Clinical Kit 95 Acupuncture Safety in Pregnancy
Acupuncture Safety and Pregnancy
For those of you that are dry needling or practicing acupuncture, one of the delicate clinical areas is the interplay of needling during the first 3 months when the rate of spontaneous abortion is highest (20%). Along with good clinical practice (good communication and gaining client consent before needling) research is indicating that there is probably no link between needling and spontaneous abortion, in fact possibly the opposite. This has previously been discussed in a Clinical Kit newsletter.
Another area relates to the needling of traditional chinese medicine points that have been graphically termed 'forbidden points'. Just published is an open source document in Acupuncture in Medicine http://aim.bmj.com/content/33/5/413?etoc titled The safety of obstetric acupuncture: forbidden points revisited. It was written by Dr David John Carr, Institute of Medical and Biomedical Education, St George's, University of London.
Background/aim Although the safety of acupuncture per se in pregnancy is reasonably well accepted, there remains debate regarding needling at points historically considered to be ‘forbidden’ during pregnancy. This article reviews the scientific literature on this topic.
Main findings There is no objective evidence of harm following needling at forbidden points, summarised by the following four lines of evidence. (1) In 15 clinical trials (n=823 women receiving n=4549–7234 acupuncture treatments at one or more forbidden points) rates of preterm birth (PTB) and stillbirth following are equivalent to those in untreated control groups and consistent with background rates of these complications in the general population. (2) Observational studies, including a large cohort of 5885 pregnant women needled at forbidden points at all stage of pregnancy, demonstrate that rates of miscarriage, PTB, preterm prelabour rupture of membranes (PPROM), and preterm contractions (preterm labour (PTL) or threatened PTL) are comparable with untreated controls and/or consistent with their anticipated incidence. (3) There is no reliable evidence that acupuncture/electroacupuncture (EA) can induce miscarriage/labour, even under otherwise favourable circumstances such as post-dates pregnancy or intrauterine fetal death. (4) Laboratory experiments using pregnant rats have demonstrated that repeated EA at forbidden points throughout gestation does not influence rates of post-implantation embryonic demise or cause miscarriage, fetal loss or resorption.
Conclusions These findings are reassuring and will help individualised risk:benefit assessment before treating pregnant women. Given the numerous evidence-based indications for obstetric acupuncture and lack of evidence of harm, risk:benefit assessments will often fall in favour of treatment.
Professor João Bosco Guerreiro da Silva has also written an interesting Editorial piece on Acupuncture in Pregnancy for the Journal Acupncture in Medicine. You can read the start of the article here and those that have access can read the full article via their instituation or membership.
Love to hear your thoughts and experiences.
Doug Cary FACP
Specialist Musculoskeletal Physiotherapist (awarded by Australian College of Physiotherapy, 2009)
PhD Candidate Curtin University
Clinical Director AAP Education
ph/fx: 08 90715055