Nausea is a common experience for many women during pregnancy, which varies in onset, severity, and duration. Nausea and vomiting can begin from as early as 4 - 5 wks of pregnancy and be experienced with greater intensity in the first trimester. For some women nausea and vomiting can continue throughout the pregnancy, or flare up again at different stages of pregnancy. However, for the majority of women, nausea and vomiting which has been experienced as chronic and relentless will ease as the pregnancy develops into the second trimester. In a smaller percentage of pregnant women, a severe form of nausea and vomiting known as hyperemesis gravidarum (HG) can also develop if there is difficulty maintaining fluid intake and weight. In the later stages of pregnancy, leading up to birth and during labour, it is also quite common and usually normal for there to be symptoms of vomiting and an intense desire to purge as the body is preparing for birth of baby.

Particularly, in the first trimester the ongoing nature of nausea coupled with intense fatigue can significantly impact quality of life, including physical, psychological and emotional health during the early phase of pregnancy. Unfortunately, the treatment options are limited in western biomedicine to medications which do not always offer effective relieve or address the underlying cause of the nausea in pregnancy.

Acupuncture is a holistic treatment offering a medication free approach to address the underlying cause of nausea and help to reduce the severity of nausea and frequency of vomiting. A recent systematic review and meta-analysis found that treatments with acupuncture and moxibustion (a warming therapy) were more effective than the control group and the conventional therapy group in alleviating nausea and vomiting in early pregnant women (Hu et al 2024). Treatment early in pregnancy helps to support the health of both mother and developing baby and has benefits for the long-term health of the pregnancy.

What is hyperemesis gravidarum? 

Hyperemesis gravidarum (HG) is a severe form of chronic nausea and vomiting which can lead to reduced fluid and food intake, dehydration, weight loss, nutritional deficiencies, electrolyte imbalances, and acid/base imbalance in the body (Fejzo M.S et al 2019). Onset can occur in the first month of pregnancy, usually from 6 – 8 weeks to 16 – 20 weeks of pregnancy. Treatment for hyperemesis usually consists of antinausea medication such as Ondansetron, IV fluids, and treating any micronutrient deficiencies (Fejzo et al 2019). HG is a serious condition which has wide ranging stressful impacts on fetal health and the health of pregnant women both during pregnancy, labour and birth, and post-partum. Women who experience HG in pregnancy are at greater risk of developing post-partum post-traumatic stress disorder (Fejzo et al 2019). There are always potential unknown long-term risks of medication use during pregnancy for the baby due to the limitations around research in pregnant women. However, research has shown Odansetron to be associated with a small increase in the risk of orofacial cleft defects and other congenital malformations in baby’s who are exposed to Odansetron in utero (Medsafe 2020). In Aotearoa-NZ Medsafe only recommends prescribing Odansetron with informed consent on the risks of use, and in cases where the immediate benefits of use for the mother and baby outweigh the potential long-term risk of harm (Medsafe 2020).

Why does nausea occur in pregnancy?

Biomedical Perspective

Biomedical science typically offers a reductionist approach to the body, with the downside being that it does not take into account the complexity of the wholism of body and mind and the influence of psychological and emotional states on physical symptoms. This is often why pharmaceutical medications have both short-term and long-term adverse side effects, and are not able to be researched easily due to the complexity of individual responses and the ethical concerns of research in pregnant women. From a biomedical perspective one of the main understandings of the causes of nausea and vomiting in pregnancy relates to endocrine and gastrointestinal effects which have an influence on the brainstem. The brainstem is an area of the brain also known as the reptilian brain. It shares similar functions with our reptilian ancestors and is involved in instinctual responses in the body such as hypervigilence, survival and sexual impulses, emotions such as rage, anger, as well as states of the nervous system where the dorsal vagal nerve is activated and the body experiences ‘shutdown’ in response to threat, fear of death, or preparation for death. Recent biomedical research has shown a correlation of nausea in pregnancy and HG with a sensitivity to the hormone GDF15, which acts on the brainstem (Fejzo et al 2023). It is understood that women with low GDF15 pre-conception are at higher risk for developing increased sensitivity to rising GDF15 from the growing fetus during pregnancy, and this increased sensitivity is associated with an elevated risk of nausea and vomiting in pregnancy and the development of HG (Fejzo et al 2023). There are also other hormones and receptors which are implicated in the aetiology of nausea in pregnancy including: thyroid stimulating hormone, progesterone and serotonin receptors, and insulin like growth binding factor 7 (Fejzo et al 2019).

Chinese Medicine Perspective

In Chinese medicine nausea and vomiting are commonly understood to occur when the qì (‘energy’) in the body moves in a counter-flow direction rising upwards from the stomach and uterus with a purging quality, rather than the desired natural movement of qì which is to flow downwards into the uterus and down through the legs to the feet and ground (Rochat de La Vallee 2007). One of the patterns commonly seen is when there is an imbalance between Spleen/Stomach (Earth element) and Liver/Gallbladder (Wood element). In Chinese medicine this is known as a disharmony between earth and wood elements in the body. This disharmony is also related to the functioning of a particularly powerful and deep vessel in the body known as the Penetrating Vessel (Chong mai - 衝 脈). The Penetrating vessel connects deeply to the function of the stomach, the womb, the earth element and to how we experience nourishment in life (Chase and Shima 2010). The Penetrating Vessel is formed in-utero and as such it is related to embryonic development of our bodies (Richardson 2018). It is therefore profoundly shaped by our in-utero experience, our birth experience, and by the early years of our life as an infant in the way we were born, and received nourishment through attachment and feeding (Richardson 2018).

Often there can be obstructions to the flow of qì and blood in the reproductive area, this can be correlated with pre-existing biomedical gynaecological conditions such as: endometriosis, fibroids, polycystic ovary syndrome, pelvic inflammatory disease, premenstrual syndrome and premenstrual premenstrual dysphoric disorder. Another common pattern in Chinese medicine is when there is Kidney yīn deficiency, which is often seen when there is a combination of extreme fatigue alongside the nausea or vomiting (Betts 2006). If there is yīn deficiency in the body, it can feel difficult to experience the body connected to the earth and the ground through the feet and legs, and consequently there can be associated symptoms which involve qì rising in the upper body, such as nausea, vomiting, high blood pressure, headaches, migraines, tinnitus, dizziness, heat in head and chest. As well as these symptoms there can also be signs of weakness or fatigue in the lower parts of the body from pelvis and lowerback downwards, and difficulty having a restful sleep at night. During pregnancy a healthy flow of qì and blood throughout the body and particularly from the head, and heart, down to the uterus supports the reduction in nausea, vomiting, headaches and migraines.

Treatment with Acupuncture

A restful acupuncture treatment helps to restore yīn energy in the body and support the re-direction of the qì movement downwards. An acupuncture treatment typically keeps the symptoms at bay for 4 – 5 days post treatment. During acute periods of nausea and vomiting it is recommended to have regular weekly treatment which supports the reduction in symptoms, and offers a preventative health benefit for the remainder of the pregnancy. Often a treatment which supports the release of energy not freely circulating in the occipital and brainstem region, helps to support the free flowing movement of energy in the womb and reproductive area.

Natural approaches and dietary recommendations which may help to alleviate nausea in pregnancy

• Acupressure of acupuncture points: including commonly uses points including Spleen 4, and Pericardium 6, Kidney 27

• Fresh ginger root tea (if the nausea is associated with a pattern of cold). Dried ginger root tea or dried ginger powder is very hot and has a different medicinal effect to fresh ginger tea, so it is best to try fresh ginger tea unless advised otherwise by your herbal medicine practitioner

• Perilla Leaf tea (if nausea is associated with a pattern of cold in the Spleen and Stomach)

• Peppermint leaf tea (if the nausea is associated with a pattern of heat constrained in the Liver/Gallbladder/Stomach/Spleen)

• A commonly used herb in pregnancy in Chinese medicine is Bai Zhu (Rhizoma Atractylodis Macrocephalae - the root of the plant) known to ‘calm the fetus’ when the Spleen energy is compromised and nausea is present in pregnancy

• Regular small meals/snacks to help calm the stomach

• If fluid intake and food intake is difficult, fluids containing nutrients and micronutrients can be incorporated e.g. mineral drops, electrolyte fluids/drops, coconut water, dilute fresh fruit or vegetable juice, miso soup, vegetable or bone broth, clear soups e.t.c

• Avoid very cold or iced drinks and foods, and exposure of the body to cold water and cold environments especially in the colder months as cold food and drinks when consumed regularly weaken the kidneys and the stomach’s digestive fire energy, and can congeal blood in the uterus

• Avoid and limit intake of foods which create dampness in the body, e.g. greasy foods such as fried foods, pastries, processed or roasted high fat foods, refined and very sweet foods, dairy products and cold frozen foods like icecream.

• Cooked grains like rice, millet, sorgum, or oats can help to settle the stomach by building the stomach and spleen qì, as well as providing moisture for the stomach to digest food properly

• Rest is a big factor that helps reduce severity of nausea and vomiting, especially when nausea is due to yīn deficiency and it is accompanied by intense fatigue. Rest helps to replenish yīn energy. The first trimester requires a huge amount of energy in order to support the development of baby. All of the bodies deep neural foundation is being created in the early embryonic and fetal stages of development and this significantly draws on the pregnant women’s reproductive Kidney energy. Adequate rest can include sleep, quite time and rest from mental activity or emotional stress, and activities that help to restore energy e.g. listening to music, gentle movement, walks in nature, baths e.t.c. Anything that creates a space to connect and listen to your body, to your womb and growing baby, and that supports rest for your mind.

If you are considering herbal medicine, or using acupressure in pregnancy it is advised to consult first with a qualified herbal medicine practitioner or registered acupuncturist to best support your health.

If you are experiencing nausea or vomiting in pregnancy and would like to experience some symptom relief and support for the health of your pregnancy you can book online in our Tauranga Acupuncture clinic, or contact Acupuncturist and Chinese Medicine Practitioner Rose Skerten if you have any queries.

Rose Skerten is a registered Acupuncturist and Chinese Medicine Practitioner and Certified Healing Birth Practitioner. She specialises in Birth Trauma Therapy, pregnancy and postpartum acupuncture, acupuncture for fertility and hormonal support, acupuncture for mental health and chronic pain.

References

Betts D. The Essential Guide to Acupuncture in Pregnancy and Childbirth. Hove: Journal of Chinese Medicine Publications; 2006.

Chase C and Shima M. An exposition on the Eight Extraordinary Vessels: Acupuncture, Alchemy and Herbal Medicine. Seattle: Eastland Press; 2010

Fejzo M, Trovik J, Grooten I et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Primers 5, 62 (2019). https://doi.org/10.1038/s41572-019-0120-1

Fejzo M, Rocha N, Cimino I et al. GDF15 linked to maternal risk of nausea and vomiting during pregnancy. Nature 625, 760–767 (2024). https://doi.org/10.1038/s41586-023-06921-9

Hu Y, Yang Q and Hu X. The efficacy and safety of acupuncture and moxibustion for the management of nausea and vomiting in pregnant women: A systematic review and meta-analysis. Heliyon 10 (2024) e24439. https://doi.org/10.1016/j.heliyon.2024.e24439

Medsafe. Ondansetron and oral cleft defects. Medsafe Prescriber Update June 2020, 41(2): 27–28 Accessed from: https://medsafe.govt.nz/profs/PUArticles/June2020/Ondansetron-oral-cleft-defects.html [Accessed Aug 8 2024]

Richardson T and Morris W. Extraordinary Chinese Medicine: The Extraordinary Vessels, Extraordinary Organs, and the Art of Being Human. Singing Dragon, 2018.

Rochat de la Vallèe E. The Essential Women: Female Health and Fertility in Chinese Classical Texts. Monkey Press, 2007.