Acupuncture and Pregnancy: Classical Meets Modern (2024)

Traditional Chinese Medicine (TCM), including acupuncture, has been growing worldwide for about 40 years. In recent years, it has gradually developed from a generalist perspective to a more specialist one. This is particularly true of TCM gynecology, as its influence is increasing worldwide. According to a survey conducted in Australia and New Zealand, 96% of acupuncturists are regularly treating patients for gynecological problems.¹ Considering the history of TCM, it has been used to treat gynecological diseases for more than 2,500 years. Ancient practitioner Zhang Zhongjing (c. 150–219 ce) wrote special chapters on gynecological pregnancy diseases in the book Jingui Yaolue (Essential Prescriptions of the Golden Coffer).

Beginning in the 1970s, American media reports on acupuncture anesthesia in China aroused people's interest in this ancient traditional medicine all over the world and brought the Western medical community's attention to the analgesic effects of acupuncture. Since then, attention has also been turned to the treatment of pain in gynecological diseases using acupuncture. In the late 1980s, acupuncture began to be used to intervene in the field of obstetrics and gynecology. Lyrenäs et al. first published a clinical observation study on acupuncture intervention in labor and pain during childbirth in the Journal of Gynecologic and Obstetric Investigation.² Dunn et al. also found that using electrical stimulation of SP6 and Liv 3 acupoints to enhance uterine contractions in the intervention of post-dates pregnant women significantly increased the frequency and strength of uterine contractions compared to the placebo.³ Later, a review of randomized controlled trials and systematic reviews also indicated the benefits of using acupuncture to treat and manage pregnancy-related issues such as nausea, back and pelvic pain, breech presentation, and pain relief in labor.⁴ Although there is a growing interest in the use of acupuncture during pregnancy and it is highly safe in the general population, some clinical studies have linked acupuncture during pregnancy with a small number of mild adverse effects with needling, unspecified pain, or bleeding. The “forbidden points in pregnancy” is a controversial area that requires further studies.⁵

Since 1996, reproductive physicians in Europe have begun to pay attention to the role of acupuncture intervention in in vitro fertilization-embryo transfer (IVF-ET). Stener et al. first published an electric acupuncture intervention trial in IVF-ET, and their studies showed that electroacupuncture can reduce the blood flow impedance parameters of the uterine artery in embryo transfer patients, speculating that electroacupuncture can increase the hemoperfusion of the endometrium, improving the conditions for embryo implantation, and thereby improving the pregnancy rate.^6,7 In 2002, Paulus et al. used body acupuncture in IVF-ET, and the study found that it could significantly improve the clinical pregnancy rate. The publication of this paper aroused great interest in the reproductive medical field. Its acupuncture treatment prescription was soon adopted by other clinical reproductive medicine experts and was praised as the “gold protocol.”⁸ However, with the increased numbers of clinical trials, there were conflicting results.^9,10 Recent clinical studies of gynecological acupuncture have entered a bottleneck due to the difficulty in collecting large samples and establishing a suitable control group. Some physicians view that the further extensive promotion and application of acupuncture in the field of obstetrics and gynecology lacks the data to prove its effectiveness through ideal scientific research design and convincing clinical demonstration.¹¹

So, are the results of the acupuncture randomized controlled trials (RCT) reliable? The RCT has been the gold standard for determining the efficacy of therapeutic interventions for more than half a century. The outcome of RCT is typically reported as an average treatment effect. So, conventional RCT is not necessarily the most appropriate approach to evaluating what may be the best treatment for an individual because not all patients respond and those who do may not all respond the same.¹²

Western medicine normally requires a “protocol” for treatment, which adopts a “one-size-fits all” treatment scheme to obtain a general treatment with repeated results, but in recent years, personalized and precision medicine are presenting new opportunities for better patient care.¹² Proposed “one-person trials”¹³ present an interesting possibility for further research, but this approach also has unique challenges. For future trials, we recommend engaging acupuncture practitioners to facilitate the incorporation of TCM diagnosis, individualized acupuncture treatments to implement new clinical research strategies in acupuncture clinical trial designs, including basket, umbrella, and N-of-1 trials. In terms of clinical research, TCM emphasizes treating the same disease with different principles of therapies, now called umbrella trials, and treating different diseases with similar principles of therapies, called basket trials.

TCM emphasizes the individualized treatment based on syndrome differentiation and a tailored medical system. It stresses the importance of personalized treatment from more than 2,500 years ago. The book The Yellow Emperor's Classic of Internal Medicine established an eight-line syndrome differentiation system, which takes Yin and Yang as the general outline and forms a network of personalized diagnosis and treatment systems. The application of Yin Yang theory in modern medicine has been recognized by many mainstream medical journals, as the dynamic balance of molecular biological regulation is illustrated by the Yin Yang symbol.^14–16

How do we improve the curative effect of acupuncture? TCM, including acupuncture, offers opportunities for personalized and more precise approaches to individual patient care. First, the treatment of disease must focus on the “Root” cause, or primary cause of disease. For example, if the cause of infertility is a diminished ovarian reserve, then it the use of Chinese herbs and/or acupuncture should be encouraged in the 2–3 months prior to IVF in order to improve the success rate, instead of just giving 2–3 times the dosage of acupuncture during ET, as this is not in line with the theoretical thinking of TCM. Current clinical studies have shown that acupuncture could improve the number of oocytes retrieved, high-quality embryos, and the clinical pregnancy rate in patients with diminished ovarian reserve during IVF-ET.^17,18

Second, administer treatment according to the TCM pattern called “tailored therapies.” TCM distinguishes each patient's constitution, Yin and Yang attributes, and then tailors the treatment based on individual patient symptoms of characteristics. For example, vomiting in pregnancy can be divided into Stomach Heat or Cold, and different treatment principles should be adopted to obtain the effect.

Third, use preventive treatment. According to TCM, the human body is an organic whole and dynamic balance, and the diseases are cognizable and preventable. If you are already ill, you should be treated promptly and be able to predict the possible development direction of the disease so as to prevent further progress of the illness. For example, improving the tension headache due to the hyperactivity of Liver-Yang (one of the traditional Liver syndromes according to TCM terminology) during the third trimester can prevent the occurrence of hypertension and eclampsia.

Although acupuncture has been used in pregnancy for thousands of years in China, the application of acupuncture worldwide, especially in gynecology, is quite recent, and scientific research on its clinical efficacy has only just started. However, we are pleased to see that on the basis of overall philosophy, TCM theory and modern molecular physiology and medicine have a very close common understanding that the fundamental point of human health is balance. As Harvard Medical School professor Aikawa mentioned, “Ancient philosophers already knew that health is life in balance, but underlying mechanisms are complex. More than a millennium later, we are still attempting to answer the same questions.”¹⁹ Therefore, at present, in the field of medical acupuncture, the main task is to use reasonable modern scientific research methods to prove the effectiveness of acupuncture. Meanwhile, we should remember the ancient comprehensive thinking methods of acupuncture to provide a safe and effective treatment for women's reproductive health.