human chorionic
gonadotropin (hCG), and elevated estrogen. However, the roles of hCG and estrogen
remain controversial.

Many pregnant women with hyperemesis have suppressed

thyrotropin-stimulating hormone (TSH) levels.

Interaction of hCG and TSH in

pregnant women is still under investigation.3 Gastrointestinal tract dysfunction was

also thought to be a cause of NVP. Delayed gastric motility due to progesterone has
been shown to be a potential cause, including abnormalities of gastric electrical rhythm
(gastric dysrhythmias).

A recent study suggested that chronic infection with

Helicobacter pylori may play a role in hyperemesis gravidarum. In this study, 61.8% of

pregnant women with hyperemesis were found to be positive for the H. pylori genome,
compared with 27.6% of pregnant women without hyperemesis.3

The physical and emotional impact of NVP often results in anxiety and concern
about possible fetal effects. NVP negatively impacts family relationships and has major
consequences on the pregnant womans working capabilities.4

Early recognition and

management of NVP prevents progression to hyperemesis gravidarum and improve the

quality of life during pregnancy. Women often try numerous strategies to alleviate
symptoms such as eating small, frequent meals consisting of bland and non-fatty foods.
An alternative to treatment is ginger supplementation. The latter was found to be
beneficial (level IA evidence) and is recommended in the 2002 Clinical Practice
Guidelines of the Society of Obstetricians and Gynecologists in Canada.4

Women with uncomplicated NVP had good pregnancy outcomes: fewer

miscarriages, preterm deliveries, stillbirths, intrauterine growth restriction, and
mortality.3. Hyperemesis gravidarum, on the other hand, has been associated with
increased maternal morbidity such as splenic avulsion, esophageal rupture, MalloryWeiss tears, pneumothorax, peripheral neuropathy, preeclampsia, and risks of fetal
growth restriction and mortality.3

Ginger (Zingiber officinale) is widely available in the Philippines and is a

common food condiment and beverage. Dating back 2500 years in China and India, it
has a long history of medicinal use for ailments such as headaches, nausea, rheumatism
and colds. It has several effects on the gastrointestinal tract, including spasmolytic,

carminative and absorbent properties.5 Several trials have shown that ginger may be
effective for the treatment of nausea and vomiting in the general population. Despite
the many studies using ginger for treatment of NVP, here in the Philippines, there is no
agreed upon treatment for NVP.

Ginger is a perennial plant typically growing two to four feet in height and
preferring warm, humid climates. It has narrow, glossy, bright green leaves, and its
summer flowers are yellowish green.9 Ginger has been used in several forms, e.g. tea,
preserves, syrup, and capsules.

A number of pungent constituents and active

ingredients constitute ginger. Steam distillation of powdered ginger produces ginger oil,
containing
zingiberene.

a high

proportion

of sesquiterpene

hydrocarbons,

predominantly

The major pungent compounds in ginger yielded potentially active

gingerols, which can be converted to shogaols, zingerone, and paradol. The compound
6-gingerol may be responsible for the characteristic taste of ginger. Zingerone and
shogaols are found in small amounts in fresh ginger and in larger amounts in dried or
extracted products.5

Ginger acts within the gastrointestinal tract by increasing tone

and peristalsis due to anticholinergic and antiserotonin action.10 The exact mechanism,
however, is not clearly understood.

The compounds 6-gingerol and 6-shogaol have been shown to have a number of
pharmacological activities, including antipyretic, analgesic, antitussive, and hypotensive
effects.

Ginger has also been studied for motion sickness, post-surgical and

chemotherapy-induced nausea and osteoarthritis.

Review of Related Literature

There are no evidence-based guidelines that exist for the management of NVP.
Traditionally, dietary and lifestyle changes have been the mainstay of treatment, and
there is little reason to question the assumption that dietary recommendations are safe.6
Such dietary advice consists of eating small portions of food at frequent intervals,
ingesting dry toast or crackers upon arising, and eating bland low-fat foods.7

Among the many histamine antagonists (H1 blockers), the following have been
indicated

for

nausea

and

vomiting:

buclizine,

cyclizine,

dimenhydrinate,

diphenhydramine, doxylamine, hydroxyzine, and meclizine. H1 receptor antagonists

have no human teratogenic potential. Among the anticholinergics, only dicyclomine and
scopolamine are used for treatment of nausea and vomiting in the nonpregnant
population, however, no effectiveness trials for NVP have been published. Several
dopamine

antagonists

such

as

phenothiazines,

domperidone,

droperidol,

metoclopromide and trimethobenzamide may be used to treat NVP. Anecdotal cases,

however, have associated first trimester phenothiazine use with major malformations.
Most reviews and editorials advise that antiemetic therapy be instituted only when
women are unable to maintain hydration, nutrition, or both. Metoclopramide has not
been extensively studied for the treatment of NVP, even though it was used in clinical
practice in many countries. HT3 antagonists, such as ondansetron, are the most widely
used of this class of drugs, and is considered safe for pregnancy. Corticosteroids (e.g
dexamethasone, prednisolone) may also be effective for NVP, and stemmed from the
hypothesis that severe NVP may result from ACTH deficiency.6

Evidence from controlled trials has shown that all of the following are safe and
effective for treatment of varying degrees of NVP: bendectin/diclectin (doxylamine,
pyridoxine), antihistamine (H1 blockers), and phenothiazines. If success is not achieved
with one of these agents, then it is reasonable to switch to another. Also, many of these
agents may be used in combination (e.g antihistamines, pyridoxine, metoclopromide,
along with non-pharmacologic approaches).6

Pyridoxine (vitamin B6) has been demonstrated to be effective in trials using

doses of 30-75 mg/day. Up to 100 mg/day can be given in divided doses; however, the
most common regimen is 25 mg three times per day which is well tolerated with least
side effects. The most commonly prescribed drugs is metoclopramide (category A)
usually a dose of 10 mg 3-4 times per day as necessary. A sedating antihistamine such
as promethazine may be of benefit as an additional therapy.8

Several studies have suggested acupressure as treatment for NVP. The most
common location for acupressure is the pericardium 6 (P6) or Neiguan point, located
three fingerbreadths above the wrist on the volar surface.3

The efficacy of P6

accupressure in reducing symptoms of NVP was investigated in a 7-day study. In this

prospective, randomized, placebo-controlled study, 161 pregnant patients with NVP
received P6 acupressure, placebo or no therapy (control). Women in the treatment
group were given acupressure wristbands (Sea-Bands) and instructed to apply the bands
at the wrist.

Ninety-two and a half percent of patients who completed the study had a

significant decrease in nausea, vomiting, retching, regardless of which randomized

group they were assigned. This study suggested that the use of P6 acupressure provides

no significant medical benefit.7 Since acupressure is a nonpharmacologic intervention

with no known adverse side effects, it may also be offered to patients.
Some women with NVP and hyperemesis may become depressed or exhibit
affective changes. It is important that these women receive appropriate support from
family members and medical and nursing staff. Consultation is indicated if a pregnant
woman is depressed, domestic violence is suspected, or evidence of substance abuse or
psychiatric illness exists.

Other non-pharmacologic treatments include intravenous

fluid, enteral or parenteral nutrition.3

The 2002 Clinical Practice Guidelines of the Society of Obstetricians and

Gynecologists in Canada include alternative therapies such as ginger supplementation
as beneficial for NVP (Level IA).4 There were several studies which revealed that ginger
may be used effectively for women with NVP. Thus, there is a growing interest in the
use of ginger as an alternative treatment for NVP since it is readily available and very
inexpensive.

A randomized, cross-over, double blind study by Sontakke et al in 2003

concluded that powdered ginger root was effective in reducing nausea and vomiting
induced by low dose cyclophosphamide in combination with drugs causing mild
emesis.11

Another double-blind randomized controlled trial by Nanthakomon et al

studied the efficacy of ginger in the prevention of nausea and vomiting in 120 patients
undergoing major gynecologic surgery. This study concluded that ginger is effective in
the prevention of nausea and vomiting after major gynecologic surgery.11

In an article by Borrelli et al12 in 2005, six double-blind randomized controlled

trials using ginger on women with NVP with a

total of 675 participants and a

prospective observational cohort study (n=187) were analyzed.

Based on this study,

ginger may be an effective therapy for nausea and vomiting in pregnancy; however,
more observational studies with a larger sample size are needed to confirm the
encouraging preliminary data on ginger safety.12

A comparative study on the safety and effectiveness of ginger for treatment of

NVP was published by Portnoi et al in 2003. In this study, pregnant women taking
ginger during the first trimester of pregnancy and pregnant women exposed to nonteratogenic but not antiemetic medications were followed-up for pregnancy outcome.
Of the 187 pregnancies studied, there were 181 live births, 2 still births, 3 spontaneous
and 1 threatened abortion. There were no statistical difference in the outcomes between
the ginger group and the comparison group. The results of this study suggest that
ginger does not appear to increase the rates of major malformations.13 To date, there
have been no published reports of fetal anomalies associated with the use of ginger.
However, one investigator warned that ginger root contains thromboxane synthetase
inhibitor, which may interfere with testosterone receptor binding in the fetus. Other
investigators noted that although safety data are lacking, people in many cultures use
ginger as a spice; the amounts used are similar to those commonly prescribed for the
treatment of NVP.3

The efficacy of ginger as treatment for nausea and vomiting of pregnancy had
been discussed in detail in several randomized trials.

No pooled evidence exists

regarding its efficacy and safety in the treatment of nausea and vomiting of pregnant
women in their first trimester of pregnancy. So far, no similar on-going meta-analysis
in the local setting is currently being undertaken. Moreover, the use of ginger has not
been widely utilized here in the Philippines despite the fact that ginger is widely
cultivated here in our country.

Rationale of the Study

There is paucity of data to support or detract the claims that ginger is effective in
the treatment of nausea and vomiting of pregnancy. This review will therefore
investigate the cumulative effects of ginger as well as its safety on the treatment of
nausea and vomiting of pregnant women.

General Objective

To determine the efficacy of ginger in the treatment of nausea and vomiting

among pregnant women during the first and second trimesters of pregnancy.

Specific Objective:
1. To determine the efficacy of ginger using a meta-analysis of randomized
controlled trials
2. To measure the severity of nausea and vomiting and the number of episodes
3. To make symptom assessment using Likert scales

4. To determine the adverse effects of ginger on the pregnancy and pregnancy

outcomes

Materials and Methodology

Literature Search and Search Strategy

The Cochrane Pregnancy and Childbirth trial registry was searched for metaanalysis of studies on nausea and vomiting in pregnancy, hyperemesis gravidarum, and
ginger treatment. No articles were found. The search was expanded to MEDLINE,
EMBASE and LILACS using the keywords nausea, vomiting, pregnancy, hyperemesis
gravidarum, ginger and meta-analysis under publication type and covered the period
1966 to 2008. A search of the following journals: Philippine Journal of Obstetrics and
Gynecology, American Journal of Obstetrics and Gynecology, British Journal of
Obstetrics and Gynecology, Clinical Obstetrics and Gynecology, and Obstetrics and
Gynecology was done and cross referencing from bibliographies of relevant articles.

Ten out of one hundred and twenty potentially relevant studies screened met the
inclusion criteria and contained usable data.

The search yield and process of

elimination of studies is summarized in Figure 1. The profile of each trial is tabulated in

Table 1.

10

Methodology

A total of 10 studies were assessed. These studies were published between 1991 to
2008. The latest study reviewed was published in 2008 (study 8) while earliest was
published back in 1991 (study 1). Majority of the studies were based in Asia
predominantly Thailand (Study 2, 4,7,9) while two studies were based in Australia
(study 5,6), one study based in the United States (study 3), one in Denmark (study 1)
and one in Iran (study 8).

Duplicate copies of the 10 articles were subjected for independent assessment by

the author and 2 other co-reviewers. Disagreement between reviewers was resolved by
consensus.

A predefined data collection form was used by each reviewer to abstract each
study to assess study characteristics, particularly that of the participants, methodology,
intervention and outcomes. Method of randomization, allocation concealment, dropout
rates and intention to treat analysis was determined and recorded using the data
extraction form of the pregnancy and childbirth review groups. Data was encoded in
RevMan 4.2.10.

Peto Odds ratios was computed using the random effects model.

Heterogeneity was determined using the chi-square test and I squared test for
heterogeneity.

11

Results
Figure-1 Literature Yield
Potentially relevant studies
identified: citations or abstracts
screened for retrieval (n= 120)

Full studies retrieved for more

detailed evaluation (n= 32 )

Potentially appropriate studies to

be included in the analysis
(either quantitative meta-analysis
or qualitative) (n=17 )

Excluded due to study design (nonrandomized, non-comparative)

(n=88)

Excluded due to inability to extract

statistical estimate , unclear
randomization procedures (n=15)

No desired outcomes completely

reported (n=6)
No Intention to treat analysis (n=2)

Studies with usable information

by outcome (n= 10)

Profile of Participants and Study Design

All studies investigated the effect of ginger on pregnancy-related nausea and

vomiting although one study included subjects with hyperemesis gravidarum (Study 10).
The inclusion criteria for age of gestation varied. Four trials randomized singleton
pregnancies less than 16 weeks gestation (study 4, 6, 7 & 9), two studies were conducted
among less than 17 weeks (study 2, 8), and two more studies had it done among less
than 20 weeks (study 1,5).

12

A total sample pool of 1,041 pregnancies was included at the start of the trial.
Sample size ranged from 30 (study 1) to 291 subjects (study 6). After the clinical trial,
the sample size recorded was 966 (range from 23 to 235).

Random assignment to the ginger arm ranged from 13 to 120 while the range for
the control/placebo arm was from 10 to 115.

All were randomized double blind

controlled trials involving ginger compared to placebo (study 1,2,3,5) or vitamin B6

(study 4,6,9) or dimenhydrinate (study 7). Only one trial (study 1) was a cross-over
trial. This study was included since a clear cut wash out period for succeeding
interventions was pre-specified in the protocol and the objective assessments for relief
of nausea and vomiting were reported.

All studies mentioned adequacy of randomization by establishing sample

homogeneity at baseline in terms of age, severity of symptoms, gestational age, comorbid conditions and requirement for other medications.

Nature of Interventions

The dosage of administration of ginger either in extract, powdered or syrup form

varied and are as follows: 0.5 mg/day (study 7) ; 125 mg four times a day (study 5) ;
250 mg four times a day (study 1,2,3); 350 mg three times a day (study 6) and 500 mg
three times a day (study 4); 650 mg three times a day (study 9) and 1 gram daily (study
8), the highest dose.

13

Trial Endpoints

All trials primarily investigated the effect of ginger on nausea severity using a
visual analogue scale (VAS), nausea frequency, as well as vomiting episodes using Likert
scales ranging from a 4-point system (study 1) to a 10-point system (study 3). We
observed differences in the qualifying criteria across severity grade as established in
each trial, hence a composite assessment of the mean change in scores were not done
and could even lead to difficulty in the interpretation of the scores when statistically
combined. A more specific tool such as the Rhodes Index form was utilized in three
studies (study 5,6,9). One study investigated the change in health status using the MOS
36-item Short Form Health Survey (Study 6). In all studies, within-group comparison
of symptom scores from baseline to post-treatment date was done as well as betweengroup comparisons were made.

In all studies, authors concluded a significant drop in the symptom scores from
baseline.

Ginger was better than placebo in reducing the severity of nausea and the

frequency of vomiting episodes in all trials except for trial 5 which claimed otherwise
concerning gingers anti-emetic potential.

Only three studies reported the actual proportion of patients improving as

documented by the observed drop in post-treatment scores. (study 2,3,8).

Six studies documented the adverse effects of ginger which were predominantly
minor such as heart burn , abdominal discomfort while sedating effects were reported

14

among those who used dimenhydrinate as control. One study (1) documented changes
in maternal body weight, while one study investigated any fetal effects of ginger (study
5). The latter study claimed no adverse fetal effects compared to the general sample of
controls compared in the study.

Included Trials

Table-1 summarizes the included trials in this study, with the study design,
nature of participants, interventions, trial endpoints, results and the quality score (value
assigned to represent the validity of a study either for a specific criterion).

Table-1
General Description of Included Trials, Meta-analysis of Ginger
for Nausea & Vomiting in Pregnancy, 2008
Study
(Year)
1FisherRasmussen
(1991)

Nature of
Participants

Design
Randomized
double blind
cross-over trial

30 women
with AOG
<20 weeks
G=14,
C=13

Interventions

250 mg
ginger QID
for 4 days

Trial
Endpoints

2Vutyavanich

(2001)

Randomized
double blind
controlled trial

3Keating

(2002)

Randomized
double blind
controlled trial

70 women
with AOG
<17 weeks
G=35,C=3
5

250 mg
ginger QID
for 4 days
versus
placebo

26 women
with AOG
<12 weeks
G=13,C=1
3

250 mg
ginger QID
versus
placebo for
2 weeks

Scale for
nausea
severity and
vomiting (4point
system)
Change in
body
weight
VAS for
nausea &
vomiting, no.
of vomiting
episodes ,
adverse
effects on
pregnancy
Nausea scale
(10-point)
Vomiting
episodes

Ginger was better

than placebo in
eliminating nausea
and vomiting

Improvement in
the nausea scale
scores with 28/32
in the ginger group
and 10/35 in the
control group
(p<.001)

Nausea
improvement with
ginger (10/13)
versus 2/10 in
control
Cessation of
vomiting in 8/12 in
the ginger group
while 2/10 in the
placebo
Reduced mean

4Sripramote

Randomized

138

500 mg

Nausea

Quality
Score

Results

15

(2003)

double blind
controlled trial

women
with AOG
< 16
weeks
G=64,
C=64)

ginger
versus
10mg
vitamin B6
TID for 3
days

scores
Vomiting
frequency
Minor sideeffects

5Willets

(2003)

Randomized
double blind
placebocontrolled trial

6Smith

(2004)

Randomized
double blind
controlled trial

7Pongrojpaw

(2007)

Randomized
double blind
controlled trial

120
women
with AOG
< 20
weeks
G=60,
C=60

125 mg
ginger
extract
(equiv= to
1.5 g ) given
QI D for 4
days

291
women
with AOG
< 16
weeks
G=120,
C=115
170
women
with AOG
< 16
weeks

1.05 mg
ginger vs 75
mg vitamin
B6 daily for
3 weeks

Nausea &
vomiting
scores at day
7,14,21

0.5 mg
ginger
versus 50
mg
dimenhydri
nate for 7
days

VAS scores
for nausea
Frequency of
vomiting

Rhodes
nausea index
Birthweight,
gestational
age, APGAR
scores

8Ensiyeh

(2008)

Randomized
double blind
controlled trial

70 women
with AOG
< 17 weeks
G=35,
C=35

1gram
ginger vs
40 mg
vitamin B6
for 7 days

VAS for
severity of
nausea, no.
of vomiting
episodes

9Chittuma

(2007)

Randomized
double blind
controlled trial

126
women
with AOG
< 16
weeks
123
returned
for followup

650 mg
ginger vs 25
mg vitamin
B6 given
TID for 4
days only

Rhodes
symptom
score
including
frequencies,
duration and
episodes of
nausea
% sideeffects

change in scores
post-treatment
between ginger &
placebo but not
significant
Vomiting episodes
reduced
significantly in both
groups
Sedative effects for
ginger = 26.6% vs
32.8% ; heart
burn=9.4% vs 6.3%
Nausea scores and
retching episodes
lesser in favor for
ginger
No difference in
vomiting
Fetal outcomes
within normal
range in the ginger
group
Vomiting, retching
scores were similar
in both groups

Vomiting episodes
statistically greater
in the ginger group
vs control during
day 1-2
No significant
difference seen
during day 3-7
Drowsiness greater
in dimenhydrinate
(77.64% vs 5.88%)
Drop in VAS scores
dropped from
baseline in favor for
ginger (29/35) vs
23/34 in control
Decreased vomiting
in both groups
(non-significant
difference)
Mean change in
scores in favor for
ginger
Minor side-effects
in ginger-25.4% vs
23.8% in the
control

VAS-visual analogue scale, G-ginger, C-control, AOG age of gestation

16

Effect of Ginger on Nausea and Vomiting

Three studies reported the proportion of patients improving in terms of nausea

and vomiting severity. From three pooled studies, treatment benefit is seen. The risk of
no relief from nausea using ginger was only 0.29 (95% CI 0.17, 0.50, p<.001 , fixed
effects model).

Figure 2. Effect of Ginger on Nausea and Vomiting

17

Adverse Events of Ginger Treatment in Nausea and Vomiting in Pregnancy

The risk of cumulative side effects of ginger treatment based on three pooled
studies was only 0.32 (95% CI 0.21, 0.47, p<.001). Enumerated side effects include
sedation, heart burn and mild abdominal discomfort.

Figure 3. Adverse Events of Ginger in NVP

Discussion

Nausea and vomiting in pregnancy occur in approximately 80% of women. It can

negatively affect the quality of life of the patient making it hard to function normally
from day to day, causing anxiety and depression. Hence, its recognition and treatment
is paramount. There has been a gamut of modalities such as pharmacological and nonpharmacological approaches to abate the symptoms.

The crossover of ancient herbal medications to modern medicine has made

ginger to be widely accepted as an alternative treatment for nausea and vomiting. This
meta-analysis presented the effects of ginger on nausea and vomiting in pregnancy.

In

18

all studies except 1 (study 5), ginger was better than placebo in reducing the severity of
nausea and frequency of vomiting episodes (Figure -2). The aromatic, spasmolytic,
carminative and absorbent properties of ginger suggest that it has direct effects on the
gastrointestinal tract. Ginger acts within the gastrointestinal tract by increasing tone
and peristalsis due to anticholinergic and antiserotonin action.10 Study 5, however,
concluded that the nausea scores and retching episodes are less in the ginger arm, but
there is no difference in vomiting.

This may be attributable to the preparation of

ginger as extract rather than capsule formulation.

Herbal products are generally perceived as being natural and free of side
effects.14 However, ginger has few recorded side effects. In large doses, ginger may
increase gastric exfoliation and antiprostaglandin activity in vitro.10 Hence, another
primary endpoint of this meta-analysis is the determination of adverse events associated
with ginger treatment. From Figure 3, the risk of cumulative side effects was only 0.32
(95% CI 0.21, 0.47, p < 0.001), clearly favoring the ginger treatment arm. Pregnant
women who took ginger reported unfavorable effects which include sedation, heart
burn, and mild abdominal discomfort. Only one study (study 5) reported that fetal
outcomes are within normal range in the ginger group. The sedative effect of ginger is
not well understood.

Publication Bias

Publication bias is of concern for all systematic reviews which may lead to a false
positive overall result. This review is not without publication bias. Sources of this bias

19

may include failure to search for studies with very small effect sizes despite our
exhaustive search, studies that did not report the outcomes completely and
heterogeneity of the individual studies included.

Conclusions

Nausea and vomiting remain a considerable quandary with regard to its effect in
pregnancy. This meta-analysis presented the efficacy of ginger on the treatment of
nausea and vomiting. The antiemetic efficacy of ginger was found to be equal to that of
the control group. Hence, ginger may be used as an alternative choice of treatment for
the management of the aforementioned symptoms.

The adverse events described with use of ginger showed a very small cumulative
risk relative to the benefit that may occur from its use.

Recommendations

An update of this meta-analysis will be done accounting for the studies in which
only abstracts were included as we await full text responses from the respective authors.

20

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Koch, K.

Gastrointestinal factors in nausea and vomiting of pregnancy

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Cunningham, W et al. Williams Obstetrics 22nd ed. USA: McGraw Hill, 2005.

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Quinlan JD, Hill DA. Nausea and vomiting of pregnancy. Am Fam Physician
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Arsenault, M; Lane, CA.

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21

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