Iranian Red Crescent Medical Journal. 2013 September; 15(9): 854-61.

DOI: 10.5812/ircmj.12984
Published Online 2013 September 05. Research Article

Acupressure and Ginger to Relieve Nausea and Vomiting in Pregnancy: a

Randomized Study
1 2 3, * 4
Farzaneh Saberi , Zohreh Sadat , Masoumeh Abedzadeh-Kalahroudi , Mahboobeh Taebi
1 Department of Midwifery, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
2 Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
3 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
4 Department of Midwifery, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran

*Corresponding author: Masoumeh Abedzadeh-Kalahroudi, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3615620634Fax: +98-3615620634,
E-mail: abedzadeh@kaums.ac.ir.

Received: June 17, 2013; Revised: July 21, 2013; Accepted: August 10, 2013

Background: Nausea and vomiting of pregnancy (NVP) is the most common medical condition of pregnancy, affecting up to 85% of
expecting mothers. NVP can have serious adverse effects on the quality of a woman's life, social, and domestic functioning, and her general
well-being. Therefore, it is very important to treat this condition.
Objectives: The effectiveness of ginger and acupressure in the treatment of NVP was compared in the present study.
Patients and Methods: 159 eligible pregnant women with symptoms of mild to moderate nausea and/or vomiting before 16 weeks
gestational age participated in a 7-day clinical trial. They were divided randomly into three groups: the acupressure, ginger, and control.
Participants did not receive any intervention for three days and interventions were performed for the women in acupressure and ginger
groups for four days. No intervention was performed for the control group. Data was collected by self-recorded symptoms according to
the Rhodes index. Data was analyzed by ANOVA, Kruskal-Wallis, Chi-square, and Fisher exact tests for quantitative and qualitative variables.
Results: There were no statistical differences in the baseline demographics between the three groups. ANOVA test showed that there were
significantly differences in mean difference Rhodes index scores (vomiting, nausea, retching and total score) in the three groups (P <
0.001).
Conclusions: Ginger is more effective than acupressure to relieve mild to moderate nausea and vomiting in symptomatic pregnant
women in less than 16 weeks of gestational age.

Keywords: Ginger; Acupressure; Nausea; Vomiting; Pregnancy

1. Background
Nausea and vomiting of pregnancy (NVP) is the most hospitalization and termination of pregnancy (8, 9). NVP
common complication of pregnancy which occurs up to has adverse effects on the quality of a woman's life, social,
85% of mothers (1). This problem starts about the 4th week relationship with family, and her general health; then,
of pregnancy, and usually continues to the 16th week in a properly and effectively treatment is very important in
few mothers (2). The etiology of NVP is unknown. It oc- this condition (3, 10). It is typically treated with pharma-
curs due to hormonal, immunological, and anatomical cologic and nonpharmacologic (acupressure, acustimu-
changes, although in many studies were not accepted (3). lation, acupuncture, ginger and vitamin B6) antiemetic
NVP develops to hyperemesis gravidarum in less than 2% (11, 12). Several researches have been performed about the
of women. This complication characterized by repeated effect of ginger or acupressure on nausea and vomiting in
vomiting leading to fluid and electrolyte imbalance, nu- pregnancy in Iran (13-16). In addition, surveys have shown
trition deficiency, and a weight loss of more than 5% of the that some herbal products were recommended to treat
prepregnancy weight, often leading to hospitalization NVP by midwives (17). Ginger is an herb which its rhizome
(4). Women with hyperemesis in first pregnancy have a is used as spice and medicine. It can be used fresh, dried
high risk for recurrence in next pregnancy (5). Studies and powdered, or as a juice or oil. It is commonly used to
in Iran showed that the frequency of severe nausea and treat various types of stomach problems (18). Since years
vomiting was 16% to 21.7% (6, 7). Severe NVP may lead to de- ago, ginger has been used for treating nausea and vomit-
pression, feelings of inadequacy, loss of working hours, ing in early pregnancy (13, 19). Studies have used powder

Implication for health policy/practice/research/medical education:

Midwives and obstetricians can recommend use of acupressure or ginger for relieving nausea and vomiting in pregnancy.
Copyright © 2013, Iranian Red Crescent Medical Journal; Licensee KowsarKowsar Ltd. This is an Open Access article distributed under the terms of the Creative Com-
mons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
 Saberi F et al.

or capsule forms to relieve NVP in Iran (13, 14, 20). NVP was progressing to severe (> 5 episodes per day).
Heitmann et al. in a review study reported that the risk After obtaining verbal informed consent, women un-
of congenital malformations, stillbirth / perinatal death, derwent general physical examinations and routine
preterm birth, low birth weight, or low Apgar score did obstetric evaluations. They were subsequently random-
not increase when ginger was used during pregnancy ized into three groups (ginger, acupressure and control)
(21). Therefore, a safe and effective treatment choice for using a table of random numbers.
NVP is ginger (22). The use of ginger products may be At first, the demographic form including age, age of
helpful to relieve nausea and vomiting, but the evidence marriage, gestational age, occupation, parity, wanted
of effectiveness was limited (23). or unwanted pregnancy and education was completed.
The effectiveness of acupressure at P6 point compared Women were instructed not to take any other medica-
to the placebo group in reducing NVP has been reported tions except the treatment advised by the researchers.
in various trials (24). Acupressure works on the precardi- Women were followed for 7 days. They did not receive
um 6 (P6 or Neiguan) as acupressure point on the wrist. any intervention for the first three days but interven-
This point is found by measuring, with the mother´s tions were performed for the acupressure and ginger
own finger, three fingers width up from the inner wrist groups for the next four days. All women in the three
crease where the hand joins the arm, approximately groups were instructed to go on diet during the study
where the buckle of watchstrap might rest (25). A group [split their meals into frequent small ones, rich in car-
of evidence-based medicine reviewers, reviewed the use bohydrates and low fat. Also avoiding or not to eat food
of P6 for nausea and vomiting, and resulted that it is an that may actually make nausea worse, try eating before
effective method for reliving postoperative nausea. They or as soon as you feel hungry, stop smoking, eat dry
concluded that acupressure may be a useful method for bread or cookie on awaking, avoiding fried, odorous,
the management of nausea and vomiting in a variety of spicy, greasy, or gas forming foods, maintaining good
patients, but accurate trials are needed (26). posture, drinking cold, clear, and carbonated or sour
fluids (27)].
2. Objectives The benefits, risks and effectiveness of new interven-
tion were described. We explained that the privacy of
To our knowledge, the use of ginger and acupressure
women and their personal information would be pro-
(two nonpharmacological therapies) has not been com-
tected. In addition, at the end of the study, the women
pared in a randomized clinical trial. Therefore, compari-
would be informed about the results. They were asked
son of the effectiveness of ginger and acupressure in the
to start a medication if the advised treatment failed or
treatment of nausea and vomiting in pregnancy was the
vomiting was more than 5 times per day and excluded
aim of our study.
the study.
3. Materials and Methods
All eligible women received a package containing 14
copies of Rhodes index of nausea and vomiting. In addi-
The research ethics committee of the Kashan Universi- tion, we instructed to evaluate their symptoms every 12
ty of Medical Sciences approved the study with the num- hours (twice daily for seven consecutive days). At a 7-day
ber code of 29/5/1/4406 in 06/11/2007. It was registered follow-up, women reported the severity of their symp-
in the Iranian registry of clinical trial with this number: toms by the Rhodes index form. The Rhodes index was
201103192699N4. This randomized control clinical trial expanded to eight items. Eight 5-point self-report items
was performed from 10 November 2008 to 20 Septem- measure the patient's perception of duration of nausea,
ber 2009 in antenatal clinic at Naghvi hospital, Kashan, frequency of nausea, distress from nausea, frequency
Iran. Inclusion criteria were: (1) willingness to partici- of vomiting, amount of vomiting, distress from vomit-
pate in the study, (2) having mild to moderate nausea ing, frequency of retching, and distress from retching.
and/or vomiting, (3) less than 16 weeks’ gestation, (4) This form arranges the eight items, which describes the
singleton pregnancy, (5) literate, (6) no history of other level of symptoms. The likert- type scale for each item
diseases such as gastrointestinal disorder, (7) not using was scored from zero (indicating minimal or no symp-
other methods for treatment of NVP in the past 3 weeks, tom) to four (representing the worst symptom). The
(8) able to eat the ginger capsules or place the wrist- item scores were summed for a total score with a range
bands as prescribed in the correct placement, and (9) of 0 to 32. Patients were asked to evaluate the syndrome
lived in Kashan. every 12 hours on a 5-point scale (28). The Rhodes index
Women were excluded if they were unable to return has been used for assessment of NVP in some studies in
for a follow-up visit one week later, had complications Iran (7, 29-33), and other countries (24, 34, 35). In Iranian
when using ginger or wristbands, the advised method research, its validity was confirmed by content valid-
for treatment failed to relieve nausea and vomiting, and ity, and its reliability was calculated and confirmed by

Iran Red Crescent Med J. 2013;15(9) 855

 Saberi F et al.

Cronbach's alpha (α = 0.898) (29). Also its coefficient cor- symptoms. These were indicated by mean difference
relation was high in other researches (with Cronbach Rhodes index scores between the three groups by ANOVA
alphas of 0.77 in the United Kingdom, 0.897 in the USA, test. It was calculated by mean Rhodes index scores in
and 0.929 in China) (36-38). four days after the intervention (post intervention) mi-
Each women in acupressure group was given a pair of nus in three days before the intervention (pre interven-
sea band (acupressure wristband) (Sea- Band, the U.K., tion).
Ltd., Leicester, England) and trained to use it continu- A pilot study was performed and sample size was calcu-
ously (remove only when bathing) for four days (From lated (n = 10). The mean differences Rhodes index scores
the fourth to seventh day) in the appropriate place in were 4.2 and 7.5 in acupressure and ginger groups, re-
both hands. Sea band is a buttoned elastic wristband spectively. To reject the null hypothesis of improvement
which is used to pressure on the Neiguan point. in symptoms with a power of 80% and a significance level
of 5%, sample size of 48 women per group was calculated.
Considering 10% loss in follow up, 53 women in any group
were needed. A significance level of P < 0.05 was used for
all tests.

4. Results
All women were included in the intention to treat (ITT)
analysis. From 10 November 2008 to 20 September 2009,
461 pregnant women were screened, and among them,
159 women were recruited and 302 were excluded. In gin-
ger group, one woman had heartburn when taking the
ginger capsules, one woman used medication, and one
woman did not return to clinic. In acupressure group,
one woman used other medication, two removed their
bands prior to the end of study period, and two women
did not return to clinic. In control group, five women
Figure 1. Location of Acupressure Wristband
used medication treatment, and three women did not
return to the clinic. They were excluded from the study.
Each woman in ginger group received 12 ginger cap- Finally, there were 50 women in ginger groups, 48 in
sules 250 mg (with the brand named Zintoma made in acupressure and 45 in control. Analyses were performed
Goldaroo manufacturing Pharmaceutical Company) for on 143 women (Figure 2).
4 days (during the four to seven days) and daily 3 cap- We checked normal distribution in variables. All vari-
sules. No intervention was performed for the control ables had normal distribution apart from age and age
group during 7 days. of marriage. ANOVA test was used to compare variables
The women were called twice: once in the fourth and an- with normal distribution and Kruskal-Wallis test was
other in the eighth day. On the fourth day, we answered used to compare non-normal variables in three groups.
the women's questions in three groups; also, we remind- There were no statistically significant differences in
ed the use of ginger capsules and wristbands in the in- the baseline characteristics between the three groups
tervention groups. On the eighth day, we thanked the (Table 1).
women for their participation in this study and request- We compared the mean difference Rhodes index
ed to hand over the Rhodes forms for evaluation of their scores between the three groups. The mean difference
responses to the advised methods of treatment. NVP was Rhodes index scores calculated by mean Rhodes index
evaluated by the Rhodes index score. scores in pre intervention (three days before interven-
Data was analyzed by SPSS software version 14. In the tion) minus mean Rhodes index scores in post interven-
descriptive analysis were represented as means and stan- tion (four days after intervention). It was significantly
dard deviation, while the categorical variables were rep- greater in ginger group than acupressure and control
resented as frequency and percentages. ANOVA, Kruskal- groups. ANOVA test showed that there were significant
Wallis, Chi-square and Fisher exact tests were used for differences in the mean differences in vomiting, nau-
quantitative and qualitative variables. sea, retching and total scores between the three groups
The hypothesis tested whether ginger and acupressure (P<0.001). These results were presented by error bar
were different in reduce nausea, vomiting and retching plot in Figure 3.

856 Iran Red Crescent Med J. 2013;15(9)

 Saberi F et al.

Figure 2. Trial Profile of Recruitment and Randomization to Acupressure, Ginger or Control Groups

Table 1. Baseline Characteristics of the Patientsa

Characteristics Acupressure (n = 53) ginger (n = 53) control (n = 53) P-value
Age (years) 25.68 ± 4.64 26.64 ± 6.18 25.79 ± 3.64 NSb(0.531)
Age of marriage 19.75 ± 1.96 18.66 ± 4.41 19.39 ± 1.93 NSb(0.063)
Gestational age (weeks) 9.32 ± 2.38 8.78 ± 2.32 9.11 ± 0.18 NSc(0.441)
Occupation NSd(0.479)
Housewife 51 (96.2) 50 (94.3) 48 (90.6)
Employee 2 (3.8) 3 (5.7) 5 (9.4)
Parity NSe(0.187)
Nulliparous 33 (62.3) 26 (49.1) 24 (45.3)
Multiparous 20 (37.7) 27 (50.9) 29 (54.7)
Pregnancy NSe(0.288)
wanted 50 (94.3) 45 (84.9) 47 (88.7)
Unwanted 3 (5.7) 8 (15.1) 6 (11.3)
Education NSe(0.557)
Less than high school 20 (37.7) 15 (28.3) 19 (35.8)
High school or more 33 (62.3) 38 (71.7) 34 (64.2)
a Data are presented as mean ± SD or No., (%)
b Kruskal-Wallis test was used
c ANOVA test was used
d Fisher exact test was used
e Chi-squared test was used

Iran Red Crescent Med J. 2013;15(9) 857

 Saberi F et al.

Figure 3. Comparing the Mean Difference Rhodes Index Scores of Vomiting (A), Nausea (B), Retching (C), and Total (D) between the Three Groups

Paired t-test was also used to compare the mean pre intervention in ginger and acupressure groups. No sig-
and post intervention scores. Results indicated that there nificant differences were found apart from vomiting in
were significant differences in the mean pre and post control group (Table 2).

Table 2. The Mean Pre and Post Intervention and Difference Rhodes Index Scores in the Three Groupsa
Groups Ginger (n = 50) Acupressure (n = 48) Control (n = 45) ANOVA
Variables
Pre intervention

Post intervention

Paired t test

difference

Pre intervention

Post intervention

Paired t test

difference

The first 3 days

The second 4 days

Paired t test

difference

P value

Vomiting 5.14 ± 3.10 2.49 ± 2.24 0.00 2.66 ± 2.64 5.14 ± 3.00 4.49 ± 2.76 0.043 0.64 ± 2.14 5.14 ± 2.13 4.50 ± 2.76 0.029 -0.71 ± 2.12 < 0.001
Nausea 8.42 ± 2.25 4.48 ± 2.06 0.00 3.94 ± 2.58 9.22 ± 2.31 7.21 ± 2.91 0.00 2.00 ± 2.37 8.41 ± 2.21 8.24 ± 2.53 0.50 0.18 ± 1.74 < 0.001
Retching 4.34 ± 2.13 2.33 ± 1.63 0.00 2.01 ± 1.56 4.35 ± 2.29 2.82 ± 2.03 0.00 1.52 ± 1.86 4.34 ± 2.19 4.65 ± 2.01 0.137 0.31 ± 1.36 < 0.001
Total score 17.91 ± 6.11 9.30 ± 4.68 0.00 8.61 ± 5.24 17.91 ± 5.90 13.74 ± 6.66 0.00 4.17 ± 5.53 17.90 ± 5.30 18.75 ± 5.60 0.137 -0.84 ± 3.72 < 0.001
a ANOVA were used to compare the mean difference scores

858 Iran Red Crescent Med J. 2013;15(9)

 Saberi F et al.

Tukey post hoc test was performed and the results score between acupressure and ginger groups (P = 0.29).
showed that the mean differences in vomiting, nausea, One-way repeated measure ANOVA was used to compare
retching, and total scores between the groups were sig- three group means of vomiting, nausea, retching and to-
nificantly different except for vomiting score between tal score in the first to seventh days. These means were
acupressure and control groups (P = 0.98), and retching statically significant between the three groups (Table 3).

Table 3. Mean and Standard Deviation of Vomiting, Nausea, Retching and Total Rhodes Index Score in Days 1 to 7 in the Three Groups
Variables and The First The Second The Third The Fourth The Fifth The Sixth The Seventh P
Groups Day Day Day Day Day Day Day
Vomiting < 0.001
Ginger 4.62 ± 4.05 5.24 ± 3.47 5.58 ± 3.61 3.06 ± 3.07 2.42 ± 2.73 1.90 ± 2.32 2.58 ± 3.19
Acupressure 5.42 ± 3.92 5.54 ± 3.40 4.46 ± 3.15 4.90 ± 3.42 4.69 ± 3.55 4.15 ± 3.29 4.25 ± 3.38
Control 5.23 ± 2.53 5.08 ± 2.94 5.10 ± 2.82 5.37 ± 2.91 6.26 ± 3.42 6.12 ± 3.40 5.66 ± 3.10
Nausea < 0.001
Ginger 8.92 ± 2.44 7.90 ± 2.88 8.46 ± 2.55 5.88 ± 2.17 4.44 ± 2.26 4.00 ± 3.02 3.62 ± 3.15
Acupressure 10.18 ± 2.19 8.93 ± 3.17 8.55 ± 2.61 7.32 ± 3.60 6.83 ± 3.70 6.68 ± 2.71 8.03 ± 4.11
Control 9.17 ± 2.39 7.90 ± 3.28 8.17 ± 2.80 7.82 ± 3.68 8.71 ± 3.35 9.35 ± 3.03 7.08 ± 3.0
Retching < 0.001
Ginger 4.24 ± 2.56 4.32 ± 2.08 4.42 ± 2.22 3.10 ± 1.51 2.34 ± 1.33 2.02 ± 1.98 2.12 ± 2.27
Acupressure 5.06 ± 2.81 5.12 ± 2.42 4.56 ± 1.89 3.56 ± 2.48 3.37 ± 2.04 3.12 ± 2.42 3.66 ± 2.47
Control 4.85 ± 2.51 3.79 ± 2.51 4.39 ± 2.70 4.61 ± 2.26 4.70 ± 2.01 4.92 ± 2.70 4.48 ± 2.25
Total < 0.001
Ginger 17.78 ± 7.43 17.46 ± 7.67 18.46 ± 5.98 12.04 ± 5.38 9.20 ± 5.24 7.92 ± 5.40 8.32 ± 7.48
Acupressure 19.27 ± 7.17 18.20 ± 6.72 16.19 ± 5.51 14.39 ± 8.53 13.50 ± 8.12 12.56 ± 7.26 14.56 ± 8.66
Control 19.25 ± 5.16 16.78 ± 6.95 17.67 ± 7.21 17.81 ± 7.50 19.67 ± 6.70 20.41 ± 7.58 17.23 ± 6.91

Analysis showed that total Rhodes index scores reduced in treating nausea, vomiting and retching. In Ozgoli et
49% in ginger group and 29% in acupressure group. It was al. study, the experimental group received 250 mg cap-
raised up to 0.06% in control group (Table 4). sules of ginger, 4 times a day for 4 days, and the control
group took placebo with the similar prescription form.
Table 4. The Reduction Percentage of Rhodes Index Scores in They found that ginger was an effective herbal therapy
the Studied Groups for relieving nausea and vomiting, and an improvement
Variable Ginger Acupressure Control
in nausea symptoms during pregnancy was reported by
(n = 50) (n = 48) (n = 45) the most of pregnant women in the ginger group (13). In
a randomized controlled study, intervention group took
Vomiting 52% 19% -0.24%
1 g/day for 4 days. In that trial, an improvement in nausea
Nausea 48% 29% 0.03% symptoms was reported by 82.8% of women in the gin-
Retching 46% 37% -0.09% ger group (20). However, the results in the present study
Total Score 49% 29% -0.06% showed that vomiting and nausea in the ginger group de-
creased 52% and 48% respectively. This may take place due
In general, the women in ginger group found that using to the lower ginger dose in our study (750 mg/day versus
this method was useful for relieving nausea, vomiting, 1 g/day).
and retching in pregnancy. In addition, randomized studies results have shown
statistically significant effects of acupressure in the treat-
5. Discussion ment of nausea, vomiting, and retching symptoms (P <
As our knowledge, this is the first randomized, prospec- 0.001) (24, 39). In our study, acupressure was effective in
tive trial to compare the effectiveness of ginger and acu- relieving nausea, vomiting and retching. This finding is
pressure in the treatment of NVP in referring women to consistent with the results of jamingorn study; however,
antenatal clinic. Many studies had been performed and is inconsistent with the findings of Sinha et al. study. In
provided the information of the treatment of NVP, both their trial, the frequency of nausea and vomiting during
pharmacological and nonpharmacological methods. labor and delivery did not reduce when the acupressure
Results in this trial showed that ginger was effective wristbands were applied bilaterally on women hands

Iran Red Crescent Med J. 2013;15(9) 859

 Saberi F et al.

(40). It is possible because there was no control group vised the study.
in their study and two groups revived intervention, one
group in the P6 point and the other one in the sham Financial Disclosure
point. Then, there was a placebo effect in both the inter-
The authors declare that they have no competing inter-
vention and placebo groups.
ests.
In previous studies the efficacy of ginger and vitamin B6
Funding/Support
was compared with placebo for the treatment of nausea
and vomiting in pregnancy. These studies reported that
ginger and vitamin B6 were useful for the management This study was funded and supported by the Deputy of
of nausea and vomiting in pregnancy, and ginger was research, Kashan University of Medical Sciences (KaUMS),
more effective than vitamin B6 (20, 41). Also in a random- Grant No: 8614.
ized study, the effectiveness of acupressure and vitamin
B6 in relieving symptoms of nausea and vomiting in References
early pregnancy has been compared. Finding showed 1. Madjunkova S, Maltepe C, Koren G. The Leading Concerns of
statistically significant decrease in nausea, retching, and American Women with Nausea and Vomiting of Pregnancy Call-
ing Motherisk NVP Helpline. Obstet Gynecol Intl. 2013;2013:7.
vomiting symptoms in both acupressure (P < 0.001) and
2. Naeimi Rad M, Lamyian M, Heshmat R, Jaafarabadi MA, Yazdani
vitamin B6 groups (P < 0.001) (24). S. A Randomized Clinical Trial of the Efficacy of KID21 Point (You-
To our knowledge, this is the first randomized con- men) Acupressure on Nausea and Vomiting of Pregnancy. Iran
trolled trial study which compared the effectiveness of Red Crescent Med J. 2012;14(11):697-701.
3. Ebrahimi N, Maltepe C, Einarson A. Optimal management of nau-
ginger and acupressure in alleviating mild to moderate sea and vomiting of pregnancy. Intl J Women Health. 2010;2:241.
nausea, vomiting and retching in pregnancy. According 4. Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyper-
to Table 2 the mean difference Rhodes index scores in emesis gravidarum, a literature review. Hum Reprod Update.
2005;11(5):527-39.
ginger group was more than acupressure and control
5. Wegrzyniak LJ, Repke JT, Ural SH. Treatment of hyperemesis grav-
groups. There were statistically significant differences idarum. Rev Obstet Gynecol. 2012;5(2):78-84.
in the mean difference Rhodes index scores (vomiting, 6. Soltani A, Kajuri MD, Safavi SH, Hosseini F. Frequency and sever-
nausea, retching and total) between the three groups (P ity of nausea and vomiting in pregnancy and the related factors
among pregnant women. Iran J Nursing. 2007;19(48):95-102.
= 0.00). 7. Jouybari L. The Quality of Pregnant Women Life with Nausea and
Total reduction percentage of Rhodes Index scores in Vomiting. Qom Uni Med Sci J. 2012;6(2).
the present study were 49%, 29% and -0.06% in ginger, acu- 8. Gadsby R. Pregnancy nausea and vomiting--the role of the mid-
pressure and control groups respectively. These findings wife. Pract Midwife. 2012;15(9):17-9.
9. Wood H, McKellar LV, Lightbody M. Nausea and vomiting in preg-
indicated that ginger is more effective than acupressure nancy: blooming or bloomin' awful? A review of the literature.
in treating nausea and vomiting. Women Birth. 2013;26(2):100-4.
In conclusion, ginger is more effective than acupres- 10. Zur E. Nausea and vomiting in pregnancy: a review of the pa-
thology and compounding opportunities. Int J Pharm Compd.
sure in alleviating mild to moderate NVP in symptomatic
2013;17(2):113-23.
women before 16 weeks’ gestation of pregnancy. Since 11. Maitre S, Neher J, Safranek S. FPIN's clinical inquiries: ginger for
this study was performed on mild to moderate nausea the treatment of nausea and vomiting in pregnancy. Am Fam Phy-
and vomiting, the results could not be generalized to sician. 2011;84(10):1-2.
12. Maltepe C, Koren G. Preemptive Treatment of Nausea and Vomit-
severe nausea and vomiting, And it can be considered as ing of Pregnancy: Results of a Randomized Controlled Trial. Ob-
a limitation. We suggest comparing the effectiveness of stet Gynecol Intl. 2013;2013:8.
ginger and acupressure to relieve severe nausea and vom- 13. Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on
pregnancy, nausea, and vomiting. J Altern Complement Med.
iting in pregnancy in future clinical trials.
2009;15(3):243-6.

Acknowledgements
14. Basirat Z, Moghadamnia A, Kashifard M, Sarifi-Razavi A. The Effect
of ginger biscuit on nausea and vomiting in early pregnancy.
Acta Medica Iranica. 2009;47(1):51-6.
This study was funded and supported by the Deputy of 15. Khavandizadeh AS, Mahfouzi B. EVALUATION OF THE EFFECTS OF
research, Kashan University of Medical Sciences (KaUMS), ACUPRESSURE BY SEA BAND ON NAUSEA AND VOMITING OF PREG-
the Grant No: 8614. We would like to thank for their co- NANCY. Iran J Obstet Gynecol Infert. 2010;13(2):39-44.
16. Ozgoli G, Shahbazzadegan S, RASAEIAN N, ALAVIMAJD H. Effect
operation as well as all women who made this study pos- of acupressure with wristband on nausea and vomiting of preg-
sible. nancy. J Ardabil Uni Med Sci (JAUMS). 2007;7(3):247-53.
17. Dennehy C. Omega-3 fatty acids and ginger in maternal health:
Authors’ Contribution pharmacology, efficacy, and safety. J Midwifery Womens Health.
2011;56(6):584-90.
Farzaneh Saberi was responsible for planning of the 18. Ginger. Available from: http://www.nlm.nih.gov/medlineplus/
druginfo/natural/961.html.
project and analysis of the data, Zohreh Sadat and 19. Tiran D. Ginger to reduce nausea and vomiting during pregnan-
Mahboobeh Taebi performed the experimental work. cy: evidence of effectiveness is not the same as proof of safety.
Masoumeh Abedzadeh- Kalahroudi prepared the first Complement Ther Clin Pract. 2012;18(1):22-5.
draft of the paper and made data collection, and super- 20. Ensiyeh J, Sakineh MA. Comparing ginger and vitamin B6 for the

860 Iran Red Crescent Med J. 2013;15(9)

 Saberi F et al.

treatment of nausea and vomiting in pregnancy: a randomised first trimester of pregnancy. Iran J Nursing. 2004;17(37):1-11.
controlled trial. Midwifery. 2009;25(6):649-53. 33. Shishehgar F, Peyman A. Association of Vomiting in Pregnancy
21. Heitmann K, Nordeng H, Holst L. Safety of ginger use in pregnan- with Body Mass Index and Quality of Life. Med J Hormozgan Univ.
cy: results from a large population-based cohort study. Eur J Clin 2010;13(4):220-76.
Pharmacol. 2013;69(2):269-77. 34. Rosen T, de Veciana M, Miller HS, Stewart L, Rebarber A, Slot-
22. Bryer E. A literature review of the effectiveness of ginger in al- nick RN. A randomized controlled trial of nerve stimulation
leviating mild-to-moderate nausea and vomiting of pregnancy. J for relief of nausea and vomiting in pregnancy. Obstet Gynecol.
Midwifery Womens Health. 2005;50(1):e1-3. 2003;102(1):129-35.
23. Matthews A, Dowswell T, Haas DM, Doyle M, O'Mathúna DP. Inter- 35. Puangsricharern A, Mahasukhon S. Effectiveness of auricular
ventions for nausea and vomiting in early pregnancy. Cochrane acupressure in the treatment of nausea and vomiting in early
Database System Rev. 2010;(1). pregnancy. J Med Assoc Thai. 2008;91(11):1633-8.
24. Jamigorn M, Phupong V. Acupressure and vitamin B6 to relieve 36. Molassiotis A, Coventry PA, Stricker CT, Clements C, Eaby B,
nausea and vomiting in pregnancy: a randomized study. Arch Gy- Velders L, et al. Validation and psychometric assessment of a
necol Obstet. 2007;276(3):245-9. short clinical scale to measure chemotherapy-induced nausea
25. Fraser DM, Cooper MA. Myles' textbook for midwives. 2009. and vomiting: the MASCC antiemesis tool. J Pain Symptom Man-
26. Lee EJ, Frazier SK. The efficacy of acupressure for symptom age. 2007;34(2):148-59.
management: a systematic review. J Pain Symptom Manage. 37. Fu MR, Rhodes V, Xu B. The Chinese Translation of the Index of
2011;42(4):589-603. Nausea, Vomiting, and Retching. Cancer Nursing. 2002;25(2):134-
27. Lowdermilk DL, Perry SE, Kitty Cashion RN, Alden KR. Maternity 40.
and Women's Health Care. 2011. 38. Fetzer SJ, Hand MC, Bouchard PA, Smith H, Jenkins MB. Evalua-
28. Loretz L. Primary Care Tools for Clinicians: A Compendium of Forms, tion of the Rhodes Index of Nausea and Vomiting for ambulatory
Questionnaires, and Rating Scales for Everyday Practice. 2005. surgery patients. J Adv Nursing. 2004;47(1):74-80.
29. Noorani S, Seyyed Alavi G, Kordi M. Efficacy of acupressure on re- 39. Can Gurkan O, Arslan H. Effect of acupressure on nausea
duse nasea and vomiting in the first trimester of pregnancy. Med and vomiting during pregnancy. Complement Ther Clin Pract.
J Mashhad Univ Med Sci. 2000;24(66):89-95. 2008;14(1):46-52.
30. Nourani S, Aparnak F, Sadr Nabavi R, Ebrahimzadeh S. Com- 40. Sinha A, Paech MJ, Thew ME, Rhodes M, Luscombe K, Nathan E.
parison of K-K9 and P6 points acupressure on nausea and A randomised, double-blinded, placebo-controlled study of acu-
vomiting in the first half of pregnancy. Urmia Medical Journal. pressure wristbands for the prevention of nausea and vomiting
2011;22(4):369-78. during labour and delivery. Int J Obstet Anesth. 2011;20(2):110-7.
31. Modares M, Besharat S, Mahmoudi M. Effect of Ginger and Cham- 41. Chittumma P, Kaewkiattikun K, Wiriyasiriwach B. Comparison
omile capsules on nausea and vomiting in pregnancy. J Gorgan of the effectiveness of ginger and vitamin B6 for treatment of
Univ Med Sci. 2012;14(1):46-51. nausea and vomiting in early pregnancy: a randomized double-
32. Nurane S. What makes nausea and vomiting worse during the blind controlled trial. J Med Assoc Thai. 2007;90(1):15-20.

Iran Red Crescent Med J. 2013;15(9) 861