title: Effect of acustimulation on nausea and vomiting and on hyperemesis in pregnancy: a systematic review of Western and Chinese literature.
abstract: BACKGROUND
  Nausea and vomiting in pregnancy (NVP) and hyperemesis gravidarum (HG) have a significant impact on quality of life. Medication to relieve symptoms of NVP and HG are available but pregnant women and their caregivers have been concerned about the teratogenic effect, side effects and poor efficacy. The aim of this review was to investigate if there is any clinical evidence for the efficacy of acustimulation in the treatment of NVP or HG.
  
  
  METHODS
  A systematic review of randomized controlled trials (RCTs), including both English and Chinese databases was conducted to assess the efficacy of various techniques of acustimulation for NVP and HG. The methodological quality of the studies was assessed using the Cochrane's risks of bias tool. Revised STRICTA (2010) criteria were used to appraise acustimulation procedures. Pooled relative risks (RRp) and standard mean deviations (SMD) with 95% confidence intervals (CI) were calculated from the data provided by the investigators of the original trials.
  
  
  RESULTS
  Twenty-nine trials including 3519 patients met the inclusion criteria. Twenty trials could be included in statistical pooling. The overall effect of different acustimulation techniques shows a significant reduction for the combined outcome for NVP or HG in pregnancy as a dichotomous variable (RRp 1.73, 95% CI 1.43 to 2.08). Studies with continuous outcome measures for nausea, vomiting and the combined outcome did not show any evidence for relieving symptoms of NVP and HG (SMD -0.12, 95% CI -0.35 to 0.12).
  
  
  CONCLUSIONS
  Although there is some evidence for an effect of acustimulation on nausea and vomiting or hyperemesis in pregnancy, results are not conclusive. Future clinical trials with a rigorous design and large sample sizes should be conducted to evaluate the efficacy and safety of these interventions for NVP and HG.
authors.affiliation: Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium. vdheuvel.els@gmail.com.
authors.forename: Els
authors.initials: E
authors.lastname: Van den Heuvel
authors.affiliation: Department of General Practice, KU Leuven, Leuven, Belgium.
authors.forename: Maria
authors.initials: M
authors.lastname: Goossens
authors.affiliation: Department of Family Medicine and Primary Health Care, Interuniversity Training Centre for General Practitioners, Leuven, Belgium.
authors.forename: Hilde
authors.initials: H
authors.lastname: Vanderhaegen
authors.affiliation: Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
authors.forename: Hai Xia
authors.initials: HX
authors.lastname: Sun
authors.affiliation: Department of General Practice, KU Leuven, Leuven, Belgium.|Department of General Practice, University of Maastricht, Maastricht, Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Buntinx
mesh_terms: D015670:Acupuncture Therapy; D002681:China; D005260:Female; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000628:therapy*; D009325:Nausea / Q000628:therapy*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D019366:Western World