Acupuncture in Pregnancy

Acupuncture is an excellent tool for the treatment of various conditions during pregnancy. As a non-pharmacological method, it is ideally suited to this delicate time period in a woman's life. Indeed one of its main advantages is arguably the avoidance of unnecessary medication, the potential harms of which are exemplified by the devastation caused by thalidomide, which was of course originally introduced as a treatment for pregnancy-associated nausea and vomiting. Acupuncture may be used antenatally, for labour and delivery, and even during the postnatal period. Given the lack of any evidence of harm following acupuncture treatment during pregnancy,1 which is further highlighted by the accompanying paper by Carr,2 the aim of this editorial is to provide an overview of the current indications for obstetric acupuncture, to share my personal experience in this area, and to offer some practical suggestions for treatment.  Much of the acceptance of acupuncture within the scientific community is due to pioneering work that demonstrated its effectiveness for the treatment of nausea and vomiting. While most well-designed studies have focused on chemotherapy-induced or postoperative nausea and vomiting, there is evidence that acupuncture can also be effective in pregnancy-associated nausea and vomiting across the spectrum from morning sickness to hyperemesis gravidarum.3 Around the time of delivery, it has been shown to be effective as a complementary or alternative technique for intrapartum analgesia,4 and acupuncture and/or moxibustion at BL67 is often used to promote cephalic version in breech presentation,5 ,6 typically between 33 and 35 weeks’ gestation. Acupuncture and related techniques may also be used to increase the …

section_content: Acupuncture may be an excellent tool for pregnancy. Moreover, much of its acceptance by scientific community is due to the pioneers well designed studies which demonstrated that it could be effective in gravidic nauseas [1]. 

Acupuncture can be used in antenatal period, in deliverance and postnatal. In deliverance, it is used experimentally as an optional and complementar tecnique for analgesia [2]. It can be also used before conception, both to increase the chance of a normal pregnancy and improve rates of artificial insemination or in vitro fertilization [3]. 

The use of acupuncture in the obstetrics pathologies of pregnancy like miscarriage threat and Specific Hypertensive Disease of Pregnancy is understudied although Betts et al. [4] call attention for the use in the first case. The relative success in treating Essential Hypertension in other kind of patients [5] may be a stimulus for its use in the second case, but there is not enough clinical experience yet. 

Besides emesis gravidarum, acupuncture seems to be effective -like in the absence of pregnancy -in low back and pelvic pain [6] [7] [8], tensional headache [9] insomnia [10], depression [11] and dyspepsia [12], clinical conditions that significantly impair the development of pregnancy and the quality of life of pregnant. We could not forget the use of acupuncture in hypogalactia [13] and for cephalic version in breech presentation [14]. Despite these results, there is still strong concern about using acupuncture in pregnancy. The traditional literature -here understood as textbooks that are based exclusively on Traditional Chinese Medicine [15, 16] -raises suspicions about the risk of using certain points because they might be abortifacient and should be 'forbidden'. We have been worked in the last years to show that this concern is groundless [17]. An overview of literature shows the opposite. Acupuncture in these 'forbidden' points could induce uterine contractions but only in post-term pregnant women, during labor or in cases of fetal death [18, 19]. On the other hand, it could protect animals from preterm labor induced by oxytocin [20]. In other words, acupuncture has a bidirectional regulatory effect [21]. 

Traditional and modern authors show us that acupuncture plays an homeostatic role [22, 23]. If it can normalise physiological parameters, why should it have a harmful effect when a pregnancy is normal [24] ? At least two experimental studies demonstrated that acupuncture [25] or electrodes [26, 27] in forbidden points do not produce deleterious effects to the pregnancy development. This unsustainable fear must end. The use of acupuncture in pregnancy should be encouraged. It may be an outstanding option in prenatal care. Being a non-pharmacological therapy it can avoid many complications drugs may cause in this delicate phase of female life.
section_name: Editorial