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The contribution by Kuşcu and Koyuncu on hyperemesis gravidarum discusses various treatment options for this condition.1 However, it totally neglects acupuncture/acupressure for which good evidence is available. A recent systematic review included seven randomised clinical trials with a total of 686 women suffering from morning sickness.2 Six of these trials indicted a positive effect of acupuncture. The obvious concern of women suffering from hyperemesis gravidarum is that drugs may harm their baby. Acupuncture is a relatively safe procedure3,4 and its potential for this indication should not be completely ignored.
Dr Ernst points out the efficacy of acupuncture on relieving the symptoms of hyperemesis gravidarum. Acupuncture may be defined as a safe, alternative therapy, but we do not accept it as a medical treatment. When we wrote our review, we tried to focus on common problems seen in hyperemesis, and current pharmacological management. We tried to summarise what an obstetrician could face, and what he/she could do to solve the problem. We regard acupuncture as an alternative method, which cannot be performed by obstetricians, and so it was beyond the scope of our article.
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