Ginger

Name: GINGER
Class: Herb
Risk Factor: C

Fetal Risk Summary

The rhizome of the perennial plant, ginger (Zingiber officinale) is used as a dried powdered spice in foods and as a natural medicine for its alleged carminative, cardiotonic, antithrombotic, antibacterial, antioxidant, antitussive, antiemetic, stimulant, antihepatotoxic, antiinflammatory, antimutagenic, diaphoretic, diuretic, spasmolytic, immunostimulant, and cholagogue actions (1). The active ingredients in ginger are thought to be primarily a class of structurally cardiotonic compounds called gingerols. Other pharmacologically active compounds that have been identified in ginger include shogaol, dehydrogingerdiones, gingerdiones, and zingerone. Some of these ingredients inhibit prostaglandin synthetase (cyclooxygenase) but, in some cases, this activity may be confined only to fresh ginger (1).
In a reproduction study in rats, ginger tea (20 g/L or 50 g/L) was given to rats during organogenesis (days 6 through 15) via their drinking water (2). The lower concentration (20 g/L) was equivalent to the ginger tea consumed by humans (2). No maternal toxicity or teratogenicity were seen, but early embryonic loss was double that of the controls (p<0.05) at both doses. In addition, surviving fetuses, especially females, were significantly heavier than controls and had more advanced skeletal growth (2). Another rat study used a patented standardized ethanol extract of Zingiber officinale (EV.EXT 33) to administer doses up to 1000 mg/kg/day during organogenesis (3). Compared to a control group, no embryo toxicity, teratogenicity, or treatment-related adverse effects were observed in the pregnant rats or their offspring.
Several authors have commented on or reported, with mixed results, studies examining the antiemetic properties of ginger in nonpregnant patients (4,5,6,7,8,9 and 10), and a review of this topic was published in 2000 (11). The oral dosage in the studies varied from 1 to 2 g/day of the powdered root or rhizome. Although the exact mechanism of action is unknown, it appears to be a local effect in the gastrointestinal tract rather than a central action (7,10). The effect may be mediated by antagonism of gastrointestinal 5-hydroxytryptamine (serotonin) to prevent stimulation of the vagus nerve and, thus, the vomiting center (8,10). One author commented that ginger has been long used in Chinese herbal or folk medicine for the treatment of pregnancy-induced nausea and vomiting (5).
The efficacy of ginger as an antiemetic in pregnancy was studied in a double-blind, randomized, cross-over trial involving women with hyperemesis gravidarum (12). All the subjects had been admitted to a hospital with hyperemesis and if their symptoms persisted for more than 2 days, they were enrolled in the study after giving informed consent. A total of 27 women at a mean gestational age of about 11 weeks completed the study. The women were administered either powdered root of ginger (1 g/day) or placebo for 4 days, then nothing for 2 days, then given the alternate agent for 4 days. More patients stated a pReference for (p=0.003), and had greater relief from their symptoms (p=0.035), with ginger than with placebo. No maternal adverse effects were observed. The pregnancy outcomes were one spontaneous abortion in the 12th week of gestation, one elective abortion for reasons other than nausea and vomiting, and 25 normal living infants. The mean gestational age at delivery was 39.9 weeks (range 36–41 weeks) with a mean birth weight of 3585 g (range 2450–5150 g). All had Apgar scores of 9–10 at 5 minutes, and none had a congenital abnormality (12).
In a comment relating to the above study, one author urged caution in the use of ginger during pregnancy, citing ginger's action as a thromboxane synthetase inhibitor which, theoretically, could affect testosterone receptor binding and result in adverse sex steroid differentiation of the fetal brain (13). Although the author's research failed to find evidence of toxicity due to ginger, he recommended that it not be used in pregnancy until this effect was studied. No published reports to refute or support this alleged effect, however, have been located.
A 2001 randomized, double-masked study also evaluated the effect on ginger on nausea and vomiting of pregnancy (14). Ginger 1 g/day was compared to placebo for 4 days starting at a mean gestational age of about 10 weeks. Ginger resulted in a significant decrease in the severity of nausea and vomiting. No adverse effects on pregnancy outcome were detected (14).

Breast Feeding Summary

No studies describing the use of ginger during lactation have been located. It is unlikely, however, that small doses of ginger, such as those used as a spice, would affect a nursing infant. The effects, if any, of the higher doses used as an antiemetic are also unknown, but probably of little consequence to the infant. The oral bioavailability of ginger and its active ingredients, however, has not been studied in animals or humans.

References

1. Ginger. The Review of Natural Products. St Louis, MO:Facts and Comparisons, May 2000.
2. Wilkinson JM. Effect of ginger tea on the fetal development of Sprague-Dawley rats. Reprod Toxicol 2000;14:507–12.
3. Weidner MS, Sigwart K. Investigation of the teratogenic potential of a Zingiber officinale extract in the rat. Reprod Toxicol 2001;15:75–80.
4. Mowrey DB, Clayson DE. Motion sickness, ginger, and psychophysics. Lancet 1982;1:655–7.
5. Liu WHD. Ginger root, a new antiemetic. Anaesthesia 1990;45:1085.
6. Bone ME, Wilkinson DJ, Young JR, McNeil J, Charlton S. Ginger root—a new antiemetic. The effect of ginger root on postoperative nausea and vomiting after major gynaecological surgery. Anaesthesia 1990;45:669–71.
7. Phillips S, Ruggier R, Hutchinson SE. Zingiber officinale (Ginger)—an antiemetic for day case surgery. Anaesthesia 1993;48:715–7.
8. Lumb AB. Mechanism of antiemetic effect of ginger. Anaesthesia 1993;48:1118.
9. Arfeen Z, Owen H, Plummer JL, Ilsley AH, Sorby-Adams RAC, Doecke CJ. A double-blind randomized controlled trial of ginger for the prevention of postoperative nausea and vomiting. Anaesth Intens Care 1995;23:449–52.
10. Visalyaputra S, Petchpaisit N, Somcharoen K, Choavaratana R. The efficacy of ginger root in the prevention of postoperative nausea and vomiting after outpatient gynaecological laparoscopy. Anaesthesia 1998;53:486–510.
11. Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth 2000;84:367–71.
12. Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping U. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Rep Bio 1990;38:19–24.
13. Backon J. Ginger in preventing nausea and vomiting of pregnancy: a caveat due to its thromboxane synthetase activity and effect on testosterone binding. Eur J Obstet Gynecol Rep Bio 1991;42:163.
14. Vutyavanich T, Kraisarin T, Ruangsri RA. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol 2001;97:577–82.

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