Comparative Effectiveness of Pharmacological and Non-Pharmacological Interventions for Nausea and Vomiting in Pregnancy: A Systematic Review and Network Meta-Analysis.
- 2026-04-20
- Nutrients 18(8)
- Lőrinc Frivaldszky
- Mahmoud Obeidat
- Péter Hegyi
- Csongor Kárpáti
- Zoltán Kobza
- Nándor Ács
- Ferenc Bánhidy
- Gergely Agócs
- Boglárka Lilla Szentes
- Márton Keszthelyi
- PubMed: 42075106
- DOI: 10.3390/nu18081293
Study Design
- Type
- Meta-Analysis
- Sample size
- n = 3,017
- Population
- pregnant women with nausea and vomiting in pregnancy
- Methods
- systematic review and network meta-analysis of randomized controlled trials comparing pharmacological and non-pharmacological interventions with placebo; databases CENTRAL, PubMed, EMBASE up to 28 May 2024; data pooled using frequentist pairwise and network meta-analyses; risk of bias assessed using RoB2, certainty of evidence evaluated using CINeMA
- Rigorous Journal
Background: Nausea and vomiting in pregnancy affects up to 80% of pregnant women and may progress to hyperemesis gravidarum, leading to maternal morbidity and adverse pregnancy outcomes. Despite numerous pharmacological and non-pharmacological options, the comparative efficacy and safety of these interventions remain unclear. Methods: We conducted a systematic review and network meta-analysis of randomized controlled trials assessing pharmacological and non-pharmacological interventions for nausea and vomiting in pregnancy. The databases searched included CENTRAL, PubMed, and EMBASE (up to 28 May 2024). Eligible trials compared interventions with a placebo in pregnant women with nausea and vomiting in pregnancy. The primary outcomes were symptom severity, assessed using validated tools. Safety outcomes included adverse effects. Data were pooled using frequentist pairwise and network meta-analyses. The risk of bias was assessed using the RoB2 tool, and the certainty of evidence was evaluated using the CINeMA framework. Results: Of 9844 records screened, 24 randomized controlled trials (3017 participants) met the inclusion criteria, encompassing 16 intervention categories. Network analysis ranked quince, vitamin B6 with pomegranate and mint, acupressure P6, dimenhydrinate, and acupuncture combined with doxylamine-pyridoxine as the most effective interventions for reducing symptoms of nausea and vomiting in pregnancy, with considerable uncertainty and low-to-moderate quality of evidence. Reporting of adverse events was limited. Risk of bias was low to moderate. Discussion: Most interventions demonstrated significant benefit over a placebo. However, high heterogeneity and sparse reporting of adverse effects warrant caution when translating these results into clinical practice. Conclusions: This study indicates that both pharmacological (vitamin B6, metoclopramide, dimenhydrinate) and non-pharmacological (ginger, quince, acupressure, acupuncture) interventions might be effective in reducing symptoms of nausea and vomiting in pregnancy.
Research Insights
This study indicates that both pharmacological (vitamin B6, metoclopramide, dimenhydrinate) and non-pharmacological (ginger, quince, acupressure, acupuncture) interventions might be effective in reducing symptoms of nausea and vomiting in pregnancy.
- Effect
- Beneficial
- Effect size
- Moderate
This study indicates that both pharmacological (vitamin B6, metoclopramide, dimenhydrinate) and non-pharmacological (ginger, quince, acupressure, acupuncture) interventions might be effective in reducing symptoms of nausea and vomiting in pregnancy.
- Effect
- Beneficial
- Effect size
- Moderate
Adverse Events Reported
Reporting of adverse events was limited.
- Finding
- Reported
- Magnitude
- sparse reporting of adverse effects
Reporting of adverse events was limited.
- Finding
- Reported
- Magnitude
- sparse reporting of adverse effects