Pinning Down your Lunch when Pregnant – Drugs or Acupuncture?

Acupuncture for pregnancy-associated nausea 

In a 2015 Cochrane review, a respected medical journal that summarizes research over time and evaluates its quality, put together two “meta analysis” of research on acupuncture and nausea. One was on morning sickness and the other was on nausea after surgery. Both studies found that needling PC6 was indeed effective in reducing nausea. This is very impressive because most research on modalities considered “alternative” to mainstream medicine do not pass the Cochrane review evaluation. They found that while the studies were not the best quality they did show that needling PC6 was better than using sham acupuncture. As described above, sham acupuncture is minimal acupuncture with possible specific (non-placebo) effects used as a control in research studies. There is no true “placebo” in acupuncture research like there can be in drug studies.  The Cochrane review also found acupuncture with PC6 is comparable to taking an anti-nausea medication. So as we discuss ahead next Diclectin drug, the effects may be small but significant.

Gord Grant, Acupuncturist

Gord Grant, PhD, RAc; discusses the health and drug context of pregnancy associated nausea

Drug treatment for pregnancy-associated nausea – by Gord Grant

 The drug Diclectin is a commonly prescribed by doctors; in fact, it is the only approved drug in Canada to treat nausea and vomiting in pregnancy.  This drug, usually seen by doctors as a first line treatment, is a combination of the compound doxylamine (an antihistamine) and vitamin B6 (pyridoxine).  Unlike the infamous drug thalidamide which was used for pregnancy in the 1950’s and caused birth defects, no epidemiological studies have found any negative effects on the developing fetus. Thalidamide was used to treat many conditions, including  insomnia, coughs, colds and headaches.   At this time the use of medications during pregnancy was not strictly controlled, and drugs were not as thoroughly tested as they are today.  Thalidimide paved the way for proper research and controls. Drugs now still get carefully monitored, especially during pregnancy; over 33 million women have used the combination of pyridoxine/doxylamine during pregnancy, and scientific analysis on more than 200,000 exposed pregnancies have show there is no harmful to the unborn baby or later to the developing child. This drug is generally “recognized as having no adverse effects. The most commonly reported adverse reaction of doxylamine is drowsiness, (as is with all non-specific antihistamines). Otherwise, adverse drug reactions associated with doxylamine succinate may include: vertigo, nervousness, epigastric pain (since it affects stomach acid production), headache, palpitation, diarrhea, disorientation, irritability, convulsions (a rare but noted effect), urinary retention or insomnia.” (Wiki – note: bracketed words are are our comments).

We expect a drug not only to be safe, but effective, right?! Recent data however has come to light to change how we see Diclectin; this information was not originally published with the initial research that validated its use.  It has been revealed this drug may not work much better than a placebo. Dr. Persaud, from St Michael’s Hospital in Toronto, recently discovered this discrepancy via the drug transparency legislation called Vanessa’s Law, and analyzed the Health Canada documents about Diclectin. His paper concludes that there is no “clinically important benefit” of taking Diclectin to help alleviate nausea and vomiting during pregnancy. To be deemed “clinically effective” a drug must reduce a symptom 3 points better than placebo – this drug only marginally reduced nausea (by 0.7). 

To go one step further, a discussion in the British Medical Journal regarding a clinical case study, offers a glimpse into the concerns and complexity that doctors have regarding mass research data.  The issue at hand is when should a doctor pay more careful attention to a problem like nausea and not just treat the symptom.  One of these doctors was concerned by the way nausea in pregnancy can be too quickly treated by simple responses like Vitamin B6 (or the drug doxylamine that B6 as coupled in Diclectin).  In the discussion he stated, “Pregnancy sickness should be taken seriously as a (possible) signal of nutrient deficiencies. It should not be regarded as an opportunity for randomized trials of pharmaceutical drugs or unmonitored single nutritional supplements (like vitamin B6).”:Pregnancy, cortisol, oestrogens and oral contraceptives can induce vitamin B6 deficiency by increasing the activity of the enzyme tryptophan oxygenase, which requires vitamin B6 as a co-factor.”  He goes on to describe the importance of this in essential fatty acid metabolism, the importance of Zinc in the diet for B6 absorption and magnesium for B6 metabolism, and finally the interaction of B6 with other B vitamins! He argued strongly against unscreened women been given supplements or drugs as a first line approach without further investigation.  He argued, “hormonal imbalances like primary dysmenorrhoea (painful periods), pregnancy sickness, premenstrual syndrome, and menopausal flushing etc) “are usually warning signs of multiple biochemical upsets and an inability to cope with changes in hormone levels. Common nutritional deficiencies increase adverse reactions to foods and chemicals. Therefore giving sporadic or continuous single nutrient supplementation, or even pharmaceutical drugs, is unlikely to prevent the recurrence of daily symptoms.”  This sounds like a holistic doctor looking after someones whole nutritional and biochemical health!  Ideally, this should be the goal of all therapists, acupuncturists, ND’s, GP’s and specialists;  it is complex and it is based on knowledge and science and evidence.  But most of all, it is based on applying this information uniquely to the person at hand, not to the mass data of people who have subtle yet important different circumstances and health states.

This can be problematic, since an investigative approach by doctors is time consuming and expensive; for common problems that are not serious, the medical system supports more practical and simple treatments that often can resolve the main symptom (like a drug prescription). If the problem is not resolved or new problems emerge your doctor is trained to investigate more deeply with more tests to better understand the problem.

Take come message :

Acupuncture can work alone or in conjunction with Diclectin.  You can combine acupuncture with safe, common and relatively less studied remedies like peppermint, ginger, and vitamin B6 alone. Temporary diet changes can also be helpful. The banana, rice, applesauce, and the toast diet (BRAT diet) can be helpful in reducing nausea and is usually well tolerated.  Acupuncture is a safe, effective, and affordable way to combat the discomfort of morning sickness without side effects. But make sure you work with your doctor and acupuncturist to understand your health as the foundation of both the problem and the treatments.

Regardless of working with your medical doctor, or your second line therapist (such as your acupuncturist, nutritionist or ND), be careful not over simplify your problem down to a single solution (even if it is safe), especially conditions which do not resolve quickly.  Further investigation with your doctor to understand the problem may be needed.

References

Dr. Persaud’ findings on the drug Diclectin

http://www.jpsmjournal.com/article/S0885-3924(00)00185-8/fulltext

https://www.ncbi.nlm.nih.gov/pubmed/11843784

http://www.cochrane.org/CD003281/ANAESTH_wrist-pc6-acupuncture-point-stimulation-prevent-nausea-and-vomiting-after-surgery

http://www.cochrane.org/CD007575/PREG_interventions-nausea-and-vomiting-early-pregnancy

http://www.bmj.com/rapid-response/2011/10/30/vitamin-b6-nausea-and-vomiting-pregnancy

https://link.springer.com/article/10.1007/s40272-014-0065-5#Sec13