Drug Information Rounds

Treating Pregnancy-Related Nausea and Vomiting with Ginger

Sarah A Boone and Kelly M Shields

OBJECTIVE: To review literature assessing the safety and efficacy of the use of ginger to treat nausea and vomiting in pregnancy.

DATA SOURCES: Iowa Drug Information Service (1966–September 2004), International Pharmaceutical Abstracts (1971–September
2004), MEDLINE (1966–September 2004), and EMBASE (1966–September 2004) were searched. Key terms included ginger,
nausea, vomiting, emesis, and pregnancy.
DATA SYNTHESIS: Studies evaluating the safety and efficacy of ginger in the management of nausea and vomiting in pregnancy were
reviewed. Various doses and forms of ginger were used to treat women during their first and second trimesters of pregnancy. Ginger
has been shown to improve the symptoms of nausea and vomiting compared with placebo in pregnant women.
CONCLUSIONS: While data are insufficient to recommend ginger universally and there are concerns with product quality due to
limited regulation of dietary supplements, ginger appears to be a fairly low-risk and effective treatment for nausea and vomiting
associated with pregnancy. In low doses, this may be appropriate for patients not responding to traditional first-line therapies.
KEY WORDS: ginger, nausea and vomiting, pregnancy.

Ann Pharmacother 2005;39:1710-3.

Published Online, 30 Aug 2005, www.theannals.com, DOI 10.1345/aph.1G086

REQUEST iron supplements. If these nonpharmacologic approaches

Is ginger safe and effective in treating pregnancy-related do not alleviate symptoms, other options, including multi-
nausea and vomiting? vitamins, vitamin B6, doxylamine, ginger, antihistamines,
anticholinergics, and corticosteroids, may be tried.4 Many
RESPONSE patients prefer to avoid “drugs” during pregnancy, choos-
ing instead “natural” alternatives. One of these popular op-
BACKGROUND
tions is ginger. The efficacy and safety of this product is
Nausea with or without emesis is one of the most com- still in question, and it is classified as pregnancy category
mon complaints in early pregnancy. It is estimated that up C.5 Ginger root is commonly used as a flavoring agent in
to 80% of women experience some degree of nausea in the food and beverages and as a fragrance additive in cosmetic
first trimester (usually between 8 and 12 wk gestation). products. The antiemetic constituents of ginger exert their
Approximately 20% of women will continue to experience effects in the gastrointestinal tract, but the specific mecha-
symptoms past the 20th week.1,2 Hyperemesis gravidarum nism is unknown. In vitro, it has been shown to have some
is generally defined as severe nausea and vomiting charac- ability to antagonize serotonin 5-HT3 receptors.6
terized by dehydration and electrolyte disturbances that re- While ginger is commonly recommended for pregnant
quire hospitalization. This condition occurs in <1% of women by health food store employees7 and does appear
pregnancies and is often confused with severe nausea and to be well tolerated in doses up to 5 g, there are some con-
vomiting of pregnancy. Women with the former condition cerns. Adverse effects are uncommon, but may include
cannot tolerate oral therapy, while those with the latter gastrointestinal upset, heartburn, diarrhea, and mouth/
condition can.1-3 throat irritation. Drug interactions appear rare with this
Treatment options for nausea and vomiting of pregnan- product. There are many theoretical interactions with gin-
cy are limited because of concerns about safety. Initially, ger, but only one case report of increased anticoagulation
treatment consists of identifying and avoiding nausea trig- with phenprocoumon has been published. Follow-up stud-
gers, avoidance of spicy and fatty foods, and cessation of ies have not shown ginger to have a clinically significant
impact on warfarin concentrations. Excessive doses of gin-
ger may affect the action of antidiabetic drugs in some pa-
Author information provided at the end of the text. tients.6,8

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 Dietary supplements and herbal products are not regu- 10 = worst) was used to evaluate the degree of nausea and
lated as drugs by the Food and Drug Administration impairment of daily functioning. Ten subjects in the ginger
(FDA). They are legislated under the Dietary Supplement group and 2 in the placebo group experienced at least a 4-
Health and Education Act, and this legislation does not point improvement in the nausea scale following treat-
currently have enforced principles of good manufacturing ment. By day 6 of the study, 8 women in the ginger group
practices. Contamination with prescription medications, and 2 in the placebo group had stopped vomiting.
heavy metals, and pesticides is a concern with many sup- The researchers did not perform statistical analysis of
plements, and the concern is amplified in the population of the data because of small study size. All study participants
pregnant women. delivered with no complications. Taste was a confounder
The relatively good safety profile of ginger and possible in this trial since the placebo was flavored with lemon oil,
efficacy have led researchers to evaluate the role of ginger making blinding difficult. The sample size was small due
in the management of pregnancy-induced nausea and vomit- to the difficulty in enrolling participants. Although all of
ing. A literature search was performed using Iowa Drug In- the women were <12 weeks’ pregnant, no follow-up was
formation Service (1966–September 2004), International performed to assess possible teratogenicity.9
Pharmaceutical Abstracts (1971–September 2004), EM- The effectiveness of ginger for nausea and vomiting in
BASE (1966–September 2004), and MEDLINE (1966– pregnancy was evaluated in another double-blind, placebo-
September 2004). Text search terms included ginger, nau- controlled, randomized trial.10 Seventy (32 ginger, 38 con-
sea, vomiting, emesis, and pregnancy, and results were re- trol) women in varying stages of pregnancy who experi-
stricted to articles published in English. Seven articles were enced nausea with or without vomiting were instructed to
located for review, and all were utilized for this article. take 1 capsule (250 mg of ginger or placebo) 4 times a day
for 4 days. Subjects rated their nausea both on a 10-cen-
LITERATURE REVIEW timeter visual analog scale (0 = no nausea, 10 = worst nau-
sea) and a 5-item Likert scale (much worse to much better)
A prospective cohort study was performed to evaluate twice a day. Women were also asked to record vomiting
pregnancy outcomes in women who used ginger during episodes before and during treatment.
the first trimester of their pregnancy.1 There were 187 Visual analog scores for the ginger group experienced
women enrolled in both the ginger and no-exposure groups significantly more improvement 2.1 ± 1.9 from baseline
(N = 374). Women reporting any amount of ginger expo- versus 0.9 ± 2.2 (mean ± SD) for the placebo group (p =
sure were questioned as to type of ginger, dosage, timing 0.014). Twenty women in the ginger group and one in the
of exposure, and duration of use. All participants were placebo group rated nausea “much better” on the Likert
asked about demographics and obstetric history. Follow-up scale. In addition, 9 subjects in the placebo group and none
was performed no later than 12 months after birth or termi- in the ginger group reported nausea as worse on the scale
nation of pregnancy. (p < 0.001). Significantly fewer women in the ginger
There were no statistical differences between the ginger group reported vomiting than in the placebo group (12 vs
and control groups when comparing number of stillbirths 23, respectively; p = 0.021) after 4 days. Three sponta-
(2 vs 1), spontaneous abortions (3 vs 8), major malforma- neous abortions occurred in the placebo treatment arm and
tions (3 vs 2), and mean gestational age ± SD at delivery one in the ginger group, with no congenital anomalies re-
(39 ± 2 wk in both groups). There were 12 infants in the ported for either group. While the study was generally well
control group with low birth weight (<2500 g) compared conducted, the ginger capsules were not tested to deter-
with 3 in the ginger group (p = 0.033). The investigators mine exact composition of the preparation used. The study
determined that using ginger during the first trimester of period (4 days) may have been too short to show full ef-
pregnancy does not appear to increase the risk of serious fect, but due to the short treatment period, there was good
adverse effects on the fetus.1 adherence (>77% for both groups).10
As with all prospective studies, there was no control A double-blind, placebo-controlled, randomized trial in-
over many of the variables (eg, product used, duration, cluding 120 women evaluated the effectiveness of ginger
counseling), so the evidence is not conclusive. There was a in treating nausea in pregnancy.11 Women were required to
higher rate of twins born in the ginger group (8/187 com- be <20 weeks’ pregnant. Sixty women received capsules
pared with the population average of 1/80), which may be containing 125 mg of ginger or placebo 4 times a day for 4
due to the more severe nausea generally associated with days. The Rhodes Index of Nausea, Vomiting, and Retch-
multiple-fetus pregnancy.1 ing (a 5-point scale ranging from 0 to 12, with a higher
A double-blind, placebo-controlled, randomized trial score indicating more symptoms) was completed one hour
was performed to evaluate the efficacy of ginger syrup as after each dose. There was an almost equal reduction in
an antiemetic in the first trimester of pregnancy.9 Twenty- nausea and vomiting in both groups. The ginger group had
six (14 treatment, 12 placebo) women received 1 table- significantly lower scores than the placebo group for retch-
spoon of syrup containing 250 mg of ginger or placebo 4 ing on the first 2 days only (values not given; p = 0.05).
times a day for 2 weeks. Subjects recorded doses taken, Follow-up indicated there were 3 spontaneous abortions
number of vomiting episodes, degree of nausea, and per- in the ginger treatment arm and 1 in the placebo group,
spective of daily functioning. A 10-point scale (1 = best, with no congenital anomalies reported for either group.

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SA Boone and KM Shields

The rates of birth defects from the combined study partici- received either 250 mg of ginger or placebo 4 times a day
pants were no greater than in the average population, al- for 4 days, then switched after a 2-day washout period. A
though since organogenesis occurs before 12 weeks of scoring system was created that assigned numerical values
gestation, the inclusion of women with more advanced to changes in nausea and vomiting and the patient’s opin-
pregnancies could have impacted the accuracy of the re- ion about the treatment. Negative numbers were given for
sults. The authors reported significant reductions in nausea worsening symptoms, zero was utilized for no change, and
scores in both groups.11 positive numbers were given for improvement of symp-
The efficacy of ginger was compared with that of vita- toms. The mean relief from symptom values was signifi-
min B6 in treating pregnancy-related nausea and vomit- cant with 3.9 for the ginger period and 0.4 for the placebo
ing.12 This double-blind, randomized, non-inferiority trial period (p = 0.035). When women were asked which treat-
enrolled 291 (146 ginger, 145 vitamin B6) women. The ment they preferred, 19 (70.4%) chose the ginger treatment,
participants received one capsule of either ginger 350 mg 4 (14.8%) preferred the placebo treatment, and 4 (14.8%) in-
or vitamin B6 25 mg 3 times a day for 3 weeks. The dicated no preference (p = 0.003). One miscarriage and no
Rhodes Index of Nausea, Vomiting, and Retching and the deformities or other birth complications were reported.
Medical Outcomes Study 36 short-form health survey (an While the authors of this study intended to investigate
8-multi-item scale, with higher scores indicating a better women with hyperemesis gravidarum, their use of oral
outcome) were used to assess efficacy. Ginger and vitamin therapy indicates that the patients were experiencing severe
B6 showed equivalent reduction in symptoms of nausea nausea and vomiting, not hyperemesis. Limitations of this
(3.6 vs 3.9), vomiting (0.9 vs 1.4), and retching (0.5 vs study include the lack of standardized ginger therapy, an in-
0.7). For both groups, there was overall improvement in appropriately defined population, and a small sample size.3
health status, but vitamin B6 was superior to ginger in 6 of
8 items on the Medical Outcomes Study 36. SUMMARY
There were 9 spontaneous abortions and 3 stillbirths in
There is evidence suggesting that ginger is effective in
the vitamin B6 group and 3 spontaneous abortions and no
reducing nausea and vomiting experienced during preg-
stillbirths in the ginger group. There were no significant
nancy. The studies used divided doses ranging between
differences in the number of congenital abnormalities be-
500 and 1500 mg/day, with no higher incidence of birth
tween groups. During this trial, the women were allowed
defects, miscarriages, or deformities than in the general
to continue any medications other than vitamin B6 and gin-
population. While most of the studies concluded that there
ger, which could have affected the results.
was no increased risk of birth defects in women taking gin-
Another double-blind, randomized trial comparing gin-
ger, the inclusion of those >12 weeks’ gestation means that
ger and vitamin B6 enrolled 128 (64 in each group) women
their data are, in reality, inconclusive.
at or before 16 weeks of pregnancy.13 The subjects re-
Without more stringent product quality regulations and
ceived either 500-mg ginger capsules or 10-mg vitamin B6
large-scale trials confirming safety and efficacy, ginger
capsules 3 times a day for 3 days. A 10-centimeter visual
should not be universally recommended. Patients should
analog scale (0 = no nausea, 10 = worst nausea possible)
be counseled regarding the limits of the currently available
was used to grade nausea before the first capsule was taken
literature. However, current data do indicate that ginger is
and 3 times a day during the study period, and the number
low risk and probably effective in the management of nau-
of daily vomiting episodes was recorded. The mean im-
sea and vomiting in the first trimester of pregnancy and
provement in nausea scores ± SD, compared with baseline,
may be a good option for patients not responding to non-
was 1.4 ± 2.22 in the ginger group (p < 0.001) and 2.0 ±
pharmacologic interventions.
2.19 in the vitamin B6 group (p < 0.001). Mean reduction
in number of vomiting episodes, compared with baseline,
Sarah A Boone, PharmD Student, Raabe College of Pharmacy,
was 0.7 ± 2.18 in the ginger group (p = 0.003) and 0.5 ± Ohio Northern University, Ada, OH
1.44 in the vitamin B6 group (p = 0.008). The total number Kelly M Shields PharmD, Assistant Professor of Pharmacy Prac-
of women vomiting was less in the ginger group than in tice, Department of Pharmacy Practice, Raabe College of Pharma-
the vitamin B6 group (28 and 38 respectively; p = 0.146). cy, Ohio Northern University
Since the authors did not follow the women after deliv- Reprints: Dr. Shields, Department of Pharmacy Practice, Raabe
College of Pharmacy, Ohio Northern University, Ada, OH 45810-
ery, it is not possible to assess the safety of ginger based on 1078, fax 419/772-2289, k-shields@onu.edu
these trial results; however, there did not appear to be dif-
ferences between groups in tolerability and adverse effect References
profile. The lack of comparison between the ginger and vi-
tamin B6 groups does not account for the possibility of the 1. Portnoi G, Chng L, Karimi-Tabesh L, Koren G, Tan M, Einarson A.
Prospective comparative study of the safety and effectiveness of ginger
placebo effect. Additionally, ginger was not standardized for the treatment of nausea and vomiting in pregnancy. Am J Obstet Gy-
and chemical composition was not tested.13 necol 2003;189:1374-7. Erratum 2004;190:1140
Women presenting with hyperemesis gravidarum before 2. Quinlan J, Hill D. Nausea and vomiting of pregnancy. Am Fam Physi-
their twentieth week of pregnancy were enrolled in a dou- cian 2003;68:121-8.
3. Fischer-Rasmussen W, Kjaer S, Dahl C, Asping U. Ginger treatment of
ble-blind, randomized, crossover trial comparing ginger hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 1990;38:
with lactose placebo.3 Thirty women were hospitalized and 19-24.

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 Treating Pregnancy-Related Nausea and Vomiting with Ginger

4. Niebyl J, Goodwin T. Overview of nausea and vomiting of pregnancy utilizaron varias dosis y formas de jengibre para tratar mujeres en su
with an emphasis on vitamins and ginger. Am J Obstet Gynecol 2002; primer y segundo trimestre del embarazo. Se ha demostrado que el
186(suppl):253-5. jengibre mejora los síntomas de náuseas y vómitos en comparación con
5. Briggs G, Freeman R, Yaffe S. Drugs in pregnancy and lactation. 6th ed. el placebo en mujeres embarazadas.
Philadelphia: Lippincott Williams & Wilkins, 2002.
CONCLUSIONES: A pesar de no haber datos suficientes para recomendar
6. Therapeutic Research Facility. Natural Medicines Comprehensive siempre el jengibre y de que existe una preocupación en cuanto a la
Database. Stockton, CA: Therapeutic Research Facility (US), 1995.
calidad de los productos debido a la poca reglamentación de los
www.naturaldatabase.com (accessed 2005 Aug 18).
suplementos dietéticos, el jengibre parece ser un tratamiento de poco
7. Buckner KD, Chavez ML, Raney EC, Stoehr JD. Health food stores’
riesgo y eficaz para las náuseas y los vómitos del embarazo. A dosis
recommendations for nausea and migraines during pregnancy. Ann Phar-
macother 2005;39:274-9. Epub 11 Jan 2005. DOI 10.1345/aph.1E433
bajas, pudiera ser adecuado en pacientes que no responden a terapias
tradicionales de primera línea.
8. Ernst E, Pittler M. Efficacy of ginger for nausea and vomiting: a system-
atic review of randomized clinical trials. Br J Anaesth 2000;84:367-71. Rafaela Mena
9. Keting A, Chez R. Ginger syrup as an antiemetic in early pregnancy. Alt
Ther 2002;8:89-91.
10. Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting RÉSUMÉ
in pregnancy: randomized, double-masked, placebo-controlled trial. Ob- OBJECTIF: Faire le point sur la littérature publiée évaluant le sécurité et
stet Gynecol 2001;97:577-82. l’efficacité de l’emploi de gingembre pour traiter les nausées et les
11. Willetts K, Ekangaki A, Eden J. Effect of ginger extract on pregnancy-in- vomissements de la grossesse.
duced nausea: a randomised controlled trial. Aust N Z J Obstet Gynecol
2003;43:139-44. REVUE DE LITTÉRATURE: Littérature en langue anglaise repérée par des

12. Smith C, Crowther C, Willson K, Hotham N, McMillian V. A random- recherches sur Iowa/IDIS (1966 à septembre 2004), International
ized controlled trial of ginger to treat nausea and vomiting in pregnancy. Pharmaceutical Abstracts (1971 à septembre 2004), MEDLINE (1966 à
Obstet Gynecol 2004;103:639-45. septembre 2004), et EMBASE (1966 à septembre 2004) avec les mots-
13. Sripramote M, Lekhyananda N. A randomized comparison of ginger and clés ginger, nausea, vomiting, emesis, et pregnancy.
vitamin B6 in the treatment of nausea and vomiting of pregnancy. J Med RÉSUMÉ: Les études évaluant la sécurité et l’efficacité du gingembre dans
Assoc Thai 2003;86:846-53. la prise en charge des nausées et des vomissements de la grossesse ont
été examinées. Diverses doses et présentations de gingembre ont été
employées pour traiter des femmes durant les 2 premiers trimestres de
leur grossesse. Par rapport au placebo, le gingembre s’est révélé
améliorer les symptômes de nausées et de vomissements chez les
EXTRACTO femmes enceintes.
OBJETIVO: Revisar la literatura médica publicada que evalúa la seguridad CONCLUSIONS: Bien que les données soient insuffisantes pour
y la eficacia del uso del jengibre para tratar las náuseas y los vómitos del recommander le gingembre dans tous les cas, et qu’il persiste des
embarazo. questions sur la qualité des produits en raison d’une réglementation
FUENTES DE INFORMACIÓN: Iowa/IDIS (1966–septiembre 2004), limitée des compléments alimentaires, le gingembre semble être un
International Pharmaceutical Abstracts (1971–septiembre 2004), traitement efficace et à faible risque des nausées et des vomissements de
MEDLINE (1966–septiembre 2004), y EMBASE (1966–septiembre la grossesse. A faibles doses, il est susceptible d’être approprié pour les
2004). Los términos de búsqueda incluyeron jengibre, náuseas, vómitos, patientes ne répondant pas aux traitements habituels de première
emesis, y embarazo. intention.
SÍNTESIS: Se revisaron estudios que evaluaron la seguridad y la eficacia
Bruno Edouard
del jengibre en el manejo de las náuseas y los vómitos del embarazo. Se

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