There are 490 documented positive pregnancy outcomes after use of ginger root during pregnancy registered with the European Medicines Agency (EMA). Data indicates that no malformation or fetal toxicity was associated with the use of ginger root during pregnancy. But, because they require a minimum of 1,000 cases to determine safety, the EMA still advises a precautionary measure, and states, “it is preferable to avoid the use during pregnancy.”
However, published studies and other reliable sources including the Natural Medicine Data Base and the American Herbal Products Association (AHPA) both consider it likely safe or safe. From the Natural Medicine Data Base: “PREGNANCY: LIKELY SAFE…when consumed in the amounts typically found in foods. POSSIBLY SAFE…when used for medicinal purposes. Despite some early reports of adverse effects and one observational study suggesting that taking dried ginger and other herbal supplements during the first 20 weeks of pregnancy marginally increased the chance of stillbirth, most research shows that ginger is unlikely to cause harm to the baby. The risk for major malformations in infants of parents who took ginger when pregnant does not appear to be higher than the baseline rate of 1% to 3%). Also, other research suggests that ginger intake during various trimesters does not significantly affect the risk of spontaneous abortion, congenital malformations, stillbirth, perinatal death, preterm birth, low birth weight, or low Apgar scores. Ginger use has been associated with an increase in non-severe vaginal bleeding, including spotting, after week 17 of pregnancy.”
A 2018 review assessed effectiveness and safety of ginger consumption during early pregnancy. A systematic literature search was conducted on Medline until the end of December 2017. For the evaluation of efficacy, only double-blind, randomized, controlled trials were included. For the evaluation of the safety, controlled, uncontrolled, and pre-clinical studies were included in the review. No toxicity issues could be extrapolated to humans from in vitro results. In vivo studies did not identify any major toxicities. Concerning efficacy and safety, a total of 15 studies and 3 prospective clinical studies had been studied. For 1 g of fresh ginger root per day for four days, results show a significant decrease in nausea and vomiting and no risk for the mother or her future baby.
Other studies:
Chittumma P, et al. Comparison of the effectiveness of ginger and viamin B6 for treatment of nausea and vomiting in early pregnancy. A randomized double-blind controlled trial. J Med Assoc. Thai. 2007; 90 (1):15-20.
Fischer-Rasmussen, W, et al. Ginger treatment of hyperemesis gravidarum. Eur. J. Obstet. Gynecol. Reprod. Biol. 1991; 38(1): 19-24
Keating A. Chez R. Ginger syrup as an antiemetic in early pregnancy. 2002; Altern. Ther. Health Med. 2002; 8(5)L 89-91.
Smith C, et al. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet. Gynecol 2004; 103(4):639-645.
Sripramote M, Lekhyananda N. A randomized comparison of ginger and vitamin B6 in the treatment of nausea and vomiting of pregnancy. J Jed. Assoc. Thai. 2003; 86: 846-853.
Vutyavanich T, et al. Ginger for nausea and vomiting in pregnancy: Randomized, double-masked, placebo-controlled trial. Obstet. Gynecol 2001; 97(4): 577-582.
Willetts K, et al. Effect of a ginger extract on pregnancy-induced nausea: A randomized controlled trial. Aust. N.A. J. Obste. Gynacecol 2003; 43(2):139-144.
The current study, the subject of my report and commentary was conducted to determine the safety of a concentrated ginger root extract used by pregnant women for gastrointestinal discomfort. The study included 51 women who met the inclusion criteria and were pregnant for less than three months. The patients could take a maximum of two 50-mg ginger extract tablets daily for gastrointestinal discomfort.
Each tablet contained 50 mg ginger dry extract corresponding to 500 mg ginger dry powder. The product is standardized at 10-15% gingerols.
Outcomes included the number of complications in pregnant women and malformations and complications in newborns. These were compared with Flemish women who delivered during the study period.
Two patients had a miscarriage. One of those patients had not taken any study tablets. The other patient, who took two tablets daily, miscarried after 17 weeks of pregnancy. Three hospitalized patients suffered from hyperemesis gravidarum. One of them was induced at 36 weeks and five days because of her symptoms. Three patients had diabetes mellitus; one delivered a baby with hip immaturity at 39 weeks and one day. She had taken an excessive amount of ginger at 19 ginger tablets. Two patients who had cholestasis delivered early. Five patients had preterm labor and three of them delivered prematurely.
Four newborns were born prematurely with developmental hip dysplasia and one of those, who also had a growth restriction of the corpus callosum, was born to a woman who did not take any ginger tablets. Another infant, although they did not have abnormalities, was born to a patient who took 55 tablets and suffered from hypertension during her pregnancy. The third infant was born to a patient who took 19 ginger tablets and who had diabetes during her pregnancy. The fourth infant was born to a patient who took five tablets but did not suffer any complications.
A mother who had taken 11 ginger tablets, had an infant with a malformation on one foot. A mother who had taken 3 ginger tablets, gave birth to a child who underwent a procedure to correct a lip abnormality.
Thirty of the pregnant women considered the ginger tablets to be sufficiently effective.
Commentary: A few items of note. Several of the women had a previous history of miscarriage. It would have been more useful to screen out those women and not included them in the study. Hypertension as also fairly common in the participants. That also would have been a health condition that could have meant those women were excluded from the study.
Several randomized controlled trials suggest that ginger may be both safe and effective for the nausea and vomiting associated with pregnancy. Doses between 500 mg and 1,500 mg per day have been used and some would advise that doses not greater than 1 gm per day be used due to the potential emmenagogue effects for ginger. However, there has been no reported scientific or medical contraindications for using ginger during pregnancy. [1]
Nausea and vomiting are the most common unpleasant symptoms during pregnancy. 50% to 90% of women experience these complications.
A 2009 study was a single-blind controlled randomized clinical trial in women in Iran, up to 20 weeks of pregnancy. [2] Thirty two women received ginger and thirty five received placebo. One ginger (250 mg) or placebo capsule four times per day was given over the course of four days. Women were also asked to record nausea intensity twice a day. At the end of four days, a researcher completed the questionnaire based on the woman’s responses. Nausea intensity improved in 84% of those who used the ginger and in 56% of the women in the control group. The incidence of vomiting in the control group was 9% decreased and 50% decreased in the ginger group. This study showed not only a positive effect, but women were satisfied with that effect and no complications were observed during the treatment period.
At least four previously published randomized, controlled trials prior to the 2009 study have shown success in the use of ginger for nausea and vomiting of pregnancy. Doses of 1,000 mg – 1,500 mg per day have been used previously. In one of these studies, 2003, the efficacy of ginger was compared to vitamin B6.[3] Women with nausea and vomiting of pregnancy received either 500 mg of ginger or 10 mg of B6 per day for 3 days. Both ginger and vitamin B6 significantly reduced the average nausea scores, ginger from 5.0 to 3.6 and vitamin B6 from 5.3 to 3.3 which was not considered statistically significantly different. There was no placebo group. In another of these studies, women who were fewer than 20 weeks pregnant, a ginger extract was tested on 120 women with morning sickness. Women received either 125 mg of the extract, which was equivalent to 1.5 gm per day of dried ginger or placebo, four times per day for 4 days. Significant decreases in nausea were seen in the ginger extract group, but no significant differences were seen between the ginger and the placebo group in vomiting. [4] Nausea scores were significantly reduced and the number of vomiting episodes were significantly decreased when compared to placebo in 70 women at or before 17 weeks of gestation when taking either 1 gm/day of ginger 4 days. [5] An earlier study in 1990 studied 30 women with hyperemesis gravidarum.[6] Women were given 250 mg of ginger for 4 days and then a 2 day washout followed by or placebo lactose four times daily for 4 days. And lastly, in another, when women were taking the ginger, they experienced a significant improvement in their symptoms compared to placebo.[7]
Commentary:
My conclusion with reviewing this report, the Natural Medicine Data Base and the published studies on the matter, is that the available evidence suggests that ginger is safe to use in pregnant women for nausea of pregnancy in doses of 1,000-1,500 mg/day.
Reference: Laekeman GM, Van Calsteren K, Devlieger R, Sarafanova E, Van Limbeek J, Dierckxsens Y. Ginger (Zingiber officinale) root extract during pregnancy: a clinical feasibility study. Planta Med. August 2021;87(10-11):907-912.
[1] Fulder S, Tenne M. Ginger as an anti-nausea remedy in pregnancy: the issue of safety. Herbalgram 1996;38:47-50.
[2] Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea and vomiting. J Alternative and Complementary Medicine 2009;15(3):243-246
[3] Sripramote M, Lekhyananda N. A randomized comparison of ginger and vitamin B6 in the treatment of nausea and vomiting of pregnancy. J Med Assoc Thai 2003; 86(9):846-853.
[4] Willetts K, Ekangaki A, Eden J. Effect of a ginger extract on pregnancy-induced nausea: a randomised controlled trial. Aust N Z J Obstet Gynaecol 2003;43 (2):139-144.
[5] Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol 2001;97(4):577-582.
[6] Fischer-Rasmussen W, Kjaer S, Dahl C, et al. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 1990;38(1):19-24.
Other relevant studies:
Chittumma P, et al. Comparison of the effectiveness of ginger and viamin B6 for treatment of nausea and vomiting in early pregnancy. A randomized double-blind controlled trial. J Med Assoc. Thai. 2007; 90 (1):15-20.
Keating A. Chez R. Ginger syrup as an antiemetic in early pregnancy. 2002; Altern. Ther. Health Med. 2002; 8(5)L 89-91.
Smith C, et al. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet. Gynecol 2004; 103(4):639-645.
