---
title: "Nausea and vomiting in pregnancy"
url: "https://acuiq.com/wiki/evidence/nausea-in-pregnancy"
updated: 2026-10-11
last_verified: 2026-10-11
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-11"
reading_minutes: 10
sources: 18
---

# Nausea and vomiting in pregnancy

_What two Cochrane reviews, later meta-analyses, three trials and the NICE, RCOG and ACOG guidelines report on acupressure and acupuncture at PC6 for nausea, vomiting and hyperemesis gravidarum in pregnancy._

Nausea and vomiting in pregnancy, which guidelines shorten to NVP, begins before 16 weeks of pregnancy and has no other cause, in the definition the [Royal College of Obstetricians and Gynaecologists](https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/the-management-of-nausea-and-vomiting-of-pregnancy-and-hyperemesis-gravidarum-green-top-guideline-no-69/) (RCOG) uses. Its severe form, hyperemesis gravidarum (HG), affects between 0.3% and 3.6% of pregnant women by the same source’s count, and interferes with eating and drinking normally. Research on acupuncture for both conditions centres on one point, [`PC06`](/points/PC06) (Neiguan), on the inner forearm above the wrist, which trials press with a finger or a wristband, stimulate electrically or needle. Cochrane keeps two reviews, one for early pregnancy and one for hyperemesis gravidarum.

## The Cochrane review of early pregnancy

The [2015 update](https://doi.org/10.1002/14651858.CD007575.pub4) of Cochrane’s review, by Anne Matthews and colleagues at Dublin City University, searched to January 2015 and included 41 randomised trials with 5,449 women up to 20 weeks’ gestation. The trials tested acupressure, acupuncture, ginger, vitamin B6, anti-sickness drugs and several oils. Women with hyperemesis gravidarum were excluded, since a separate review covers them. The trials measured symptoms on so many different scales that the authors could pool few results, and for the same reason this version has no summary-of-findings table and no GRADE ratings, the system for rating how far an estimate can be trusted. Cochrane has published no later version.

Six trials compared PC6 acupressure, mostly by wristband, with a placebo, and the review could enter data from five, with 601 women. In one trial of 100 women, nausea and vomiting were less severe after four days of acupressure. Trials of 97, 40, 93 and 60 women found no clear difference; the trial of 93 compared the band with no treatment at all, which the review counted as placebo. One trial of 230 women applied low-level electrical stimulation at PC6 and reported more improvement over three weeks than placebo, with more weight gain and less dehydration. One trial of 66 women found no difference in nausea between PC6 acupressure and vitamin B6, though the acupressure group used less rescue medication. Another, of 80 women, reported less nausea on day four with pressure on [`KD21`](/points/KD21) (Youmen), on the upper abdomen, than with sham pressure. Ear acupressure, in one trial of 91 women, showed no significant difference from no treatment.

Two trials with 648 women compared needle acupuncture with sham, and most of their results showed no significant difference for nausea, dry retching or vomiting. The authors concluded that no intervention for early pregnancy had high-quality evidence behind it, and wrote that this differs from finding the interventions ineffective. They also found little reporting of harms to mother or baby.

## The Cochrane review of hyperemesis gravidarum

Cochrane’s [2016 review](https://doi.org/10.1002/14651858.CD010607.pub2) by Rupsa Boelig and colleagues searched to December 2015 and included 25 trials with 2,052 women, spread over 18 comparisons that mostly rested on one small study each. For acupuncture against placebo, no trial reported the review’s primary outcomes. Single trials of 36 and 57 women found no clear difference in anxiety and depression symptoms, miscarriage, preterm birth or perinatal death, at low or very low certainty. In one trial of 81 women, acupuncture and the drug metoclopramide could not be told apart on reducing or stopping nausea (risk ratio 1.40, 95% confidence interval 0.79 to 2.49) or vomiting (risk ratio 1.51, 0.92 to 2.48), at very low certainty. The authors found little high-quality, consistent evidence for any intervention, acupuncture or drug.

## Later reviews

| Review | Scope | Trials (women) | Quality as rated |
| --- | --- | --- | --- |
| Van den Heuvel 2016 | Any acustimulation, NVP and HG, English and Chinese databases | 29 (3,519), 20 pooled | Cochrane risk-of-bias tool; no GRADE |
| Lu 2021 | Acupuncture for HG against conventional treatment | 16 (1,043) | Possible low quality and publication bias, by the authors’ account |
| Gong 2024 | Acupressure for NVP, English and Chinese databases to November 2022 | 33 (3,390) | Not stated |
| Wang 2024 | Acupressure for NVP, randomised trials to July 2023 | 11 (1,378) | Moderate, on the risk-of-bias tool |
| Jin 2024 | Acupuncture for NVP, against sham, drugs, or added to drugs | 24 (2,390) | GRADE moderate to very low |

Several of these reviews count the “effective rate”, the share of women each trial classed as improved on a scale it set itself, alongside symptom scores, and in two of them the measures disagree. [Van den Heuvel and colleagues](https://doi.org/10.1186/s12906-016-0985-4) found more women improved with acustimulation when outcomes were counted that way (risk ratio 1.73, 1.43 to 2.08), but no difference on continuous symptom scores (standardised mean difference −0.12, −0.35 to 0.12), and called the results inconclusive. [Lu and colleagues](https://doi.org/10.1155/2021/2731446) found a higher effective rate with acupuncture than with conventional treatment for HG (odds ratio 8.11, 5.29 to 12.43) and no difference in nausea intensity or the number of vomiting episodes.

[Gong and colleagues](https://doi.org/10.1016/j.explore.2023.06.015) reported more women improved with acupressure (odds ratio 4.81, 3.47 to 6.68), shorter hospital stays and better quality of life, and no difference in anxiety scores. [Wang and colleagues](https://doi.org/10.1007/s00404-023-07313-0) separated sham from other controls. Against sham, symptom scores fell further with acupressure (mean difference −1.33, −2.06 to −0.61), but acupressure made no difference to whether NVP developed, to hospital stay or to satisfaction; one trial reported minor side effects. The authors judged the evidence not yet strong.

[Jin and colleagues](https://doi.org/10.1016/j.ctim.2024.103079) found fewer women unimproved when acupuncture was added to drugs than with drugs alone (risk ratio 0.27, 0.19 to 0.39; 16 trials). Acupuncture alone against drugs gave fewer unimproved women (risk ratio 0.50, 0.30 to 0.81; 5 trials) but no difference on the Pregnancy-Unique Quantification of Emesis score, a standard nausea and vomiting scale (mean difference −0.80, −3.06 to 1.46; 3 trials). Against sham, the effect on depression and anxiety was unclear. Of the 24 trials, 19 used PC6, 16 [`ST36`](/points/ST36) (Zusanli) and 13 [`CV12`](/points/CV12) (Zhongwan). AcuiQ’s catalogue entries for `CV12` and `KD21` carry a caution about needling over the pregnant uterus, which [Pregnancy and the forbidden points](/wiki/safety/pregnancy-and-the-forbidden-points) explains.

A [2026 overview](https://doi.org/10.3389/fendo.2026.1886667) by Cui and colleagues appraised nine of these reviews with AMSTAR 2, a checklist for review methods, and rated one moderate, two low and six critically low. Of the 52 outcomes it graded, 2 reached moderate certainty, 20 low and 30 very low. It concluded that the true effect of acupuncture on NVP remains unclear.

## The trials

The [largest trial](https://doi.org/10.1046/j.1523-536x.2002.00149.x), by Caroline Smith and colleagues at a maternity teaching hospital in Adelaide and published in 2002, randomised 593 women under 14 weeks pregnant to four groups: traditional acupuncture, PC6 acupuncture, sham acupuncture, and no acupuncture. Treatment was weekly for four weeks. Against no acupuncture, the traditional group reported less nausea throughout and less dry retching from week 2, and the PC6 group less nausea from week 2 and less dry retching from week 3. The sham group also reported less nausea and dry retching than no acupuncture from week 3. No group differed in vomiting at any point, and the authors describe a placebo effect that grew with time. A [follow-up of the same women](https://doi.org/10.1054/ctim.2002.0523) found no differences between groups in perinatal outcome, congenital abnormalities or pregnancy complications.

A [2001 trial](https://doi.org/10.1016/s0029-7844(00)01152-2) by Knight and colleagues in Exeter gave 55 women at 6 to 10 weeks either traditional acupuncture or a sham using a cocktail stick, three or four times over three weeks. Median nausea scores fell from 85.5 to 47.5 with acupuncture and from 87.0 to 48.0 with sham, on a visual analogue scale, and the analysis found an effect of time but none of group.

For hyperemesis gravidarum, a [2017 trial](https://doi.org/10.1111/jog.13269) by Adlan and colleagues at University Malaya Medical Centre in Kuala Lumpur gave inpatients a PC6 acupressure band or an identical band that applied no pressure, for 12 hours a day over their first three days in hospital, alongside standard care. Symptom scores improved more with the active band from day 1 to day 3, ketones in the urine fell further and hospital stays were shorter. The only side effect reported was redness at the wrist.

## What guidelines say

NICE’s [antenatal care guideline](https://www.nice.org.uk/guidance/ng201/chapter/Recommendations) (NG201, published 19 August 2021) suggests ginger for mild-to-moderate NVP in women who prefer a non-drug option, and recommends considering acupressure as an add-on treatment for moderate-to-severe NVP (recommendation 1.4.6). Its [rationale](https://www.nice.org.uk/guidance/ng201/chapter/Rationale-and-impact) says the evidence showed benefit for acupressure combined with standard care in moderate-to-severe NVP, and did not show it in mild-to-moderate NVP.

The RCOG’s Green-top Guideline No. 69 has had two editions. The [first, of June 2016](https://www.rcog.org.uk/media/y3fen1x1/gtg69-hyperemesis.pdf), told clinicians that women may be reassured acupressure and acupuncture are safe in pregnancy and that acupressure may improve NVP, a grade B recommendation. The [second edition](https://doi.org/10.1111/1471-0528.17739), by Catherine Nelson-Piercy and colleagues and published in BJOG on 4 February 2024, mentions neither acupressure nor acupuncture; its recommendations cover anti-sickness drugs, fluids and nutrition. The RCOG’s page lists it as the second edition, with review due to begin in 2027.

The American College of Obstetricians and Gynecologists’ [Practice Bulletin No. 189](https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/01/nausea-and-vomiting-of-pregnancy), issued in January 2018, was reaffirmed in 2024. Its full text is open to subscribers only, and this page does not report its position on acupressure. [Acupressure](/wiki/techniques/acupressure) describes the technique.

## What the reviews could not settle

Whether stimulation at PC6 does more than a convincing sham is still open: sham groups improved alongside needled ones in the Smith and Knight trials, the Cochrane reviews found few differences against sham or placebo, and Wang’s pooled sham comparisons of acupressure split by outcome. In two of the later reviews, effective rates favoured treatment where symptom scores showed no difference. Matthews and colleagues asked for consistent, justified outcome measures, and Boelig and colleagues for a consistent definition of hyperemesis gravidarum and larger placebo-controlled trials. Neither Cochrane review has been updated since, and few trials reported harms to mother or baby. [Nausea after surgery](/wiki/evidence/nausea-after-surgery) and [Nausea from chemotherapy](/wiki/evidence/nausea-from-chemotherapy) report the evidence for PC6 outside pregnancy.

AcuiQ’s [nausea in pregnancy](/symptoms/nausea-pregnancy), [morning sickness](/symptoms/morning-sickness) and [hyperemesis gravidarum](/symptoms/hyperemesis-gravidarum) pages list the protocols individual studies prescribed, each with its citation.

### Sources

1. Matthews A, Haas DM, O'Mathúna DP, Dowswell T, Interventions for nausea and vomiting in early pregnancy, Cochrane Database of Systematic Reviews 2015, CD007575 — https://doi.org/10.1002/14651858.CD007575.pub4
2. Boelig RC, Barton SJ, Saccone G, Kelly AJ, Edwards SJ, Berghella V, Interventions for treating hyperemesis gravidarum, Cochrane Database of Systematic Reviews 2016, CD010607 — https://doi.org/10.1002/14651858.CD010607.pub2
3. Van den Heuvel E, Goossens M, Vanderhaegen H, Sun HX, Buntinx F, Effect of acustimulation on nausea and vomiting and on hyperemesis in pregnancy: a systematic review of Western and Chinese literature, BMC Complementary and Alternative Medicine 2016 — https://doi.org/10.1186/s12906-016-0985-4
4. Lu H, Zheng C, Zhong Y, Cheng L, Zhou Y, Effectiveness of acupuncture in the treatment of hyperemesis gravidarum: a systematic review and meta-analysis, Evidence-Based Complementary and Alternative Medicine 2021 — https://doi.org/10.1155/2021/2731446
5. Gong J, Gu D, Wang H, Zhang F, Shen W, Yan H, Xie J, Effect of acupressure in nausea and vomiting treatment during pregnancy: a meta-analysis, Explore 2024 — https://doi.org/10.1016/j.explore.2023.06.015
6. Wang X, Yang G, Li K, Yang F, Liang X, Wu S, Efficacy and safety of acupressure in nausea and vomiting during pregnancy: a systematic review and meta-analysis of randomized controlled trials, Archives of Gynecology and Obstetrics 2024 — https://doi.org/10.1007/s00404-023-07313-0
7. Jin B, Han Y, Jiang Y, Zhang J, Shen W, Zhang Y, Acupuncture for nausea and vomiting during pregnancy: a systematic review and meta-analysis, Complementary Therapies in Medicine 2024 — https://doi.org/10.1016/j.ctim.2024.103079
8. Cui J, Ai Z, Shen W, Han M, Acupuncture for nausea and vomiting during pregnancy: an overview of systematic reviews, Frontiers in Endocrinology 2026 — https://doi.org/10.3389/fendo.2026.1886667
9. Smith C, Crowther C, Beilby J, Acupuncture to treat nausea and vomiting in early pregnancy: a randomized controlled trial, Birth 2002 — https://doi.org/10.1046/j.1523-536x.2002.00149.x
10. Smith C, Crowther C, Beilby J, Pregnancy outcome following women's participation in a randomised controlled trial of acupuncture to treat nausea and vomiting in early pregnancy, Complementary Therapies in Medicine 2002 — https://doi.org/10.1054/ctim.2002.0523
11. Knight B, Mudge C, Openshaw S, White A, Hart A, Effect of acupuncture on nausea of pregnancy: a randomized, controlled trial, Obstetrics and Gynecology 2001 — https://doi.org/10.1016/s0029-7844(00)01152-2
12. Adlan AS, Chooi KY, Mat Adenan NA, Acupressure as adjuvant treatment for the inpatient management of nausea and vomiting in early pregnancy: a double-blind randomized controlled trial, Journal of Obstetrics and Gynaecology Research 2017 — https://doi.org/10.1111/jog.13269
13. National Institute for Health and Care Excellence, Antenatal care (NG201), recommendations, 2021 — https://www.nice.org.uk/guidance/ng201/chapter/Recommendations
14. National Institute for Health and Care Excellence, Antenatal care (NG201), rationale and impact, 2021 — https://www.nice.org.uk/guidance/ng201/chapter/Rationale-and-impact
15. Royal College of Obstetricians and Gynaecologists, The management of nausea and vomiting of pregnancy and hyperemesis gravidarum, Green-top Guideline No. 69, first edition, 2016 — https://www.rcog.org.uk/media/y3fen1x1/gtg69-hyperemesis.pdf
16. Nelson-Piercy C, Dean C, Shehmar M, Gadsby R, O'Hara M, Hodson K, Nana M, The management of nausea and vomiting in pregnancy and hyperemesis gravidarum (Green-top Guideline No. 69), BJOG 2024 — https://doi.org/10.1111/1471-0528.17739
17. Royal College of Obstetricians and Gynaecologists, Green-top Guideline No. 69 (guideline page and version history), accessed October 2026 — https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/the-management-of-nausea-and-vomiting-of-pregnancy-and-hyperemesis-gravidarum-green-top-guideline-no-69/
18. American College of Obstetricians and Gynecologists, Practice Bulletin No. 189: Nausea and vomiting of pregnancy, 2018, reaffirmed 2024 — https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/01/nausea-and-vomiting-of-pregnancy