Clinical Kit 18-03-2014 Needling & Safety During Pregnancy

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I recently received this email from Tenielle Henson (with thanks), which coincided with a systematic review of the related literature, that I thought would be relevant, and of interest to a wider audience.

“ I enjoy getting your news & research updates and having a read through. But I wonder if you have any info on the use of dry needling in pregnant women. As far as I was aware, all was okay as long as the patient had blood pressure managed & wasn't anywhere near the foetus & in general was asymptomatic for any vascular or neural related illness. However, I have a friend who is in the very early stages of pregnancy & who has an Achilles issue of which I recommended I can do dry needling & massage etc. She wasn't keen as a massage therapist had told her no way should she be getting massages or any form of needling, and in particular near the ankles. I find this very interesting and would value your opinion greatly.”

Title

“The Safety of Acupuncture during Pregnancy: A Systematic Review”. You can access it as an open source review article here .

Method

The objective of the review is to identify adverse events (AEs) associated with acupuncture treatment throughout the phases of pregnancy. They reviewed all the standard databases and included 5 Korean language ones up to Feb 2013. Studies of acupuncture for delivery, abortion, assisted reproduction or postpartum conditions were excluded. AE data were extracted and assessed in terms of severity and causality, and incidence was determined.

Results

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

Conclusion

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

Discussion

Concerns over drug use during pregnancy have helped increase the use of non-pharmacological treatments during pregnancy. Specifically in association with pregnancy, acupuncture is used to assist with pain control and moderation of ‘morning sickness’; nausea and vomiting symptoms.

These results need to be considered against a background of recent reports looking at the level of AEs in general acupuncture populations; one a prospective survey on adverse events (AEs), found that the risk of a serious AE with acupuncture is estimated to be 0.01 per 10 000 acupuncture sessions and 0.09 per 10 000 individual patients, which in context are regarded as ‘very low’. Mild AE's like pain, bleeding and fatigue usually are found to be in the range of 8-10%.

One of my personal areas of concern, relates to spontaneous abortions in early pregnancy. The 15 miscarriages reported were all from one study* in which the participants received five sessions of acupuncture over a month for nausea and vomiting in the early pregnancy phase. The reported miscarriage rate was 5% (15/293) in the acupuncture in addition to usual care group, 4% (6/147) in the sham acupuncture in addition to usual care group and 6% (9/143) in the usual care only group. These findings were lower than the population risk estimate of 11% in Australia, suggesting that acupuncture was not associated with a higher risk of miscarriage.

* Smith C, Crowther C, Beilby J. Pregnancy outcome following women’s participation in a randomised controlled trial of acupuncture to treat nausea and vomiting in early pregnancy. Complement Ther Med 2002;10:78–83.

I have previously blogged about safety aspects of needling that you can review here;

All the best,

Doug Cary FACP
Specialist Musculoskeletal Physiotherapist (awarded by Australian College of Physiotherapy, 2009)
PhD Candidate Curtin University
Clinical Director AAP Education

email: doug@aapeducation.com.au

ph/fx: 08 90715055

Have Your Say

Please add your comments and experiences in regards to needling - they are very welcome and of definite interest to other clinicians.

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