2021 Evidence-Based Complementary and Alternative Medicine

Acupuncture is an effective approach for hyperemesis gravidarum and has a great potential to mitigate ketonuria, ease nausea and vomiting, increase food intake, and shorten the hospital stay.

Studies meeting inclusion criteria, from 1995 to 2020, have been incorporated into this meta-analysis to make evaluations on the outcome of acupuncture in the treatment of hyperemesis gravidarum (HG). Totally, 16 studies and 1043 patients (531 vs 512) were covered. According to this study, acupuncture was more effective than the conventional treatment of HG; it could better promote the conversion of the urinary ketone to improve ketonuria. In terms of symptoms, acupuncture seems to be more effective in reducing nausea and vomiting and increasing food intake.

In short, acupuncture is an effective approach for HG and has a great potential to mitigate ketonuria, ease nausea and vomiting, increase food intake, and shorten the hospital stay. There is some evidence that acupuncture may be utilized as a supplement and alternative to HG. However, the poor quality of the incorporated studies and potential publication bias can exert a certain impact on the results. For the better clinical application and promotion of acupuncture in the treatment of HG, more large-scale samples, multi-center, and top-quality RCTs are needed urgently. In the future, it is necessary to further study the relationship between acupuncture and conventional medication and acupuncture placebo to obtain the best clinical solution.

Effectiveness of Acupuncture in the Treatment of Hyperemesis Gravidarum: A Systematic Review and Meta-Analysis Haizhen Lu, Chengwen Zheng, Yanmei Zhong, Linhao Cheng, Yi Zhou

2021 Healthcare

Our updated systematic review and meta-analysis suggested that moxibustion has a positive effect on correcting breech presentation.

Our study found that acupuncture-type interventions (including moxibustion, acupuncture, and moxibustion plus acupuncture) at BL67 increase the frequency of cephalic presentation at birth. Moxibustion seemed to be more effective in correcting non-vertex presentation in the Asian population than in the non-Asian population.

Our study included only RCTs that were eligible and up-to-date. To minimalize the impact of potential bias, a sensitivity analysis was performed; such an analysis was not reported as being conducted in most previous studies. After comparing the net effects of different acupuncture-type interventions before and after sensitivity analysis, a positive effect on correcting breech presentation, particularly with moxibustion alone or in combination with acupuncture, is consistent. Our findings provide robust support of the effectiveness of moxibustion on correcting breech presentation.

Correction of Breech Presentation with Moxibustion and Acupuncture: A Systematic Review and Meta-Analysis Liao J-A, Shao S-C, Chang C-T, Chai PY-C, Owang K-L, Huang T-H, Yang C-H, Lee T-J, Chen Y-C

2021 World Journal of Acupuncture-Moxibustion

Acupuncture treatment for postpartum depression is effective and can improve Hamilton Depression (HAMD) Scale, Edinburgh Postnatal Depression Scale (EPDS) and serum estradiol scores.

Meta analysis was conducted in the literature in recent 10 years relating to clinical randomized controlled trials of acupuncture in treatment of postpartum depression, which provided references for acupuncture in treatment of postpartum depression.

Fourteen articles were included in this study, among which, acupuncture group was set as treatment group, and oral administration of fluoxetine as control group in 4 articles; acupuncture group was set as treatment group, and oral administration of maltodextrin granules as control group in 2 articles. The differences in the 6 articles were statistically significant, without interference from other compound factors.

Meta analysis on acupuncture for postpartum depression WANG, J., TAN, L., MEI, Q., ZHENG, Q., YANG, S., & MEI, Z.

2020 Nature and Science of Sleep

Acupuncture was shown to significantly improve the sleep quality in pregnant women, possibly through increasing melatonin secretion.

Fifty-five of 72 participants completed the study. There was no statistically significant difference regarding PSQI score and 6-sulfatoxymelatonin level between intervention and control groups at the baseline. At the end of the study period, treatment with acupuncture significantly improved the PSQI score with a large effect size of 3.7, as well as 6-sulfatoxymelatonin level with a medium effect size of 0.6 as compared to the control group. No adverse effects were noted during acupuncture sessions and follow-up visits.

Acupuncture was shown to significantly improve the sleep quality in pregnant women, possibly through increasing melatonin secretion, and could be recommended as a low-cost and low-risk alternative treatment to pharmacological therapies.

Effect of Acupuncture on Pregnancy-Related Insomnia and Melatonin: A Single-Blinded, Randomized, Placebo-Controlled Trial Foroughinia S, Hessami K, Asadi N, Foroughinia L, Hadianfard M, Hajihosseini A, Pirasteh N, Vossoughi M, Vafaei H, Faraji A, Kasraeian M, Doroudchi M, Rafiee Monjezi M, Roozmeh S, Bazrafshan K.

2020 Cochrane Database of Systematic Reviews

Acupuncture and acupressure for labor pain.

This review of 28 trials encompassing 3960 women assessed the efficacy of acupuncture and acupressure in managing labor pain. Results indicate that acupuncture may enhance pain relief satisfaction and reduce analgesic use. Acupressure, compared to combined control or usual care, may decrease pain intensity. However, evidence quality varies, emphasizing the need for further high-quality research including sham controls, and exploring additional outcomes like sense of control in labor and overall childbirth satisfaction.

Acupuncture or acupressure for pain management during labour Caroline A Smith,Carmel T Collins,Kate M Levett,Mike Armour,Hannah G Dahlen,Aidan L Tan,Bita Mesgarpour

2020 BioMed Research International

Endometriosis and Adenomyosis can have impact on miscarriage risk in pregnancy.

The study analyzed 39 publications involving 697,984 women to assess the impact of endometriosis (EMS) and adenomyosis (AD) on miscarriage risk. Women with EMS showed increased miscarriage risk in spontaneous conception (SC), but similar risk in assisted reproductive technology (ART) compared to tubal infertility. AD was associated with higher miscarriage risk in ART. Sensitivity analyses supported these conclusions. EMS staging did not significantly alter miscarriage risk. Early-stage EMS showed higher early abortion risk. No significant associations were found between EMS and low birthweight, placental abruption, intrauterine growth restriction, or preeclampsia. EMS correlated with higher odds of antepartum hemorrhage, postpartum hemorrhage, preterm birth, placenta praevia, and stillbirth. SUP and DIE were linked to increased miscarriage risk, while OMA showed no significant association. The findings suggest the need for closer monitoring and follow-up for pregnant women with EMS or AD, particularly in early pregnancy. Standardized recording of EMS types, stages, and miscarriage timing is recommended for future studies.

Miscarriage on Endometriosis and Adenomyosis in Women by Assisted Reproductive Technology or with Spontaneous Conception: A Systematic Review and Meta-Analysis Yangxue Huang, Xianhong Zhao, Yiyuan Chen, Jie Wang, Weilin Zheng, Lixing Cao

2019 Journal of the Chinese Medical Association

Traditional Chinese acupuncture seems to be effective in improving some symptoms of postpartum depression.

A total of 887 PPD patients from 12 randomised controlled trials were included in the quantitative meta-analysis, with 443 patients in the treatment group and 444 patients in the control group. Patients in the acupuncture group had significantly better performances assessed by the Hamilton Depression Scale than those in the control group, and the pooled MD was −1.27 (95% CI: −2.55 to 0.01; p = 0.05, I2 = 83%) in the random-effect model. In addition, significantly better performance in the effective rate was observed in the acupuncture group than in the control group, and the pooled RR was 1.20 (95% CI: 1.09 to 1.33; p < 0.0001, I2 = 46%). However, in subgroup analysis for the acupuncture therapy alone, only effective rate showed a significantly better performance.

Traditional Chinese acupuncture and postpartum depression: A systematic review and meta-analysis Tong P, Dong LP, Yang Y, Shi YH, Sun T, Bo P

2019 BioMed Research International

Acupuncture could reduce Hamilton Rating Scale for Depression (HAMD) scores for postpartum depression.

Though our meta-analysis revealed that acupuncture had a lower efficacy compared to other antidepression treatments, symptoms of depression relief were observed in the majority of the studies analysed. These findings indicate that although the efficacy of acupuncture was lower compared to antidepressants, the benefits of acupuncture were still attractive to women with postpartum depression due to their negligible side-effects.

In summary, despite the limitations mentioned above, this current systematic review suggests that acupuncture could reduce HAMD scores. However, EPDS, clinical response, and serum estradiol levels were unaffected by acupuncture treatment. Furthermore, our analysis revealed that treatment efficacy was variable and depended on the control types used. Large-scale and well-designed RCTs are required before a conclusive statement could be made regarding the efficacy of acupuncture for the treatment of postpartum depression.

Effectiveness of Acupuncture Used for the Management of Postpartum Depression: A Systematic Review and Meta-Analysis Li W, Yin P, Lao L, Xu S

2018 Complementary Therapies in Medicine

Chinese herbal medicine improved depression symptoms and severity compared to antidepressants for postpartum depression.

This systematic review provides up-to-date evidence of acupuncture and Chinese herbal medicine for postpartum depression. We found Chinese herbal medicine improved depression symptoms and severity compared to antidepressants. Acupuncture was neither superior nor inferior to sham or antidepressants. Adverse events were similar to sham/placebo and less than antidepressants. The full extent of the effect remains inconclusive due to poor quality extant randomized controlled trials.

A systematic review of acupuncture and Chinese herbal medicine for postpartum depression Yang L, Di YM, Shergis JL, Li Y, Zhang AL, Lu C, Guo X, Xue CC

2018 Acupuncture in Medicine

Acupuncture appears to be effective for postpartum depression with respect to certain outcomes.

Nine trials involving 653 women were selected. The result of this meta-analysis demonstrated that the acupuncture group had a significantly greater overall effective rate compared with the control group. Moreover, acupuncture significantly increased oestradiol levels compared with the control group. Regarding the Hamilton Rating Scale for Depression (HAMD) and Edinburgh Postnatal Depression Scale (EPDS) scores, no difference was found between the two groups.

Effectiveness of Acupuncture in Postpartum Depression: A Systematic Review and Meta-Analysis Li S, Zhong W, Peng W, Jiang G

2018 British Journal of Midwifery

Acupuncture in postpartum depression was at least as effective as fluoxetine hydrochloride, supporting the notion that acupuncture may be a safe and effective option.

Of the 1592 studies reviewed, three met the inclusion criteria for quantitative analysis. Two studies reported no significant differences between acupuncture and fluoxetine for depression, while the third reported significant improvements.

Acupuncture versus antidepressants in the management of postpartum depression: A systematic review Akari Komori, David Arthur, Samara Radford, Hsiewe Ying Tan, Li Zheng, Mira An, Rika Umeda, and Zhen Zheng

2018 Evidence-Based Complementary and Alternative Medicine

Acupuncture alone is more effective in treating postpartum urinary retention than intramuscular injection of neostigmine, with good safety profile.

Based on our meta-analysis, the cure rate and effectiveness rate were significantly better in the acupuncture alone group than in intramuscular injection of neostigmine alone group. Thus, although intramuscular injection of neostigmine is the most commonly used drug for postpartum urinary retention, its efficacy is suboptimal; instead, acupuncture can achieve better curative effect. Moreover, no adverse event was reported in the acupuncture group, demonstrating acupuncture is safe and reliable. Therefore, acupuncture is more effective and safe in treating postpartum urinary retention.

This review of 15 randomized trials shows that acupuncture is more effective and safe in treating postpartum urinary retention compared with intramuscular injection of neostigmine. However, the beneficial findings are inconclusive due to generally moderate evidence, and further large, rigorous trials are still warranted.

Acupuncture Compared with Intramuscular Injection of Neostigmine for Postpartum Urinary Retention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Xiao-Mei Wang, Jing Gong, Si-Cong Li, and Mei Han

2017 Cochrane Database of Systematic Reviews

Acupuncture and acupressure show potential for improving cervical readiness and certain birthing outcomes, their impact on reducing caesarean section rates remains inconclusive.

The study evaluates the efficacy and safety of acupuncture and acupressure for third-trimester cervical ripening or labor induction. Of the 22 trials analyzed, acupuncture's effect on caesarean sections remains inconclusive, while electro-acupuncture appears to influence birthing outcomes like cesarean section rates, instrumental vaginal birth, and spontaneous vaginal birth. The quality of evidence varies, and more comprehensive trials are required to establish their effectiveness and potential safety.

Acupuncture or acupressure for induction of labour Smith CA, Armour M, Dahlen HG

2016 BMC Pregnancy and Childbirth

Acupuncture was a feasible intervention and reduced threatened miscarriage symptoms when compared to a touch intervention.

Threatened miscarriage is a common complication of early pregnancy increasing the risk of miscarriage or premature labour. Currently there is limited evidence to recommend any biomedical pharmacological or self-care management, resulting in a ‘watchful waiting’ approach. The objective of this study was to examine the feasibility of offering acupuncture as a therapeutic treatment for women presenting with threatened miscarriage.

Acupuncture was a feasible intervention and reduced threatened miscarriage symptoms when compared to a touch intervention. Further research is required to further explore acupuncture use for this common complication and whether it can reduce the incidence of miscarriage.

Does acupuncture have a role in the treatment of threatened miscarriage? Findings from a feasibility randomised trial and semi-structured participant interviews Betts D, Smith CA, Dahlen HG.

2015 Cochrane Database of Systematic Reviews

There is moderate‐quality evidence from individual studies suggesting that acupuncture improved pelvic pain more than usual prenatal care.

The evidence is current to 19 January 2015. We included 34 randomised studies in this updated review, with 5121 pregnant women, aged 16 to 45 years. Women were from 12 to 38 weeks’ pregnant. Studies looked at different treatments for pregnant women with low‐back pain, pelvic pain or both types of pain. All treatments were added to usual prenatal care, and were compared with usual prenatal care alone in 23 studies. Studies measured women's symptoms in different ways, ranging from self‐reported pain and sick leave to the results of specific tests.

Interventions for preventing and treating low-back and pelvic pain during pregnancy Liddle SD, Pennick V

2014 Journal of Advanced Nursing

Acupuncture showed both clinically important changes and statistically significant results for management of low back and/or pelvic pain (LBPP) in pregnancy.

Eight studies were selected for full review. Two acupuncture studies with low risk of bias showed both clinically important changes and statistically significant results. There was evidence of effectiveness for osteopathy and chiropractic. However, osteopathy and chiropractic studies scored high for risk of bias. Strength of the evidence across studies was very low.

A systematic review investigating the effectiveness of Complementary and Alternative Medicine (CAM) for the management of low back and/or pelvic pain (LBPP) in pregnancy Close C, Sinclair M, Liddle SD, Madden E, McCullough JE, Hughes C.

2014 Acupuncture in Medicine

Acupuncture during pregnancy appears to be associated with few adverse events when correctly applied.

Of 105 included studies, detailed adverse events (AE) were reported only in 25 studies represented by 27 articles (25.7%). AEs evaluated as certain, probable or possible in the causality assessment were all mild/moderate in severity, with needling pain being the most frequent. Severe AEs or deaths were few and all considered unlikely to have been caused by acupuncture. Total AE incidence was 1.9%, and the incidence of AEs evaluated as certainly, probably or possibly causally related to acupuncture was 1.3%.

The Safety of Acupuncture during Pregnancy: A Systematic Review Park J, Sohn Y, White AR, Lee H.

2013 Medical Acupuncture

There is high-level evidence to support the use of acupuncture for treating major depressive disorder in pregnancy.

Six articles used the desired inclusion and exclusion criteria. The quality of research varied heavily. Five studies were properly randomized. Three were double-blinded. Three used individualized acupuncture. Four studies were of at least reasonable quality. One was of marginal quality, and one was of poor quality. There was a significant difference between acupuncture and at least one control in all six trials.

Acupuncture for Treating Anxiety and Depression in Women: A Clinical Systematic Review Sniezek DP, Siddiqui IJ.

2013 Medical Acupuncture

Acupuncture's efficacy in treating gynecologic and obstetric disorders

This comprehensive review evaluates acupuncture's efficacy and safety in treating gynecologic and obstetric disorders. Examining systematic reviews and randomized controlled trials, the study addresses conditions like pregnancy-related pelvic and low-back pain, labor pain, primary dysmenorrhea, and menopausal symptoms. The results are inconclusive, with some evidence supporting acupuncture's potential in reducing pelvic and back pain during pregnancy and alleviating climacteric vasomotor symptoms. However, more rigorous research is necessary for definitive conclusions. Adverse effects were minimal. The review emphasizes the need for well-designed studies to enhance the precision and reliability of findings regarding acupuncture's therapeutic benefits in these disorders.

Efficacy and Safety of Needle Acupuncture for Treating Gynecologic and Obstetric Disorders: An Overview Selva Olid A, Martinez Zapata MJ, Sola I, Stojanovic Z, Uriona Tuma SM, Bonfill Cosp X.

2012 BMC Complementary Medicine and Therapies

Complementary and alternative medicine (CAM) therapies have the potential to provide supportive care for women presenting with threatened miscarriage.

Within fertility research, acupuncture demonstrates beneficial hormonal responses with decreased miscarriage rates, raising the possibility acupuncture may promote specific beneficial effects in early pregnancy. With the lack of current medical options for women presenting with threatened miscarriage it is timely to examine the possible treatment benefits of providing CAM therapies such as acupuncture.

Acupuncture as a therapeutic treatment option for threatened miscarriage Betts D, Smith CA, Hannah DG.

2010 BJOG: An International Journal of Obstetrics & Gynaecology

Acupuncture ineffective for labour pain relief:

A systematic review and meta-analysis assessed acupuncture's efficacy in relieving labor pain. Ten randomized controlled trials involving 2038 women were analyzed. Acupuncture showed no significant superiority over minimal acupuncture at 1 and 2 hours post-treatment. Electroacupuncture demonstrated temporary pain reduction at 15 and 30 minutes compared to placebo, but effects weren't sustained. When compared to no intervention, acupuncture provided only an 11% reduction in pain for the initial 30 minutes. However, in trials against conventional analgesia, acupuncture led to reduced meperidine and other analgesic use. Overall, evidence doesn't strongly support acupuncture for labor pain, urging further research.

Acupuncture for pain relief in labour: a systematic review and meta-analysis S-H Cho, H Lee, E Ernst