Ginger is safe and mildly effective for the treatment of nausea and vomiting of pregnancy (NVP), according to the results of a prospective comparative study published in the November issue of the American Journal of Obstetrics and Gynecology. "Many women are hesitant to take medicinal drugs for fear of harming the fetus, so consequently they are often interested in nonmedicinal options such as acupressure, acupuncture, and ginger," write Galina Portnoi, MD, from the University of Toronto in Ontario, Canada, and colleagues. "Despite the years of the use of ginger in many cultures, there remains little information regarding its safety and efficacy during pregnancy." The investigators compared pregnant women who were taking ginger during the first trimester of pregnancy with a group of women who were exposed to nonteratogenic drugs that were not antiemetic medications. Of 187 pregnancies, there were 181 live births, two stillbirths, three spontaneous abortions, and one therapeutic abortion. There were no significant differences in outcomes between the two groups, except that more infants weighed less than 2,500 g in the comparison group (12 vs. 3; P In the group taking ginger, mean birth weight was 3,542 ± 543 g, mean gestational age was 39 ± 2 weeks, and there were three major malformations. Of 66 women who completed scores rating on a scale of 0 to 10 how effective the ginger was for their nausea and vomiting, the mean score was 3.3 ± 2.9 SD. Although the small sample size resulted in limited power to examine the rates of major malformations, the authors concluded that ginger does not appear to increase the rates above the baseline rate of 1% to 3%. "The results also suggest that ginger is somewhat helpful in alleviating the symptoms of NVP, more so with the capsules than any other preparation," they write. "This evidence-based information can be helpful to women and their health professionals when making the decision regarding the treatment of nausea and vomiting with ginger during pregnancy." Duchesnay Inc. supported the Motherisk NVP Helpline used to enroll women in this study. Mead Johnson/Canada also supported this study through an unrestricted grant. Am J Obstet Gynecol. 2003;189:1374-1377 Clinical Context Approximately 80% of pregnant women experience NVP, usually between 8 and 12 weeks of gestation. Fewer than 1% suffer from the more severe hyperemesis gravidarum. Ginger, derived from the plant Zingiber officinal, has for centuries been used by a variety of cultures for treating maladies from gastrointestinal symptoms to headaches and arthritis. More recently, it has been used to treat postoperative nausea and vomiting as well as nausea and vomiting due to motion sickness and pregnancy, according to studies cited by the authors of the current study. A randomized controlled trial by Fischer-Rasmussen and colleagues, published in the January 1991 issue of the European Journal of Obstetrics and Gynaecology and Reproductive Biology, using 250 mg of ginger capsules four times a day for four days showed a significant benefit in severe hyperemesis gravidarum. Another trial, by Vutyavanich and colleagues in the April 2001 issue of Obstetrics and Gynecology, also demonstrated improvement in nausea symptoms compared with placebo. The study used the same ginger dosage and was the same duration, but it only looked at women up to 17 weeks' gestation. However, concerns remain about the effect of ginger on the fetus because of its uncertain mechanism of action. One proposed mechanism is inhibition of thromboxane synthetase, described in rat models, which has the potential to affect sex steroid differentiation of the fetal brain. This is an observational descriptive study in a self-selected cohort of pregnant women presenting to a center for counseling on safety and risks of drugs, chemicals, radiation, and infectious diseases. Study Highlights 187 women who had called the service to inquire about the safety of ginger and who had used the product in the first trimester were enrolled. Pregnancy outcome was determined by interview with the patient and the infant's primary physician 4 to 12 months after delivery. The comparison group consisted of 187 matched controls who called the service with inquiries about nonantiemetic products and who had not used ginger during pregnancy. The groups were matched for age, smoking behavior, and alcohol use. Parity, education level, diet, and other lifestyle factors were not described. Exposure to ginger was defined as consumption of any ginger product between the fourth and 14th week of gestation. A structured telephone interview at enrollment was used to elicit history of ginger exposure and maternal and demographic factors. Primary outcome was incidence of major malformations above the expected baseline rate of 1% to 3%. Secondary outcomes were rate of spontaneous and therapeutic abortions, live births, stillbirths, gestational age, and birth weight. The study had 80% power to detect a 3.5-fold increase in rate of malformations with an á of 0.05. To detect a twofold difference, 800 subjects in each group would have been required. 66 of 187 women taking ginger completed a survey of effectiveness of ginger for nausea and vomiting using a visual analog scale of 0 to 10, with 10 being "most effective." Chi-squared analysis was used to compare categorical data, while the Mann-Whitney rank sum test was used for continuous data. Student's t test was used to analyze ginger effectiveness data. Mean birth weight was 3,542 ± 543 g for the ginger group and 3,397 ± 569 g for the comparison group. Mean gestational age was 39 ± 2 weeks for both groups. In the ginger group, there were 181 live births, 3 spontaneous abortions, 2 stillbirths, 1 therapeutic abortion for Down's syndrome, and 3 major malformations (ventricular septal defect, right lung abnormality, and pelviectasis). In the comparison group, there were 178 live births, 8 spontaneous abortions, 1 stillbirth, 0 therapeutic abortions, and 2 major malformations. There were no statistically significant differences in these outcomes between the two groups. 12 infants in the comparison group weighed less than 2,500 g compared with 3 infants in the ginger group (P = .033). There were 8 sets of twins in the ginger group. Women in the ginger group consumed a variety of ginger products including capsules, tea, cookies, candy, inhaled powdered ginger, crystals, and sugared ginger. Dosage and origin of the products was not documented. 49% of women used ginger capsules. 61% of women took ginger alone for nausea and vomiting and 39% took it concurrently with an antiemetic drug. In 66 women who used ginger for at least 3 consecutive days and who responded to the effectiveness survey, the capsules were significantly more effective than other forms of ginger (4.2 ± 3.1 vs. 1.7 ± 0.7; P < .001). The overall combined effectiveness of all forms of ginger was 3.6 ± 2.4, but almost half the women surveyed reported that ginger was ineffective in alleviating their symptoms. Pearls for Practice The rate of fetal malformation in the 187 women who consumed ginger during the first trimester was not higher than the baseline rate of 1% to 3%. Ginger was somewhat helpful for alleviating symptoms of nausea and vomiting in half of the women surveyed. 1/04 Written by: Laurie Barclay, MD Thanks to MEDSCAPE.com Remember we are NOT Doctors and have NO medical training. 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