Onm-10: Ginger Effects on Morning Sickness(Review)

Introduction: Mild-to-moderate nausea and/or vomiting affects up to 80% of all pregnant women, usually peaking by week 9 and subsiding by week 20. For 9% to 20% of women, nausea and vomiting of pregnancy persist longer; Nausea and vomiting are complex responses involving various neural pathways and motor responses to sensory stimuli. Definition: Ginger, the rhizome of Zingiber officinale, is one of the most widely used species of the ginger family (Zingiberaceae) and is a common condiment for various foods and beverages. Ginger has a long history of medicinal use dating back 2,500 years in China and India for conditions such as headaches, nausea, rheumatism, and colds.1 Characterized in traditional Chinese medicine as spicy and hot, ginger is claimed to warm the body and treat cold extremities, improve a weak and tardy pulse, address a pale complexion, and strengthen the body after blood loss. Mechanisms of Action: The mechanism underlying ginger’s anti-emetic activity is not clearly understood, but the aromatic, spasmolytic, carminative, and absorbent properties of ginger suggest it has direct effects on the gastrointestinal tract.Ginger extracts exhibit inhibition of platelet aggregation and thromboxane synthesis in vitro, which has led to concerns ginger extracts may prolong bleeding; however, several European studies using ginger orally did not find any significant anticoagulant effects in vivo. The exact mechanism of action of ginger is thought to be a gastric effect, to increase tone and peristalsis due to anticholinergic and antiserotonin action. Dosage: For most purposes a typical dose of ginger is 1-4 g daily, taken in divided doses. To prevent motion sickness, it is best to begin treatment 1-2 days before the scheduled trip and continue dosing throughout the duration of travel. For nausea and vomiting during pregnancy, ginger tea made from fresh ginger root, boiled and diluted to taste, appears to work best. Side Effects and Toxicity: Ginger is on the U. S. Food and Drug Administration’s GRAS (generally recognized as safe) list. The British Herbal Compendium documents no adverse effects of ginger. Animal studies have reported both mutagenic and antimutagenic effects of isolated components of ginger,and human studies have conflicting results regarding potential inhibition of platelet aggregation when ginger is consumed at high doses. One recent study examined pregnancy outcomes in 187 women known to have consumed ginger during the first trimester and found no statistically significant difference in major malformations, spontaneous abortion, and stillbirth rates between the ginger and the comparison group. The FDA classifies ginger as “Generally Recognized as Safe,” and the German Commission E monographs report no known side effects and no known drug/herb interactions. Adverse effects after ingestion of ginger are uncommon, but they can include mild gastrointestinal effects such as heartburn, diarrhea, and irritation of the mouth. Because there is a possibility that ginger may affect fibrinolytic activity, it may be prudent for patients taking anticoagulants such as war-farin. While data are insufficient to recommend ginger universally and there are concerns with product quality due to limited regulation of dietary supplements, ginger appears to be a fairly low-risk and effective treatment for nausea and vomiting associated with pregnancy. In low doses, this may be appropriate for patients not responding to traditional first-line therapies.Animal studies demonstrate effects on the gastrointestinal tract, the cardiovascular system, on experimental pain and fever, antioxidative, antilipidemic and antitumor effects, as well as central and other effects. The most relevant human pharmacological studies require a confirmatory study to exclude interaction of ginger preparations with platelet aggregation. Pharmacokinetic data are only available for [6]-gingerol and zingiberene. Preclinical safety data do not rule out potential toxicity, which should be monitored especially following ginger consumption over longer periods. Final Comment: Given that many antiemetic medications have the potential for sedation as a side effect, the use of ginger is a reasonable and safe alternative to treat pregnancy-induced nausea and vomiting.