Introduction
About 85% of people experience some degree of nausea and vomiting in pregnancy.[1] Nausea and vomiting can limit a person’s ability to continue their usual daily activities and affect quality of life. While certain antiemetics can be used in pregnancy, many people may prefer a non-drug option. Ginger is a traditional remedy used to treat nausea and vomiting.[1]
Intervention
Consumption of ginger alone or with vitamin B6.
Indication
Nausea and vomiting in pregnancy
Precautions/Adverse effects
There is a theoretical but unproven risk of bleeding with ginger through decreasing platelet-aggregation. A possible side effect of ginger is heartburn.[3]
Vitamin B6 can cause peripheral neuropathy. Advise the patient to stop taking vitamin B6 if they experience symptoms such as tingling, burning, numbness, or walking difficulties and to seek medical advice.
If taking ginger plus vitamin B6, check if the individual is already taking dietary supplements containing vitamin B6 to avoid overdosing. Note that vitamin B6 might be listed on a label as pyridoxine hydrochloride, pyridoxal 5-phosphate or pyridoxal 5-phosphate monohydrate.
Availability
Ginger is available in many forms, e.g. tablets/capsules, fresh, dried (spice), lollies, biscuits and tea.
Description
A 2018 network meta-analysis on alternative therapies for nausea and vomiting in pregnancy included studies comparing ginger alone to placebo (no intervention) as well as studies comparing ginger in combination with vitamin B6 to placebo (or no intervention). Ginger (alone or with vitamin B6) had the greatest mean difference of all considered therapies for nausea, and had the highest quality evidence. The effects for ginger were similar to effects of metoclopramide.[2]
Vitamin B6 showed moderate reduction in nausea scores but with greater variability and very low quality of evidence. Vitamin B6 and ginger combined showed a greater and more consistent effect.[2]
A 2022 meta-analysis also showed ginger significantly reduced nausea but did not significantly reduce vomiting compared with placebo.[1]
The Society for Obstetric Medicine of Australia and New Zealand recommends a dose of 250 mg TDS-QID (max 1000 mg/day) of standardised ginger extract, or 600 mg if combined with 37.5 mg of vitamin B6.[3]
Based on the evidence, ginger alone or with vitamin B6 can be tried for nausea and vomiting in pregnancy.
Tips and Challenges
- Some presentations of ginger, such as ginger lollies or ginger syrup, may be high in sugar and therefore not desirable for regular intake. Tea may be helpful, though being warm may amplify the smell and trigger nausea.
- One teaspoon (5 g) of freshly grated ginger has been reported to be equivalent to a 1000 mg dose of a standardised ginger extract.
- Other practical approaches (generally routine advice without evidence base) that may help with nausea and vomiting in pregnancy include the following:
- Having a few crackers by the bed to eat in the morning – this is thought to stabilise blood sugars from an overnight fast. Crackers are recommended as they are small, shelf stable and do not have a strong smell.
- Ensuring adequate fluid intake during the day. Water is preferred, though Hydralyte, juice (250ml) and milk (if tolerated) are reasonable choices. This strategy may help ensure blood pressure doesn’t dip, resulting in nausea.
- Avoiding hot foods or strong-smelling foods first thing in the morning, as they may induce or exacerbate nausea.
Grading
Moderate. (We are moderately confident in this research evidence, i.e. further research could have an important impact, which may change the estimates.)