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Journal of Traditional Chinese Medicine logoLink to Journal of Traditional Chinese Medicine
. 2023 Dec 4;44(1):16–26. doi: 10.19852/j.cnki.jtcm.20231204.006

Effectiveness and safety of acupuncture in treatment of pregnancy-related symptoms: a systematic review and Meta-analysis

Tingting LIU 1, Tongou LIU 2,, Mingfu LIU 3
PMCID: PMC10774725  PMID: 38213235

Abstract

OBJECTIVE:

To systematically evaluate the efficacy and safety of acupuncture (AM) in the treatment of pregnancy-related symptoms such as acute vomiting during pregnancy.

METHODS:

We comprehensively searched the available literature up to November 2021, including PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure Database, for randomized controlled trials (RCTs) on AM for the treatment of severe vomiting, insomnia, pharyngeal and pelvic pain, mood abnormalities, and dyspepsia during pregnancy.

RESULTS:

Sixteen RCTs with a cumulative sample size of 1178 cases were included. Of these, 964 patients were included in the Meta-analysis. The Meta-analysis results showed that AM was more efficient than Western medicine in treating discomfort during pregnancy [odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.11, 1.28), P < 0.01]. AM was better than the control group in improving the visual analog scale scores [standard mean difference (SMD) = 0.62, 95% CI(0.53, 0.71), P < 0.01]. AM was superior to the control group in improving Numerical Rating Scale (NRS) symptom scores [OR = 7.31, 95% CI(3.36, 15.94), P < 0.01]. There was no significant difference in adverse effects between the AM and sham-AM groups and the analgesic drug group [OR = 0.70, 95% CI(0.39, 1.28), P = 0.25], but the treatment and control groups had mild adverse effects with a low incidence.

CONCLUSIONS:

AM is more effective than other treatments or pharmacotherapy alone in the treatment of pregnancy-related symptoms, and is relatively safe. However, the quality of the included trials was rather poor, and high-quality studies are required to confirm our findings.

Keywords: acupuncture, pregnancy, nausea, vomiting, sleep initiation and maintenance disorders, low back pain, pelvic pain, mood abnormalities, Meta-analysis, systematic review

1. INTRODUCTION

During pregnancy, a woman may experience discomfort. Individual differences are so significant that the discomfort felt during one pregnancy may not occur during the other. Research has shown that discomfort during pregnancy is related to hormonal changes. Common discomforts during pregnancy include nausea and vomiting, insomnia, low back and pelvic pain, and mood abnormalities.1 A few people consider discomfort to be a regular part of pregnancy. A proportion of patients do not seek treatment, leading to an increased incidence of depression and the possible development of adverse outcomes, such as severe vomiting and preterm abortion.

Nausea and vomiting of pregnancy (NVP) affect approximately 50%-80% of pregnant women, and is the most common cause of hospitalization for fetal preservation in the first 20 weeks of pregnancy.2 Of these, 0.3%-3.0% develop hyperemesis gravidarum (HG), which is often associated with intractable vomiting, ketonuria, and electrolyte disturbances due to dehydration.3,4 HG is associated with significant morbidity and may lead to unfavorable pregnancy outcomes. NVP and HG are reportedly associated with human chorionic gonadotropin, estrogen, progesterone, serotonin, and thyroid hormones.5 Currently, lifestyle and dietary modifications are recommended for patients with NVP; however, approximately 10%-15% of pregnant women do not experience significant symptom relief.6,7

More than 65% of women experience low back pain, and approximately 20% experience pelvic pain during pregnancy.8 The two symptoms can occur separately or simultaneously, often worsening with pregnancy progression and lasting up to three years after delivery in some patients.9 Low back pain and pelvic pain can seriously affect a woman’s quality of life during pregnancy and even after delivery.

Insomnia is a common sleep disorder that occurs during pregnancy and is classified as primary or secondary. The prevalence of insomnia during pregnancy is as high as 38.2%, with a significantly higher prevalence in late pregnancy (39.7%) than in early pregnancy, reaching 25.3% to 27.2% mid-pregnancy.10 Early intervention for sleep disorders, including improving sleep hygiene, behavioral therapy, and pharmacotherapy, is recommended to avoid adverse pregnancy outcomes.11 Sleep alterations are strongly associated with pregnancy outcomes. Li et al 12 showed that insomnia and sleep disorders are associated with preterm birth rates. Sedov et al 13 showed that insomnia is associated with postpartum depression.

Mood complaints during pregnancy, particularly prenatal depression, are of significant concern. Up to 13% of women experience major depression during pregnancy and the survival rate in the first 12 months of postpartum increases to approximately 22%.14 Prenatal depression is mainly associated with social issues such as socioeconomic class.15 Although it is a psychological problem, it may have a significant impact on the physical health of pregnant women and is associated with low birth weight infants.16

During pregnancy, prescribing systemic drug therapy is a great challenge for physicians.17 Although German case law suggests that according to the current state of medical care, medicinal products with contraindications to pregnancy are sufficiently effective and safe, overprescription of medication is not illegal when no equivalent alternative treatment is available. However, the potential risk of in utero drug exposure to the fetus may impede growth and development leading to malformations.18 Chemical and physical causes, including maternal drug treatment, are estimated to account for 2%-4% of all malformations.19

According to Chinese medicine, acupuncture treatment consists of acupuncture and moxibustion; it entails piercing the patient's body with milli-needles using certain techniques and angles to stimulate the certain acupuncture points to improve the relevant diseases.20 Moxibustion involves the use of moxa leaves and other drugs. The heat generated from the burning of the drugs and the medications were used to fumigate relevant acupuncture points to improve the patient's clinical symptoms. “Chinese acupuncture” was inscribed in the Representative List of the Intangible Cultural Heritage of Humanity by UNESCO in 2010. It is the most widely used traditional medicine and alternative therapy in the world and has been applied in 183 countries worldwide.21,22 Acupuncture is applied in various forms, such as electroacupuncture, body-, auricular-, or head-acupuncture, buried acupuncture, cupping, and moxibustion with ginger or medicine. However, moxibustion is used less frequently in countries other than China. Acupuncture is widely used because of its clinical effectiveness and safety. The National Institutes of Health (NIH) published the "NIH Consensus Statement on Acupuncture" in 1997, which concluded that acupuncture has significant efficacy in treating NVP, severe vomiting in pregnancy, various pains, depression, insomnia, and other psychiatric disorders.23 Yamashita et al 24 showed that among 55 291 women treated with acupuncture, only 63 had minor side effects, such as forgetting to remove needles and minor burns.25

High-quality evidence-based literature to support the clinical effectiveness and safety of acupuncture for treating nausea and vomiting, mood abnormalities, and lower back and pelvic pain during pregnancy. This study aimed to systematically assess and compare the effects of acupuncture and other treatments on pregnancy discomfort to reduce discomfort and improve the quality of life of women during pregnancy.

2. MATERIALS AND METHODS

2.1. Search procedure

2.1.1. Searches

Searches were conducted independently by 2 investigators (LIU Tongou and LIU Tingting).

2.1.2. Database

The following combination of MeSH terms and free words were utilized: gestation, first pregnancy trimester, second pregnancy trimester, acupuncture therapy, acupuncture, low back pain and pelvic pain, nausea and vomiting, emotional complaints, sleep initiation and maintenance disorders, insomnia, hyperemesis gravidarum, randomized controlled trial, Cochrane Library, and relevant Chinese words in Chinese Biomedical Literature Database and China National Knowledge Infrastructure Database.

2.1.3. Retrieval time

The databases are available from build to November 30. 2021.

2.1.4. Literature search strategies

The search combined free words with subject terms using specific logical combinations in relevant databases.

2.2. Inclusion and exclusion criteria

2.2.1. Inclusion criteria

English and Chinese randomized controlled trials (RCTs) with clear diagnostic criteria were included. The experimental group received acupuncture, moxibustion, or acupuncture with moxibustion, while the control group received Chinese herbal medicine, Western Medicine, and placebo treatment. The primary observation index was total clinical efficiency, and the second observation index was the occurrence of adverse events.

2.2.2. Exclusion criteria

The following studies were excluded: (a) non-randomized controlled trial; (b) non-2-arm tests, and studies without complete and valid data; (c) thesis, conference paper, review, case report, animal experiment, theoretical discussion, and experience summary.

2.3. Data extraction

Two investigators conducted the literature search and screening alone. The titles and abstracts of the retrieved literature were imported into the NoteExpress to eliminate duplicates and exclude those that did not meet the article requirements. The selected titles and abstracts were browsed. The full-text of the literature that was considered to be consistent with this article’s study parameters were downloaded and read to screen them again. Data related to the time of publication, first author's name, number of cases, age, relevant interventions, duration of treatment, relevant outcome indicators, and factors related to the risk of bias, were extracted and summarized using Microsoft Excel. In the case of disagreements, a third investigator made the choice.

2.4. Quality assessment of the included studies

The quality of the included studies was evaluated by two investigators using the Literature Quality Assessment Tool provided by the Cochrane Collaboration mesh (https://www.cochrane.org/). The assessment parameters included random sequence generation, allocation concealment, blinding of trial subjects, study personnel, and outcomes, missed visits and withdrawals, selective reporting, and other sources of bias. Each aspect was classified as ‘high-risk’, ‘low-risk’, and ‘unknown-risk’. Any disagreements were resolved through discussions with a third author. All relevant data were entered into Microsoft Excel to produce an information base.

2.5. Statistical methods

Meta-analysis of the extracted data was performed using the Review Manager 5.4 (Cochrane Collaboration Network).26 The χ 2 test was used to test for heterogeneity. A P ≥ 0.10 or I 2 ≤ 50% indicated good homogeneity among the results of the studies, and Meta-analysis was performed using the fixed-effects model. A P < 0.10, I 2 > 50%, or both, indicated more significant heterogeneity among the results of the studies, and Meta-analysis was performed using the random-effects model. The source of heterogeneity was further determined by a sensitivity analysis.27 Effect analysis indicators were selected according to the type of statistics; the ratio of ratios (OR) and its 95% confidence interval (CI) were used for dichotomous variables, and the standardized mean difference (SMD) and its 95% CI were used for continuous variables.

3. RESULTS

3.1. Search results

Five domestic and foreign databases were searched, and 7220 records were obtained. A total of 322 full-text documents were obtained and imported into NoteExpress 3.5.0. Sixteen papers meeting the criteria were finally included, of which 7 were English-language papers28,29 and nine were Chinese.30,-32 A flow chart of the literature screening is shown in Figure 1. Basic information on the included documents is presented in Table 1.

Figure 1. Flow chart of the study selection.

Figure 1

CNKI: China National Knowledge Infrastructure Database; CBM: Chinese Biomedical Literature Database; not-RCT: non-randomized controlled trial.

Table 1.

Basic information of the included studies

Study Country Intervention (n) Treatment course Primary Outcome Measure Adverse reaction
Study
group
Control
group
Control
group
Foroughinia S et al 202028 Nasrin Acupuncture (n=36)
Sleep hygiene education+fake needle and non-penetrating needle (n=36) / Standard acupuncture was performed 10 times at 3 PSQI score No serious adverse event was reported. Only AE reported was stabbing pain
Elden H et al 200833 Sweden Standard treatment+acupuncture group Standard treatment+non-penetrating sham acupuncture group / Twice weekly for 4 weeks VAS score No serious adverse event
Silva JBGD et al 200534 Brazil Acupuncture (n=17)
Non-acupuncture (n=13) / Eight weeks, 8-12 times NRS score
One patient reported ecchymosis at some insertion points
Silva JBGD et al 200435 Brazil Acupuncture treatment+conventional treatment (n=27) Conventional treatment
(n=34)
/ Eight weeks, 8-12 times NRS score No serious adverse event
Silva JBGD 200736 Brazil Acupuncture+Conventional treatment (n=28) Conventional treatment
(n=23)
/ Eight weeks, 8-12 times NRS score Except for bruising, no serious adverse effects were observed
Kvorning N et al 2004 37 Sweden Acupuncture (n=37) No false stimulation
(n=35)
/ Patients receive acupuncture twice a week during the first 2 weeks and no more than once a week thereafter. VAS score No serious adverse reactions to acupuncture were found in patients, and no adverse reactions were seen in infants and children.
Christer PO et al 200029 Sweden Active PC6 Acupuncture+Standard Treatment (n=21) Standard treatment+placebo acupuncture
(n=19)
/ 8 d of treatment VAS score No significant adverse reactions were observed
Gan YL et al 202131 China Intravenous nutrition therapy+acupuncture point moxibustion+ear point pressure bean
(n=50)
Intravenous nutrition
(n=50)
/ Both groups were treated for 7-10 d Clinical efficiency Not mentioned
Xu Y et al 201532 China Routine rehydration
+ Acupuncture+Moxibustion (n=25)
Routine rehydration
(n=35)
/ Treat once a day for 3 to 5 d Clinical efficiency No significant adverse reactions
Xie HY 201338 China Acupuncture (n=47)

Routine rehydration
(n=47)
/ 10 times for a course of treatment, treatment 1
treatment course
Clinical efficiency Not mentioned
Joan C 201739 China Routine rehydration+Acupuncture (n=35) Routine rehydration
(n=35)
/ 2 times/d, 1 week as a course of treatment Clinical efficiency No significant adverse reactions
Jia YZ 201540 China Acupuncture (n=47) Conventional treatment
(n=47)
/ ≥1 time per week for 5 weeks of treatment VAS score No significant adverse reactions
Huang WY, Luo BZ 201941 China Acupuncture (n=40) Analgesic drugs (n=40) / week/time, 1 month of continuous needling
VAS score, AE Low incidence of adverse reactions during treatment
Jiang X 202142 China General health guidance+Acupuncture (n=35) General health guidance
(n=35)
/ 2 times/week for 6 weeks of treatment
VAS score In the observation group, some patients showed fatigue and drowsiness; in the control group, 7 patients felt fatigued and weakness because of sleep disorder.
Long Y et al 201443 China Acupuncture (n=40) Not with treatment
(n=40)
/ At least 1 time per week for 5 weeks VAS score No serious adverse reactions were found
Zhao YL 201730 China Routine rehydration+Acupuncture (n=42) Routine rehydration
(n=42)
/ 5 d for 1 course of treatment, 2 courses of treatment Clinical efficiency Not mentioned

Notes: PSQI: pittsburgh sleep quality index; VAS: visual analogue scale; NRS: numerical rating scale; HGS: hyperemesis gravidarum score.

3.2. Quality evaluation of the included literature

The Cochrane Risk Bias Tool showed that the methodological quality of the included studies was low, and the results and conclusions of these studies should be treated with caution.

Random sequence generation: all the studies mentioned the randomized control principle for grouping, with two studies27,28 using computerized randomization, four30,31, 41,42 using the random number table method, one 30,37 using the dice rolling method, one29 using the envelope method, and one32 randomizing patients according to their time of admission. All were rated as “low-risk.” Seven studies34,36,,,-40,43 were randomized and rated as “unknown-risk.”

Allocation concealment: three studies28,33,37 mentioned the use of envelopes to control the allocation concealment and rated it as "low risk," while the other studies did not describe the randomization process in detail and rated it as "unknown risk".

Blinding of participants and personnel: in four studies28,29,33,37 the personnel were blinded to the study group and subjects and rated as “low risk.” No studies were rated as “high risk.” The studies that did not mention blinding of investigators and subjects and were rated as “unknown risk.”

Blinding of outcome assessment: in one study33 blinded measurements were used and rated as “low risk,” while the studies that did not mention the use of blinded measurements were rated as “unknown risk.”

Incomplete outcome data: three studies33,35,36 had incomplete outcome data and were rated as “high risk.” All other studies had complete outcome data and were rated as “low risk.”

Selective reporting: the outcome indicators listed in the methods for all studies were reported in the results section, and no selectivity was found. However, because the original study protocol was not available, it was not possible to fully determine whether there was selectivity in the study, so they were rated as “unknown risk.”

Other bias: the main consideration was baseline consistency. All studies were consistent at baseline, comparable, and without significant biases, and were thus rated as “low risk.” The risk of bias assessment in literature is shown in Figures 2 and 3.

Figure 2. Risk of bias evaluation of included studies.

Figure 2

A: risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies; B: risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Figure 3. Comparison between Acupuncture and the control group.

Figure 3

A: forest plot of effectiveness; B: forest plot of VAS scores; C: forest plot of NRS symptom score; D: forest plot of incidence of adverse reactions. VAS: visual analogue scale; NRS: numerical rating scale.

3.3. Meta-analysis results

Meta-analyses of the primary outcome indicators, clinical effectiveness, visual analogue scale (VAS) scores, numerical rating scale (NRS) symptom scores, and adverse effects were performed in 16 studies.

3.3.1. Results

Five studies30,-32,38,39 mentioned the clinical efficacy of acupuncture. Healing, significant improvement, and effective treatment were considered “effective,” and ineffective treatment or worsening of symptoms was considered “ineffective.” These were transformed into dichotomous variables for analysis, involving 418 patients; 209 in the acupuncture group, and 209 in the treatment group. Heterogeneity [χ 2 = 1.74, df = 4 (P = 0.78) and I 2 = 0%] was indicated; therefore, a random-effects model was used. The combined effect test suggested the following: Z = 4.92 (P < 0.0001) (P < 0.01 was considered statistically significant), OR = 1.19, 95% CI (1.11, 1.28); OR interval did not contain 1. Therefore, acupuncture can be considered superior to other treatments, such as Western medicine, in terms of clinical effectiveness in improving discomfort during pregnancy (Figure 3A).

3.3.2. VAS scores

Of the 16 studies included, five29,33,40,41,43 used VAS scores as an outcome indicator. A total of 685 patients were included in the study; 337 in the acupuncture group and 348 in the treatment group. Heterogeneity [χ 2 = 12.18, df = 4 (P = 0.02); I 2 = 67) was found in the five studies; therefore, a random-effects model was used. The pooled effect size test results were as follows: Z = 6.58 (P < 0.000 01) (P < 0.01 was considered statistically significant), SMD = 0.62, 95% CI (0.53, 0.71); the SMD interval did not contain 0. This indicates that the treatment group was superior to the control group in improving VAS scores (Figure 3B).

3.3.3. NRS symptom scores

Of the 16 studies included, three34,-36 used the NRS symptom score as an outcome indicator. A total of 135 patients were included in the study; 69 in the acupuncture group and 66 in the treatment group. Good homogeneity [χ 2 = 2.43, df = 2 (P = 0.30); I 2 = 18%] was detected; therefore, a fixed-effects model was used for the Meta-analysis. The combined effect size test results were: Z = 5.01 (P < 0.000 01) (P < 0.01 was considered statistically significant), OR = 7.31, 95% CI (3.36, 15.94); OR interval did not contain 1. Thus, the treatment group was better than the control group in improving the NRS symptom scores (Figure 3C).

3.3.4. Incidence of adverse reactions

Among the 16 included studies, 13 mentioned adverse reactions,28,29,32,39,,-42 of which nine mentioned “no significant adverse reactions” or “low incidence of adverse reactions,”29,32,33,35,37,39,-41 and four28,34,36,42 reported “only stinging pain,” “petechiae at the insertion point in one patient,” "no significant adverse effects except bruising," and “some patients showed fatigue and drowsiness,” respectively. All these affected the progress of the studies. Only two of these studies33,41 examined the incidence of adverse reactions in the acupuncture group and compared it to that in the sham acupuncture or analgesic medication group. A total of 195 patients were included in the study; 98 in the acupuncture group and 97 in the treatment group. Heterogeneity [χ 2 = 3.36, df = 1 (P = 0.07); I 2 = 70%] was indicated heterogeneity in the two included studies; therefore, a random-effects model was used. The combined effect size test results were: Z = 1.16 (P = 0.25) (P > 0.01 was not considered statistically significant), OR = 0.70, 95% CI (0.39, 1.28); OR interval contained 1. Thus, there was no significant difference between the incidence of adverse effects in the treatment group and sham-acupuncture or analgesic drug group (Figure 3D).

3.3.5. Risk assessment of publication bias in the literature

Risk assessment for publication bias shows that the scattered distribution is asymmetrical, indicating a possible preference, low-quality, and insufficient sample size of the included literature (Figure 3). The remaining outcome indicators involved a small number of studies; therefore, an inverted funnel plot analysis was not performed.

Table 2.

Risk bias assessment table of the included studies

Study Country Random sequence generation Allocation concealment Blinding of participants and personnel Blinding of outcome assessment Incomplete outcome data Selective reporting Other bias
Foroughinia S et al 202028 Nasrin Low Low Low Unclear Low Unclear Unclear
Elden H et al 200833 Sweden Low Unclear Low Low High Unclear Unclear
Silva JBGD et al 200534 Brazil Unclear Low Unclear Unclear Low Unclear Unclear
Silva JBGD et al 200435 Brazil Unclear High Unclear Unclear Low Unclear Unclear
Silva JBGD 200736 Brazil Unclear High Unclear Unclear High Unclear Unclear
Kvorning N et al
200437
Sweden Low Low Low Unclear Low Unclear Unclear
Christer PO et al 200029 Sweden Low Low Low Unclear Low Unclear Unclear
Gan YL et al 202131 China Low Unclear Unclear Unclear Low Unclear Unclear
Xu Y et al 201532 China Low Unclear Unclear Unclear Low Unclear Unclear
Xie HY 201338 China Unclear Unclear Unclear Unclear Low Unclear Unclear
Joan C 201739 China Unclear Unclear Unclear Unclear Low Unclear Unclear
Jia YZ 201540 China Unclear Unclear Unclear Unclear Low Unclear Unclear
Huang WY, Luo BZ 201941 China Low Unclear Unclear Unclear Low Unclear Unclear
Jiang X 202142 China Unclear Unclear Unclear Unclear Low Unclear Unclear
Long Y et al 201443 China Unclear Unclear Unclear Unclear Low Unclear Unclear
Zhao YL 201730 China Low Unclear Unclear Unclear Low Unclear Unclear

4. DISCUSSION

Pregnancy-related diseases, also called gestational diseases, not only affects the body of the pregnant woman, continuation of pregnancy, and normal development of the fetus, but also threatens life. Chinese medicine attaches great importance to the prevention and management of pregnancy-related illnesses during pregnancy.

Traditional Chinese Medicine believes the following: women take blood as their innate; abundance of blood seas and the provision of twins are inseparable from the spleen and stomach to transport the water valley and metamorphosis of Qi and blood to nourish; the blood polyocytomer palace nourishes the fetus during pregnancy; there is Yin blood deficiency during pregnancy. In the Yi Xue Zhong Zhong Can Xi Lu,44 it is recorded that “both men and women rely on kidney Qi for strength, and the kidney is strong and self-sufficient.” The kidney is the innate foundation, the root of the yuan Qi. The kidney Qi is strong, and the heavenly decay is required for conception. The kidney mainly hides the essence, the main division Chong Ren, and the uterus, and has a decisive effect on pregnancy. The maintenance and nurturing of twins should be first considered as a cause for the rise and fall of the kidney Qi. The spleen and stomach are the foundation of the acquired nature, the source of Qi and blood biochemistry. The embryo is derived from the maternal sperm blood and implanted in the maternal uterus. The uterus, whether in function or in the meridians, is inseparable from the spleen and stomach to transport the water valley and causes metamorphosis of the Qi and blood for nourishment of the fetus. The onset of pregnancy diseases is related to Yin and blood deficiency, spleen and kidney deficiency, Qi rebellion and Qi stagnation.45 If the spleen is weak, the source of Qi and blood biochemistry is insufficient, and the fetus is not adequately nourished. When the spleen is weak and wet, the skin is submerged or water stops in the cells, resulting in NVP or pain in the lower back and abdomen. When the kidney is weak, the kidney sperm will be lost, and so will the fetus. If the kidney Qi is weak, the fetus will not be solid and will be lost, resulting in pain in the waist and abdomen, or even vaginal bleeding. This will result in preeclampsia or miscarriage, affecting the life and health of pregnant women and their fetuses. The Qi of the Chong Qi is rebellious, and after pregnancy, the menstrual blood gathers in the Chong Ren and uterus to nourish the fetus. Clinical treatment often involves notifying the kidneys, strengthening the spleen, and regulating the Qi and blood. Acupuncture is used to select different meridians and acupuncture points according to the symptoms; Zusanli (ST36) and Shenmen (HT7) are the main points.46

Pregnancy is a critical physiological process in the lives of women. However, due to individual physical, environmental, and psychological factors, they are often accompanied by various symptoms, including insomnia and anxiety, low back and pelvic pain, NVP, and even severe vomiting during pregnancy.12,47,-49 Pregnancy discomfort is reportedly associated with hormonal and uterine changes in a pregnant female body.2,8,50

In this study, acupuncture treatment in pregnant women was found to be superior to Western Medicine in terms of clinical efficiency, VAS scores, and NRS symptom scores. However, no significant differences were observed in the incidence of adverse effects between the acupuncture group and the sham-acupuncture or analgesic group. In clinical practice, antihistamines, parenteral nutrition, vitamin supplementation, or psychotherapy are primarily used in the treatment of NVP or even HG.29 To date, interventions to relieve low back and pelvic pain during pregnancy include paracetamol and nonsteroidal anti-inflammatory drug, exercise, rest, cold or hot compresses, transcutaneous electrical stimulation, and abdominal or back support devices.8,51 Tricyclic derivatives, amitriptyline medication, or psychological counseling are commonly used to alleviate emotional abnormalities in pregnancy.52 Drugs such as trazodone and diphenhydramine are commonly used in the treatment of insomnia during pregnancy.53 Conventional rehydration or western anti-inflammatory and analgesic drugs are used as symptomatic treatment. However, they do not target the etiology and are associated with the risk of side effects.54,55

All 16 studies included in this analysis used acupuncture, which is a traditional Chinese method of treatment with a complete theoretical system and long history.56,57 As an alternative non-pharmacological therapy, it is widely used at home and abroad.58,59 In the treatment of NVP, acupoints on the Yangming Gastric and Conjugate Heart meridians, such as Neiguan (PC6), Zusanli (ST36), and Zhongwan (CV12) acupoints, are the most commonly used. The acupuncture points of Neiguan (PC6), which is one of the eight chakra meeting points, are mainly used to treat vomiting, eruption, stomach pain, and dysentery. To relieve pain in the lower back and pelvis, the acupuncture points of A-Yi and kidney and large intestine acupuncture are used to nourish the liver and kidneys, and to cultivate and consolidate the origin. For the treatment of insomnia, the acupuncture points of Taixi (KI3), Shenmen (HT7), Zusanli (ST36), and Neiguan (PC6) are used; Taixi (KI3) nourishes the liver and kidneys, Shenmen (HT7) nourishes the heart and calms the mind, and Zusanli (ST36) generates stomach energy and nourishes the origin of the heart. The acupuncture points of Shenmen (HT7), Yintang (EX-HN3), and Hegu (LI4) are used for treating emotional abnormalities; Yintang (EX-HN3) nourishes the heart and calms the mind, and Hegu (LI4), which is the point where the Qi and blood converge and the original point of the large intestine, can elevate and lower turbidity and promote Qi and blood.54,58 Acupuncture is easy and inexpensive to perform, and the incidence of serious adverse events is reportedly much lower than that of Western Medicine, indicating a certain degree of safety.54

Only 16 RCTs were included in this study, which is a small volume, and a majority of the studies had small sample sizes.

Four studies34,35,37,29 had sample sizes less than 30, and only two33,31 had volumes greater than 50. The methodological quality of the included projects was poor; only three studies had allocation of hidden information,28,33,37 in only four28,33,37,29 the investigators were blinded to the study group and subjects, in only one33 blinded measurements were utilized, and in three33,35,36 the outcome data was incomplete. All of these can lead to bias in selection and results. Inconsistencies in acupuncture points, techniques, and treatments included in the studies could have affected the results of this analysis. Therefore, results of the final analysis should be considered and applied with caution. The reliability of the results will need to be validated in the future through high-quality RCTs with larger samples, multicenter studies, and more suitable and standardized study methods for acupuncture, to promote the internationalization and modernization of acupuncture.55

In this systematic review, we comprehensively evaluated the therapeutic effects of acupuncture. We found that acupuncture was more effective than herbal, Western, and placebo treatments (sham acupuncture) in relieving discomfort during pregnancy. However, owing to the low quality and heterogeneity of the evidence, further studies are needed to confirm this hypothesis.

5. ACKNOWLEDGMENTS

We thank every participant who was willing to complete our research regardless of their work overload.

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