Expert consensus-based treatment approaches in acupuncture for Hyperemesis Gravidarum: a modified Delphi study

Objectives: Ascertain which acupuncture point combinations and treatment approaches are considered by practitioners to be the most effective in the treatment of Hyperemesis Gravidarum, through consensus of expert practitioners. Design: A modified Delphi consensus study with mixed methods was used. Participants were asked to rate their agreement or otherwise to a list of statements, in three rounds of questionnaires, by use of a seven-point Likert scale. Consensus was defined as a mean rating of ≥ 5. Main outcome measures: The primary outcome of interest was identifying which acupuncture points are beneficial for treatment. The secondary outcomes measures were (a) the importance of making a differential diagnosis, (b) the role of disorders in the Chong Mai leading to Rebellious Stomach Qi, (c) the ideal frequency of treatment, (d) the utility of adjunctive therapies, and (e) themes of importance. Results: Nineteen international acupuncturists were recruited to form the expert panel. Consensus was met on eleven of the 13 acupuncture points. The avoidance of “forbidden points” was supported. Participants agreed that a disorder in the Chong Mai leading to Rebellious Stomach Qi is one of the important pathologies seen. Adjunctive treatments were viewed as useful. The recommended frequency for treatment was minimum three times per week. Themes of safety, practicality, traditional Chinese medicine theory and technique, were identified. Conclusion: Acupuncture techniques are reported by practitioners as effective for treating patterns associated with nausea and vomiting of pregnancy and Hyperemesis Gravidarum. Adjunctive treatments and high frequency of treatment are important to consider for treatment effectiveness.