Comparison of quince with vitamin B6 for treatment of nausea and vomiting in pregnancy: a randomised clinical trial

Abstract

This trial was performed to compare quince (Cydonia oblonga) fruit with vitamin B6 on 76 pregnant women with a gestational age of 6-14 weeks and mild-to-moderate nausea and vomiting (NVP) (40 in the quince and 36 in the B6 group). The 'Pregnancy-Unique Quantification of Emesis' (PUQE-24) scale was used to examine the severity of NVP. The quince syrup (1 tablespoon/TDS) or vitamin B6 tablets (20 mg/TDS) were used as intervention for 1 week. The mean (±SD) age was 27.5 (±5.2) years. The score of the PUQE was decreased from 9.5 (± 2) at baseline to 5.2 (±2.3) on the 7th day and 5.3 (±2.6) on the 14th day (p < .001) in the quince group. In the other group, the scores were 8.4 (±1.8), 7.3 (±2.4) and 7.7 (±3.8), respectively (p = .001). The change in symptoms were more marked in the quince group (p < .001). Quince syrup seems to be a suitable treatment for NVP. Impact statement What is already known on this subject: Pregnancy-induced nausea and vomiting (NVP) is one of the most common problems during gestation. Treatment is mainly symptomatic, ranging from dietary changes and oral pharmacological treatment to hospitalization in severe forms. In early pregnancy, the use of chemical drugs is avoided, so there is an increasing tendency to use alternative therapies. According to the literature review in Iranian Traditional Medicine (ITM), the quince fruit (Cydonia oblonga) can be useful in NVP. Quince has a wide range of pharmacological activities including antioxidant, antibacterial, antifungal, anti-inflammatory, hepatoprotective and antidepressant effects. ITM literature suggests some therapeutic effects of the quince fruit on important organs like brain, heart, liver and stomach. What the results of this study add: The results of this study demonstrated the significant efficacy of quince in comparison with vitamin B6. What the implications are of these findings for clinical practice and/or further research: This fruit is also safe to be administered in pregnant women suffering from NVP.

Herbal Medicinal Product Use During Pregnancy and the Postnatal Period

“…Sample size ranged from 27 to 500 women in interventional studies, 187 to 860,215 women in observational studies, and one to five women in case reports. Seven studies collected data during the first trimester of pregnancy; 71,82,85,88,96,105,107 10 during the second trimester; 41,58,67,81,83,84,87,89,101,108 12 during the third trimester; 38,62,64,80,91,92,100,102,103,106,109,110 five throughout pregnancy; 69,70,75,90,95 five around the time of labor (a few hours before or after delivery); 37,59–61,77 nine throughout pregnancy and the postnatal period; 14,31,39,72–74,78,79,111 three during the third trimester and the postnatal period; 40,112,113 20 during the postnatal period only; 24,34,56,63,65,66,68,76,86,94,97–99,104,114–119 and two did not specify the precise point during pregnancy of data collection. 57,93…”

“…The methods used to identify adverse events and herb–drug interactions were clinical examination; 37–41,56,57,59,60,63,70,81,82,105,107–112,114–119 patient interviews; 61,65,78,86,93,100,106 patient questionnaires; 24,31,34,72–74,76,85,90,94,95,97–99 diary cards; 62,66,68 laboratory or imaging studies (ie, hematologic and biochemical results, ultrasonography); 71,79,102,120 and review of medical records. 14,64,65,75,77,88,91,92,96,100,113 Eleven studies did not mention how adverse events or herb–drug interactions were identified.…”

“…Thirty-one studies identified and reported the incidence of adverse events. 14,24,56,61,64–70,72–75,81–84,86–89,93–96,99,100,105,106 Fourteen studies reported that no adverse events were observed 57,58,60,62,63,68,71,80,85,101–104,118 (see Appendixes 1–4, available online at http://links.lww.com/AOG/B334, for details). Table 1 reports the most commonly used herbal medicinal products and their reported safety issues.…”

“…The absence of adverse events were reported in 11 interventional studies assessing evening primrose oil capsules, 60 dill infusion for labor induction, 80 red sage for oligohydramnios, 57 ginger for nausea and vomiting during pregnancy, 58,101 Chinese herbal medicine for intra-uterine growth restriction, 102 quince for nausea and vomiting in pregnancy, 85 pine bark 103 and 1% green tea ointment 63 for episiotomy wound healing, saffron for labor induction, 62 and a polyherbal infusion to increase milk production. 104 One prospective cohort study assessing tea (black green, and herbal) consumption during pregnancy and adverse birth outcomes also reported absence of adverse events.…”

“…71 More than half of these studies were of poor 101–104 or average quality. 80,85 Moreover, those studies deemed to be of high quality suffered from a variety of methodologic issues, including small sample sizes, 58,62 absence of a power calculation, 60 short exposure period, 58 and failure to validate exposure. 71 Therefore, these studies should not be taken as evidence of safety based on absence of harm, and further robust studies are required.…”