The role of acupuncture in the present approach to labor induction: a systematic review and meta-analysis

Abstract

Objective: This study aimed to evaluate the bibliographic references available on the contribution of acupuncture as a strategy to avoid labor induction and the methodology used; and explore the characteristics of the population and the results of the intervention in order to direct the design of future studies.

Data source: A systematic search for publications between January 2000 and September 2023 of the CENTRAL, PubMed, CINAHL, SCOPUS, ClinicalTrials.gov, and EUDRACT databases was performed.

Study eligibility criteria: We included randomized clinical trials of pregnant women who underwent acupuncture before labor induction with a filiform needle or acupressure, including at least 1 of the following outcomes: spontaneous labor rate, time from procedure to delivery, and cesarean delivery rate. Articles published in English or German language were included.

Methods: Whenever possible, a meta-analysis using RevMan software was performed using a random effects model with the I2 statistic because important heterogeneity in the different acupuncture treatments was expected. When enough data were available, the effect of the participants' characteristics on the results of the interventions were explored using the following subgroups: 1-Age (≥35 vs <35 years), and 2- body mass index (≥30 vs <30 kg/m²). When a meta-analysis was not possible, a narrative synthesis of the results was performed. The quality of the evidence was assessed using GRADE.

Results: Seventeen studies including 3262 women fulfilled our inclusion criteria. The meta-analysis showed no statistically significant differences between groups for outcomes (relative risk, 1.00; 95% confidence interval, 0.91-1.10; I², 11%) comparing acupuncture vs sham acupuncture. However, there was a statistically significant increase in the spontaneous onset of labor rate favoring acupuncture vs no acupuncture (relative risk, 1.12; 95% confidence interval, 1.03-1.23; I², 25%). Regarding the age analysis, no differences between groups were observed in the spontaneous labor rate and cesarean delivery rate for acupuncture vs sham and acupuncture vs no acupuncture comparisons (difference between groups, P>.05).

Conclusion: This study suggests that acupuncture may be beneficial in reducing the rate of induction of labor; however, well-designed randomized controlled trials are necessary. Maternal age ≥35 years and a high body mass index were underrepresented, and the findings may not be representative of the current population in our context.

Keywords: acupressure; acupuncture; labor induction; postterm pregnancy; prolonged pregnancy; randomized controlled trial.