Is acupuncture safe for pregnant women?
Public safety should be our number one priority as health care practitioners. The term “first do no harm” comes up time and time again, that we should use the least dangerous methods of treatment first. And whenever we begin to use treatments that may increase risks of adverse events, the patient should always be fully informed and allowed to give informed consent to that treatment.
When looking at acupuncture and pregnancy, we should be looking at all aspects of pregnancy. This includes prior to pregnancy, during pregnancy and during labor. Based on the available evidence, I present a review on both in vitro fertilization and pregnancy, as well as the safety of acupuncture for common conditions during pregnancy.
IVF and pregnancy rates
A 2014 study comparing acupuncture to no acupuncture in women who underwent fresh embryo transfer found that no treatment resulted in significantly higher pregnancy rates compared to the acupuncture group (64.8% vs 43.6%) and higher live birth rates (56% vs 36%).
A 2011 study on standard acupuncture points versus points that were not on any known meridian line, now referred to as sham acupuncture points. The results of pregnancy rates were standard acupuncture at 45.3% and sham acupuncture at 52.7%.
A 2010 study on penetrating acupuncture vs placebo acupuncture (non-penetrating needles) were applied to the exact same points for IVF. Check out this video to watch a demonstration of the non-penetrating needle in action. In this study, they found the placebo acupuncture to result in significantly higher overall pregnancy rates compared to penetrating acupuncture (47.8% vs 39.8%).
A 2010 study on penetrating acupuncture vs non-penetrating acupuncture showed no major difference between groups, with pregnancy rates of 27% in the penetrating acupuncture group and 32% in the non-penetrating group. As well as birth rates of 25% for penetrating acupuncture and 30% for non-penetrating acupuncture.
A 2009 study on penetrating acupuncture vs non-penetrating acupuncture showed for a third time that non-penetrating acupuncture was superior to penetrating acupuncture 55.1% vs 43.8% but the on-going pregnancy rates and live birth rates in this study were not significantly different between the two groups.
A 2013 study comparing a standard acupuncture formula to sham acupuncture (acupuncture at non-acupoints), and a control group which received no treatment, the standard acupuncture was superior to both the sham and control group (35.7%, 7.1%, 10.7%).
5 of the 6 studies performed between 2009 and 2014 determined that standardized penetrating acupuncture was not beneficial to the success of IVF and in some cases may have actually had a negative effect on the success of embryo transfer, pregnancy rates and even live births.
Therefore based on the available evidence, I cannot recommend penetrating standardized acupuncture for IVF at this time. However, if there is new evidence to emerge in the future, I am willing to change my stance on this.
Safety of acupuncture during pregnancy
According to a systematic review of the safety of acupuncture during pregnancy, acupuncture appears to be associated with few adverse events when correctly applied during pregnancy. So let’s look at the numbers, rather than just rely on the abstract.
27 reports were selected for review based on the criteria and were analyzed for adverse events. Of these, the most frequent design was case reports/series (51.4%) followed by randomized control trials (40.0%), controlled clinical trials (5.7%) and surveys (2.9%).
Of these studies, several were conducted on pregnant women who had pelvic girdle pain or low back pain, and needling was performed on the low back, which is considered a forbidden area of needling during pregnancy and also included points such as BL-60 and LI-4, which are supposedly contraindicated during pregnancy. No adverse events relating to pregnancy were found during these studies.
Secondly, there were trials done on acupuncture for pregnant women with nausea and vomiting which found no adverse events occurred during early pregnancy.
There were trials done on acupuncture as well for the following conditions in pregnant women; breech presentation, tension-type headache, dyspepsia, emotional complaints including depression, insomnia, and tennis elbow which all did not find any adverse events relating to pregnancy that were likely caused by acupuncture.
In fact, two studies were done on rats and tried to purposely use some of the forbidden points (LI4 and SP6, and BL27 and BL28) during pregnancy to induce abortions and were unsuccessful.
The most common adverse events for women undergoing acupuncture during pregnancy were the exact same adverse events that a non-pregnant person would likely experience, including bruising, pain at the needle site, bleeding, tiredness, headache and/or drowsiness, which are rare in both this review and a previous post on this blog. The total incidence of adverse events in the acupuncture group in this review was 1.9%, and only 1.3% were likely to be caused by acupuncture, none of which were serious adverse events relating to pregnancy.
Acupuncture appears to be safe for use in common conditions during pregnancy without any risk of adverse events relating to pregnancy, even if forbidden points are used. There is no published evidence in peer reviewed journals that any of these points cause spontaneous abortion and a review of thirty five historical and modern texts in an article by Stephen Birch found that there were considerable inconsistencies between historical sources, between historical and modern sources and between different modern traditions which listed points as contraindicated during pregnancy. Surprisingly according to the article, it is a routine recommended treatment in Japan to use SP-6 with moxa in pregnancy after the fifth month to help the mother and baby and in preparation for labor.
The conclusions of my review of the current available literature for IVF are again that penetrating acupuncture at standardized points do not appear to increase pregnancy and live birth rates compared to both non-penetrating acupuncture or no acupuncture at all, and in fact may cause a decrease in pregnancy and live birth rates. However, no comparisons between non-penetrating acupuncture and no acupuncture were found, leaving the possibility that non-penetrating acupuncture may provide an acupressure effect to the points, which may result in an improvement. Perhaps penetrating acupuncture may be too traumatic during IVF, but non-penetrating acupuncture may provide a more gentle approach of stimulating the points. A three armed randomized controlled trial should be done to test this hypothesis.
The conclusions of my review of the current available literature on the safety of acupuncture during pregnancy are that acupuncture appears to be safe during pregnancy, even when so-called forbidden points are used, and can be used by pregnant women to treat common conditions such as; low back pain, pelvic girdle pain, breech presentation, tension-type headache, dyspepsia, emotional complaints including depression, insomnia, and tennis elbow without any apparent increased risk of adverse events relating to pregnancy.