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Treating Nausea and Vomiting in Being pregnant with Ginger

  • Qi-Cai Liu

Tiran, D. (2012). Ginger to reduce nausea and vomiting during being pregnant: Proof effectiveness is not the same as proof of safeness. Complimentary Remedies in Clinical Practice, 18(1), 22-25. doi: 10. 1016/j. ctcp. 2011. 08. 007

This article presents a systemic overview of the system and safety of using ginger to treat nausea and vomiting in being pregnant (NVP). In the article, the author first introduced the annals of ginger as a normal remedy in some eastern countries, then reviewed the potential threat of several different varieties of ginger which were available in the UK market. From then on, the writer explored the mechanisms of ginger's anti-emetic function. Ginger can inhibit serotonin receptor and suppress vasopressin, as well as reduce tachygastric activity. However, the precise device still remains unclear. The writer pointed out that there was no steadiness in dosages and kinds of ginger among current studies, and the dissimilarities between nausea and vomiting had not been fully understood. Next, the author discussed the safe practices of using ginger. The writer thought that ginger should be treated as a pharmacological medication rather than a "natural" cure. Therefore, it should be given with safe dosages and become obtained from the right plant, Zingiber officinale. Pursuing that, the writer talked about ginger's potential adverse effects, drug-drug connections, as well as contraindications and precautions. For instance, ginger should be contraindicated for women who have a history of miscarriage because anticoagulation is one of its well known side effects. By the end of article, the author offered a contraindications and safeguards checklist, which is very useful for healthcare providers to identify which women should avoid ginger. The restriction of the article is that it didn't emphasize ginger's therapeutic effects. The strength of this article is the valuable basic safety checklist. Overall, this information increased the awareness that ginger, although an all natural remedy, has part results and contraindications too.

Ozgoli, G. , Goli, M. & Simbar, M. (2009). Effects of ginger tablets on motherhood, nausea, and vomiting. The Journal of Alternate and Complementary Medicine, 15(3), 243-246. doi: 10. 1089/acm. 2008. 0406

This article identifies an individual blind medical trial to find out function of ginger on nausea and vomiting in being pregnant (NVP). 70 pregnant women who experienced nausea and vomiting before 20 weeks of gestation participated this analysis. Prior to the treatment with ginger, the baseline degrees of nausea and vomiting symptoms were assessed via a standard aesthetic analogue scale. The individuals were randomly given to the experimental group and control group. In the experimental group, 35 participants were cared for with ginger at a dose of 1000mg/day for 4 times. 35 individuals in the control group were cured with a placebo (lactose) with the same medication dosage and prescription form. The treatment effects were measured by asking members to finish the 4-page questionnaire and record nausea depth twice a day (3 individuals from experimental group failed to complete the questionnaire). A statistically significant decrease in the nausea and vomiting depth with ginger treatment was reported. 85% of women who received the ginger treatment reported an improvement of nausea symptoms, while only 56% reported improvement in the control group. In addition, the vomiting times for the being pregnant are also significantly decreased in the experimental group comparing to regulate group (50% versus 9%). The materials and methods section was well toned with clear description of experimental design, samples selection, data collection and analysis. The strengths of this article will be the strenuous experimental design and large sample size. The restriction of this review, as stated by the authors, is the brief assessment period. Because of this, some ginger undesireable effects may not be able to discover. The results of this review provide some evidence-based information about effects of ginger for NVP.

Ensiyeh, J. , &Sakineh, MC. (2009). Looking at ginger and vitamin supplements B6 for the treatment of nausea and vomiting in pregnancy: A randomised manipulated trial. Midwifery, 25(6), 649-653. doi: 10. 1016/j. midw. 2007. 10. 013

This study conducted a double-blind randomized handled trial to compare the effects of vitamin B6 and ginger for nausea and vomiting in being pregnant (NVP). 70 women that are pregnant who experienced nausea and vomiting symptoms before their 17 weeks gestation participated this study. Half of these were randomly preferred to receive ginger 1g per day treatment for 4 days. Being a control, half of them received vitamin B6 40 mg per day treatment at same time. The nausea strength was measured via a visual analogue level through the treatment plus 24 hours before. The vomiting shows were also saved in the same period. The procedure responses at a 7-day follow-up were measured with a five-point Likert range (one participant from control group didn't go back to clinic later). Their results exhibited that both ginger and vitamin supplements B6 treatment could reduce the symptoms of nausea, and ginger worked well significantly much better than the vitamin supplements (p=0. 024). In conditions to vomiting episodes, both ginger and vitamin B6 could reduce the consistency of vomiting, and there is no factor between them. Within the 7-day follow-up viewing, there were 29/35 members in ginger group and 23/34 individuals in vitamin B6 group reported a loss of nausea reaction (p=0. 52). This trial was smartly designed with large test size, rigorous sampling inclusion conditions, and rigor experimental process. The strength of this analysis is that they assessed and likened the long-term effects of ginger and vitamin B6 on the pregnancy final results, such as abortion and preterm labor and birth. The limitation of this analysis is that they changed the participant's eating, which might influence the treatments and benefits. The findings of this analysis provide some evidence-based understanding of the efficiency of ginger and vitamin supplements B6 in the NVP treatment, as well as their long-term results.

Therapy Assessment

Nausea and vomiting are the most frequent unpleasant problems in early motherhood. There have been about 70-80% of women experienced nausea and 50% of these experienced vomiting episodes during their early pregnancy (Ensiyeh &Sakineh, 2009). That means there are about 350, 000 Canadian women experience nausea and vomiting in being pregnant (NVP) yearly (Lee &Saha, 2011). The pathogenesis of NVP remains unclear. However, it is extensively accepted that NVP is correlated to the hormonal changes during gestation, such as the individuals chorionic gonadatropin (hCG), progesterone, and estrogen (Lee &Saha, 2011). It had been reported that the maximum of NVP is positive correlated to hCG peak, and hCG could regulate gastric simple muscle activity by rousing placental prostaglandin E2 (PGE2) (Lee &Saha, 2011). Progesterone also has a function of gastric emptying by lessening smooth muscle contractility (Lee &Saha, 2011). NVP can cause more undesirable repercussions for the women that are pregnant than unpleasant, such as interpersonal interactions, households, and professions (Ozgoli, Goli, & Simbar, 2009). About 25% of hired pregnant women have to leave their careers due to the nausea and vomiting symptoms (Ensiyeh &Sakineh, 2009). As a result, it could bring some financial and subconscious problem for the coffee lover, which will further influence medical status of themselves and even their babies' (Ozgoli et al. , 2009). Most important, nausea and vomiting symptoms can also change dietary and could lead to malnutrition for themselves and their babies. Therefore, it is very important for the women, who are experiencing NVP, to get treatment in time.

In conditions to the treatments of NVP, there are nonpharmacologic approach and pharmacologic strategy (Lee &Saha, 2011). The nonpharmacologic procedure includes dietary measures, emotional support, acupuncture, and ginger. The pharmacologic approach includes pyridoxin-doxylamine, antiemetics, promotility brokers, and antihistamines. The goal of treatment is release a the symptoms and reduce risks for the women and fetus.

It has a long record for using ginger as an natural and organic medicine to treat NVP in some eastern countries, such as China, Japan, and India (Tiran, 2012). Women that are pregnant in western countries also knew ginger's anti-emetic effects for a long time (Tiran, 2012). However, it was until just lately, the consequences of ginger for NVP were examined in the clinical way (Ensiyeh &Sakineh, 2009; Ozgoli et al. , 2009). Within the Ozgoli et al. analysis (2009), an individual blind clinical trial was conducted to research the consequences of the ginger for NVP. Their results discovered that, 1000mg/day ginger treatment could significant cut down nausea symptoms, as well as decrease the rate of recurrence of vomiting. In Ensiyeh andSakineh study (2009), a double-blind randomized controlled trial was conducted to compare the function of ginger and vitamin B6 for NVP. Their results revealed that both ginger and supplement B6 could reduce the vomiting frequency. The ginger was more efficiency on reduce nausea symptoms than supplement B6, which has a well known results on treating NVP. The strength of these two studies is that they demonstrated the ginger's effects on NVP in the scientific way. However, both studies failed to explore the device about how precisely ginger can effectively treat NVP, and one study failed to measure the long-term adverse effects of ginger. These are the weaknesses of these two studies.

Based on these research results, I would like to say ginger is a highly effective alternative remedy for NVP. In the foreseeable future nursing practice, I'd like to recommend women that are pregnant to use this herbal medicine to treat their NVP warning sign. However, as Tiran (2012) recommended, ginger should also be treated just like a pharmacological drug. I must be very wary of its mechanisms, adverse effects, drug/food relationships, and contraindications prior to making the recommendation. Being familiar with these knowledge will also permit me to educate each pregnant female why she can or cannot take ginger to treat her NVP.

Mechanisms

It established fact that ginger is very effective for treating NVP symptoms (Ensiyeh &Sakineh, 2009; Ozgoli et al. , 2009). However, the system of its anti-emetic effects still remains unclear (Tiran, 2012). What already known are that the three ginger indigents: gingerols, shogaol, and zingiberence, can bind to serotonin (5-HT) receptor and prevent its function to inhibit nausea and vomiting (Tiran, 2012). The major anti-emetic compound in ginger was thought to be gingerols (Tiran, 2012). In addtition, ginger also was reported that it could reduce nausea and vomiting symptoms through suppressing vasopressin to diminish stomach activity (Tiran, 2012). Except these gastrointestinal tract results, Tiran (2012) thought ginger might also have some results on the central stressed system. For instance, it offers sedative and hypnotic functions.

Adverse effects

The adverse effects of ginger can be easily ignored by both pregnant women and health care providers due to its natural remedy personality (Tiran, 2012). Like other pharmacological medications, ginger also offers some undesireable effects (Tiran, 2012). First, ginger has part effects on gastrointestinal tract (Tiran, 2012). Ginger can cause abdomen irritant and then lead to heartburn, which might due to its weakly cholinergic function (Tiran, 2012). Together with the same function, ginger also can promote the bile secretion (Tiran, 2012). It is also reported that terribly chewed ginger can cause intestinal blockage (Tiran, 2012). Therefore, it is necessary to recommend women to masticate ginger properly if they're approved with the dried main ginger (Tiran, 2012). Second, ginger has adverse effects on cardiovascular system. It really is reported that ginger can cause hypotension and that is one reason some women thought dizziness after had the ginger herbal (Tiran, 2012). Ginger can also cause cardiac arrhythmias, which may because of the connections with beta receptors (Tiran, 2012). Third, ginger has side results on the blood vessels. One of its notable part effects is anticoagulant, which escalates the risk of bleeding (Tiran, 2012). Beside that, ginger can also lower the blood glucose level, which might increase the threat of hypoglycemia (Tiran, 2012). Fourth, ginger can produce part effects of hot, sweating, constantly thirsty, and looking for frosty beverages. These symptoms are induced by its cholinergic function (Tiran, 2012). Last, it needs to keep consciousness that the long-term undesireable effects of ginger on fetus development remain not fully comprehended (Tiran, 2012).

Drug/food interactions

Like other pharmacological medications, ginger also offers the interactions with other drugs or food (Tiran, 2012). First, abundant evidences exhibited that ginger can interact with some recommended medications, such as beta antagonists, benzodiazepines, barbiturates, and also other natural herbs such as gingko balboa (Tiran, 2012). Second, ginger has weakly cholinergic function (Tiran, 2012). Therefore it can have conversation with other cholinergic drugs, including antagonists and agonists. For example, ginger can interact with donepezil, a muscarinic agonist, as both can raise the bile secretion. Third, ginger can interact with other drugs which can increase or reduce blood circulation pressure as ginger can cause hypotension (Tiran, 2012). For example, ginger can decrease the anti-hypotension function of epinephrine, an adrenergic agonist. Fourth, ginger can lower blood sugar level (Tiran, 2012). Therefore it can connect to other drugs which can increase or lower blood sugar level, such as insulin and metformin. Fifth, as mentioned previously, ginger gets the function of anticoagulant (Tiran, 2012). Therefore, ginger can connect to other anticoagulant and antiplatelet drugs, such as heparin, warfarin, and aspirin. Last, ginger can cause cardiac arrhythmia (Tiran, 2012). Because of this, ginger can connect to other drugs with can cause cardiac arrhythmia too, such as Levodopa.

Contraindications

As ginger has some undesireable effects and drug connections, it ought to be contraindicated to the women that are pregnant who've relevant diseases or are taking the interactive drugs. First, ginger should be contraindicated for the women with certain gastrointestinal tract diseases (Tiran, 2012). Women that are pregnant with gastroesophageal reflux disease (GERD) or heartburn indication should avoid ginger as it can worsen this warning sign by irritating abdomen (Tiran, 2012). Pregnant women with a history of gallstones should be contraindicated because ginger can encourage the secretion of bile (Tiran, 2012). Dried root ginger should not be prescribed to pregnant women who've lower gastrointestinal tract disease, such as duodenal ulcer, as it may cause intestinal blockage (Tiran, 2012). Second, pregnant women with certain cardiovascular diseases also needs to be contraindicated from ginger (Tiran, 2012). Ginger can cause hypotension (Tiran, 2012), which means women who with hypotension indication or are taking anti-hypertensive drugs to control their blood circulation pressure shouldn't take ginger. Ginger also can cause cardiac arrhythmia (Tiran, 2012). Because of this, ginger should not be prescribed to the women that are pregnant who have cardiac arrhythmia or are taking anti-arrhythmic drugs, such as Na+ and K+ channel blockers. Tiran (2012) even advised that the herbal remedies and complementary therapies should be contraindicated for pregnant women who've major cardiac diseases. Third, ginger should be contraindicated for women that are pregnant with bleeding disorders as it has a function of anticoagulant. Tiran (2012) recommended that any pregnant women who had a brief history of miscarriage, vaginal bleeding, or clotting disorder should not take ginger. These women who may have a surgery several weeks later also should stop taking ginger at least fourteen days before the operation (Tiran, 2012). Fourth, ginger has a function of lower blood sugar (Tiran, 2012). Therefore ginger should be avoided from those women who are taking drugs to regulate their diabetes mellitus, such as insulin and metformin. The ladies who've hypoglycemia also also needs to be contraindicated from ginger. Last, ginger has connections with the benzodiazepines, beta blockers, and gingko biloba (Tiran, 2012). Therefore it should be prevented for the pregnant women who are taking those drugs.

Conclusion

Ginger is an effective herbal remedies in treating NVP although its mechanism still remains to explore. As being a pharmacological medication, ginger has its own adverse effects, medicine/food relationships, and contraindications. Ginger is not always safe for every pregnant girl who are experiencing nausea and vomiting symptoms. The ladies approved with ginger should be informed with its adverse effects and its possible connection with other drugs. In addition, the women, who've certain gastrointestinal tract diseases, certain cardiovascular diseases, bleeding disorders, and hypoglycemia, also needs to be contraindicated from ginger. Overall, ginger should be cared for such as a pharmacological medication rather than natural solution when being approved for NVP treatment.

References

Ensiyeh, J. , &Sakineh, MC. (2009). Contrasting ginger and vitamin supplements B6 for the treating nausea and vomiting in motherhood: A randomised handled trial. Midwifery, 25(6), 649-653. Doi: 10. 1016/j. midw. 2007. 10. 013

Lee, N. , & Saha, S. (2011). Nausea and vomiting of motherhood. Gastroenterology Clinics of North America, 40(2), 309-334. Doi:10. 1016/j. gtc. 2011. 03. 009

Ozgoli, G. , Goli, M. & Simbar, M. (2009). Ramifications of ginger capsules on pregnancy, nausea, and vomiting. The Journal of Alternate and Complementary Medicine, 15(3), 243-246. Doi: 10. 1089/acm. 2008. 0406

Tiran, D. (2012). Ginger to reduce nausea and vomiting during being pregnant: Evidence of effectiveness is different then proof of safety. Complimentary Treatments in Clinical Practice, 18(1), 22-25. Doi: 10. 1016/j. ctcp. 2011. 08. 007

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