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Nausea and vomiting during pregnancy are common, affecting a large proportion of women (approximately 50-75%). This symptom usually begins in the first trimester and is mostly mild or moderate; however, in some cases, it impairs quality of life, reduces nutritional intake, leads to emotional distress, and, rarely, can develop into serious conditions such as hyperemesis gravidarum.
Pharmacological approaches can be effective, especially in severe cases; however, the fear of drug-related side effects among many pregnant women and physicians is a limiting factor in drug use. Therefore, the role of complementary and non-pharmacological approaches is gaining importance, particularly in pregnant women with mild to moderate nausea. On the other hand, acupressure (especially P6/Neiguan point stimulation) is a non-invasive complementary practice whose effect in reducing nausea and vomiting during pregnancy is debated. Meta-analyses report that acupressure can significantly reduce nausea symptoms in pregnancy. However, there is a need for clearer results in the literature due to methodological differences, variability in effect sizes, and low quality scores of some studies.
Quince (Cydonia oblonga), on the other hand, is not as researched an option as acupressure in the literature for managing nausea in pregnancy. In a study comparing quince syrup with vitamin B6 in the literature, quince was found to be a more effective application than vitamin B6. Quince may theoretically have the potential to reduce nausea due to its positive effects on gastrointestinal motility, its stomach-soothing properties, and its antioxidant compound content. However, randomized controlled trials proving this effect in terms of safety and efficacy during pregnancy are limited.
Nausea during pregnancy not only causes physical discomfort but also reduces quality of life, negatively affects self-care behaviors, and can increase perceived stress levels. Therefore, nausea management should aim not only at symptom reduction but also at supporting the holistic well-being of the pregnant woman. In this context, psychosocial indicators such as the Quality of Life in Pregnancy Scale, Self-Care Ability Scale, and Perceived Prenatal Stress Scale are important in revealing not only the physiological but also the psychological and behavioral effects of complementary practices.
Therefore, examining the effects of quince and acupressure applications on not only the severity of nausea but also on quality of life, self-care ability, and perceived stress levels in pregnant women with mild to moderate nausea will fill the gap in the literature and contribute to the identification of evidence-based, safe, and applicable complementary approaches in the management of nausea in pregnancy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Quince Group | Experimental | Participants will consume approximately 25-42 g of fresh quince daily for 7 consecutive days in addition to receiving standard dietary recommendations for nausea and vomiting during pregnancy. |
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| P6 Acupressure Group | Experimental | Participants will perform P6 (Neiguan) acupressure on both wrists three times daily for 5 minutes per session over 7 consecutive days in addition to receiving standard dietary recommendations. |
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| Control Group | No Intervention | Participants will receive standard dietary recommendations for nausea and vomiting during pregnancy and routine prenatal care. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fresh Quince Consumption | Other | Participants assigned to the quince group will consume approximately 25-42 g of fresh quince daily for 7 consecutive days. The amount was determined based on phenolic content equivalence to quince syrup used in a previous randomized clinical trial. Participants will receive standardized instructions regarding preparation, portion size, timing of consumption, and daily recording of intake. All participants will also receive standard dietary recommendations for the management of nausea and vomiting during pregnancy. |
| Measure | Description | Time Frame |
|---|---|---|
| Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24) Score | Assessment of the severity of nausea and vomiting during pregnancy using the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24) scale. Higher scores indicate more severe symptoms. PUQE-24 Assessment Scale: Lowest Score (0 - 3): Mild nausea and vomiting. Moderate Score (4 - 6): Moderate nausea and vomiting. Highest Score (7 - 15): Severe nausea and vomiting. | Baseline (Day 0), Daily During Intervention (Days 1-7), and Follow-up (Days 8-14) |
| Measure | Description | Time Frame |
|---|---|---|
| Prenatal Perceived Stress Scale Score | Assessment of perceived prenatal stress using the Prenatal Perceived Stress Scale. Higher scores indicate greater perceived stress. PUQE-24 Assessment Scale: Lowest Score (0 - 3): Mild nausea and vomiting. Moderate Score (4 - 6): Moderate nausea and vomiting. Highest Score (7 - 15): Severe nausea and vomiting. | Baseline (Day 0) and End of Intervention (Day 7) |
| Measure | Description | Time Frame |
|---|---|---|
| Quality of Life During Pregnancy Scale Score | Assessment of pregnancy-related quality of life using the Quality of Life During Pregnancy Scale. PUQE-24 Assessment Scale: Lowest Score (0 - 3): Mild nausea and vomiting. Moderate Score (4 - 6): Moderate nausea and vomiting. Highest Score (7 - 15): Severe nausea and vomiting. | aseline (Day 0) and End of Intervention (Day 7) |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Antalya Bilim Üniversitesi | Antalya | Muratpaşa | 00007 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Result | 1. Matthews A, Haas DM, O'Mathúna DP, Dowswell T. Interventions for nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews. 2015;(9):CD007575. 2. Herrell HE. Nausea and vomiting of pregnancy. American Family Physician. 2014;89(12):965-970. 3. Jafari-Dehkordi E, Hashem-Dabaghian F, Aliasl F, et al. Comparison of quince with vitamin B6 for treatment of nausea and vomiting in pregnancy: a randomized clinical trial. Journal of Obstetrics and Gynaecology. 2017;37(8):1048-1052. 4. Gong J, Gu D, Wang H, Zhang F, Shen W, Yan H, Xie J. Effect of acupressure in nausea and vomiting treatment during pregnancy: A meta-analysis. Explore. 2024;20(1):17-26. 5. Soltani H, Forouhari S. Effect of P6 acupressure on nausea and vomiting in pregnancy: A systematic review and meta-analysis. Journal of Integrative Medicine. 2023;21(2):121-131. |
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Individual participant data will not be shared to protect participant privacy and confidentiality.
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| ID | Term |
|---|---|
| D048968 | Morning Sickness |
| D014839 | Vomiting |
| ID | Term |
|---|---|
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D012817 | Signs and Symptoms, Digestive |
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| ID | Term |
|---|---|
| D035061 | Control Groups |
| ID | Term |
|---|---|
| D015340 | Epidemiologic Research Design |
| D004812 | Epidemiologic Methods |
| D008919 | Investigative Techniques |
| D012107 | Research Design |
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This is a single-blind, randomized, parallel-group controlled trial. Eligible pregnant women with mild to moderate nausea and vomiting of pregnancy will be randomly allocated in a 1:1:1 ratio to a quince intervention group, a P6 acupressure group, or a control group receiving standard dietary recommendations. Interventions will be administered for 7 days, followed by a 7-day follow-up period. Outcome measures will be collected longitudinally, and participants will remain in their assigned study arm throughout the trial.
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This study is designed as a single-blind randomized controlled trial. The physician responsible for participant follow-up and eligibility assessment, as well as the statistician performing data analysis, will be blinded to group allocation. Participants and researchers delivering the interventions cannot be blinded due to the nature of the interventions.
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| P6 Acupressure | Other | Participants assigned to the acupressure group will perform P6 (Neiguan) acupressure on both wrists three times daily for 5 minutes per session over a 7-day intervention period. The P6 point is located on the inner aspect of the wrist, approximately three finger widths proximal to the wrist crease between the tendons of the palmaris longus and flexor carpi radialis muscles. Participants will receive face-to-face training and demonstration by the research team. Standard dietary recommendations for nausea and vomiting during pregnancy will also be provided. |
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| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D008722 | Methods |