https://doi.org/10.15218/ejnm.2025.07 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article Knowledge Practice and Lifestyle among Pregnant Women regarding Nausea and Vomiting in Primary Health Care Centers in Erbil City ABSTRACT Background and objectives: Nausea and vomiting during pregnancy affect pregnant wom- en to varying degrees. Over the years, a large number of modalities have been used to deal with debilitating conditions and the health state of pregnant women. The study aimed to find the prevalence of nausea and vomiting among pregnant women in the first trimester and to study the effect of an educational program on their knowledge and prac- tices regarding complementary and alternative medicine to reduce nausea and vomiting in the first trimester. Methods: A quasi experimental study was conducted from January 2022 to July 2022 among pregnant women who had nausea and vomiting who attended eight primary health care centers in Erbil city. The purposive sampling method was used to select 200 pregnant women. The Rhodes index test was used to assess the rate of nausea and vom- iting. Results: The prevalence of nausea and vomiting among pregnant women in the first tri- mester was 68% in Erbil City. The largest proportion of the participants (46.3%) belonged to the age group 25-34 years. The median of the participants' knowledge score before the intervention was 3, while it significantly increased to 14 after the intervention (p<0.001). The median of their lifestyle score increased significantly from 0 before the intervention to 32 after the intervention (p<0.001). Conclusion: The prevalence of nausea and vomiting among the pregnant women, their complaint about this condition, and their knowledge, practice, and lifestyle regarding nau- sea and vomiting before and after and experienced changed significantly for the better. Keywords: Knowledge; Practice; Lifestyle, Nausea; Vomiting; Pregnant women. Shaymaa Sameer Maqsood; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. (Correspondence: shaymaa.maqsood@hmu.edu.krd) Ibrahim Hasan Mustafa; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. 57 Received: 07/04/2023 Accepted: 18/06/2023 Published: 30/05/2025 Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. mailto:(Correspondence:%20dara.albanna@hmu.edu.krd) mailto:Shaymaa.maqsood@hmu.edu.krd?subject=Shaymaa.maqsood@hmu.edu.krd%20 mailto:jawdat.baker@hmu.edu.krd?subject=jawdat.baker@hmu.edu.krd%20%20%20 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.07 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article During pregnancy, which is a natural event, women's body undergoes numerous changes.[1] Due to the physiological chang- es during pregnancy, required for fetal de- velopment, pregnant women experience various signs and symptoms.[2] Nausea and vomiting are most commonly com- plained about by pregnant women during the early trimester. In spite of the fact that nausea and vomiting of pregnancy (NVP) might happen any time during pregnancy, it is usually called morning sickness.[3] Pregnant women experience NVP, or morning sickness, from the 6th gestational week of pregnancy until the end of the 16th gestational week. [4,5] It is reported that 63% of pregnant women experience NVP during the 1st and 2nd trimesters of pregnancy, which is similar to NVP preva- lence in early pregnancy.[6] If nausea and vomiting are not treated early, pathologi- cal problems will occur due to decreased fluid in the body which in turn leads to in- creased blood concentration and conse- quent decreased blood circulation, re- sulting in bad effects on the growth and development of the fetus.[7] Although pregnant women die due to NVP in rare cases, the probability is still quite high.[8] Due to maternal system changes during pregnancy, pregnant women need to get adapted both psychologically and physical- ly.[9] Nausea and vomiting during pregnan- cy can only be treated by consuming drugs; however, drug consumption has unfavora- ble impacts on the growth and develop- ment of the fetus.[10] For this purpose, complementary medicine, particularly herbal remedies, is used all over the world. [11] Pregnant women can easily be nega- tively affected by the side effects of drugs; therefore, the safety of herbal therapies is particularly significant for them. Pregnancy can progress more as a result of consuming herbal supplements. Disorders caused by pregnancy, such as gastro-esophageal re- flux, nausea, and vomiting, are treated by consuming herbal medicine. [12,13] As re- ported by the media and pregnant women, herbal use is recommended during preg- nancy by pharmacists, natural or alternati- ve medicine practitioners, and health care providers. [14,15,16] Using herbal medici- nes has an important role in managing both minor and major illnesses. [17] Complementary therapies, including her- bal or traditional plants like ginger and peppermint oil, can be utilized to decrease nausea and vomiting during early preg- nancy. [18] As pointed out by the National Center for Complementary and Alternative Medicine (NCCAM), Complementary and Alternative Medicine (CAM) is a wide do- main of treatment resources that include all practices, modalities, and health sys- tems. [19] According to the news publis- hed in the British Medical Journal in 1996, there was a remarkable increase in world- wide use of complementary medicine. [20,21] In addition, there has been a re- markable rise in the use of complementary and alternative medicine in Australia, the United States, and Europe over the past decade. [20,22] CAMs are broadly used all over the world. [23] Different diseases and conditions in various populations are no- wadays treated using herbal medicine. [24] Moreover, pregnant women from different countries and with different backgrounds have been reported by numerous publis- hed studies to consume herbal medicine. [25] For a remarkable number of pregnant women, family and friends are the main sources to obtain information about the use of herbal medicine during pregnancy. [26] A significant number of pregnant wo- men consume herbal medicine although they do not have any knowledge related to such medicine. [27] It is well documented that because of nausea and vomiting during pregnancy, the number of pregnant 58 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.07 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article in the data collection session, age between 18 and 40 years, healthy pregnant women, singleton pregnancy, and ability to com- municate. Women with a history of infertil- ity, those with a medical and surgical histo- ry, and those who were faced with any matter causing them to abandon the study were excluded. A questionnaire was used to collect data on the pregnant women`s demographics, including age, level of edu- cation, and occupation. Obstetric data on gravida, para, abortion, and gestational age based on the first day of the last men- strual period and first ultrasound were also gathered through the questionnaire. An- other section of the questionnaire was re- lated to dietary consumption and daily life, which consisted of a four-item scale that measured the daily routine for pregnant women during the first trimester in which the responses to the items were scored based on an ordinal scale of three points varying from always 2, sometimes 1, to never 0. [29]In addition, another data col- lection instrument was used: Rhodes index score was used for no nausea and vomiting to severe nausea and vomiting. This scale consisted of 8 questions asking about the daily frequency of vomiting, the amount of vomiting, nausea and retching duration and quantity, and distress for each episode of nausea, vomiting, and dry retching. The questions focused on the first day of the assessment. The practice section of the data collection instrument consisted of five aspects, including the instruction about how to use the complementary and alter- native medicine, and determined to three groups. Moreover, the knowledge items included knowledge about nausea and vomiting, the source of relevant infor- mation, the source of hearing about com- plementary and alternative medicine, harm to the fetus, and how to decrease nausea and vomiting during pregnancy. The validity of this scale has been women who seek medical attention, medi- cations, and even herbal medicine is in- creasing. [28]To the best of our knowledge, no data exists on the con- sumption of herbal medicine and supple- ments among pregnant women in Erbil City. In this regard, the present study was conducted to find the prevalence of nau- sea and vomiting among pregnant women in the first trimester, and to study the effect of an educational program on their knowledge and practices regarding com- plementary and alternative medicine to reduce nausea and vomiting in the first trimester. The present study was conducted using a quasi-experimental design from January 2022 to July 2022. To estimate the preva- lence of nausea and vomiting among preg- nant women in the first trimester in eight primary health care centers in the Kurdi- stan Region. Before the start of the pro- ject, a pilot study was carried out. Epi info was used to estimate the size of the study sample for the prevalence of nausea and vomiting using this information: popula- tion size 31833, confidence interval 95%, expected frequency 85, and margin of er- ror 5, and the sample was 200 pregnant women. Pregnant women with nausea and vomiting during their first trimester were selected as the study sample. Also, the sample size of quasi-experimental assess- ment of knowledge and practice of nausea and vomiting among pregnant women for this purpose was selected based on the PS program power and sample size calcula- tion version 7.2.4.0 entering the confi- dence (CI), power, and proportion. The sample size was estimated to be one hun- dred twenty-three pregnant women for pre- post instruction. The inclusion criteria were the women's ability to participate 59 Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.07 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article calculated through Cronbach's alpha (α=0.8).[30]After the pregnant women were provided with information about the aim of the study, they filled out consent forms. The approval of the study was ob- tained from the Ethics Committee of Hawl- er Medical University No. 123 (dated 7-10- 2021) and the authorities of the manage- ments of the health and primary health care centers. In addition, all pregnant women were given a copy of the education resources and were required to participate in the program. SPSS (version 25.0) was employed to analyze the collected data. For this purpose, descriptive and inferential statistics were utilized to calculate frequen- cy, percentage, mean, median, and stand- ard deviation. In addition, the Wilcoxon signed- rank test, Fisher's exact test, and chi-square test were utilized. A P-value of less than or equal to 0.05 was considered statistically significant. As revealed by the results of the present study, the prevalence of nausea and vom- iting among pregnant women during the first trimester was 68 %. According to the results of the study regarding the socio- demographic characteristics of all pregnant women who participated in this study, the largest proportion (46.3%) of the sample belonged to the age group 25-34 years. Al- so, only around one-third (29.3%) of the sample were college graduates, and 30.9% were graduates of primary schools. Moreo- ver, the majority (77.2%) of the women were unemployed. In addition, the preva- lence of obesity was 13.8% (Table 1). The results also indicated that the highest percentage (58.5 %) of the women was multigravida and 43.9% were nulliparous. More than one quarter (26.8%) of the women had a history of abortion. Approxi- mately two-thirds (64.2%) were in their 6-8 weeks of gestational age (Table 2). 60 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULTS Table 1. Basic characteristics of the study Basic characteristics No. (%) Age (years) < 25 44 (35.8) 25-34 57 (46.3) ≥ 35 22 (17.9) Education level Illiterate 3 (2.4) Primary school 38 (30.9) Secondary school 26 (21.1) Institute 20 (16.3) College or higher 36 (29.3) Occupation Student 8 (6.5) Unemployed 95 (77.2) Skilled manual workers 20 (16.3) BMI (Kg/m2) <25 52 (42.3) 25-29 54 (43.9) ≥30 17 (13.8) Table 2: Obstetric history of the study Obstetric history No. (%) Gravidity Primigravida 42 (34.1) Multigravida 72 (58.5) Grand multigravida 9 (7.3) Parity Nulliparous 54 (43.9) Primiparous 34 (27.6) Multiparous 34 (27.6) Grand multiparous 1 (0.8) Abortion No 90 (73.2) Yes 33 (26.8) Gestational age (weeks) 6-8 79 (64.2) 9-12 44 (35.8) Total 123 (100) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.07 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article 61 acupressure groups increased significant- ly from 0 to 5 (in the pyridoxine and cap- sule ginger groups) and from 0 to 10 in the acupressure group (P-value <0.001). It is worth mentioning that 5 and 10 scores are the maximum scores of the mentioned scales (Table 3). without bringing anything up; however, the groups were not significantly differ- ent in this regard (P-value <0.176). The estimated amount of throwing up was small in the majority (77.2%) of the women, and the groups were not signifi- cantly different in this regard (P-value <0.440). It was also observed that 51.2% of the women felt great-severe distress due to retching, nausea, and vomiting; however, the differences be- tween the groups were not significant for these three mentioned items (P-value <0.065) (Table 4). Table 3 shows that the median of the knowledge score was 3, while it increased significantly to 14 after (P-value<0.001). The median lifestyle score increased signifi- cantly from 0 before to 32 after the pro- gram (P-value <0.001). The median practice score of pyridoxine, capsule ginger , and As indicated in Table 4, around 51.2% of the women in the pyridoxine and capsule ginger groups had felt nausea 4-7 times during the previous day, while 26.8% in the acupressure group had (p=0.036). It was also seen that all of the women remained nauseated for 1-3 hours during the previ- ous day. The majority (94.3%) of the wom- en of the whole sample had a history of vomiting 1-3 times during the previous 24 hours, and the groups were not significant- ly different in this regard (P-value <0.697). Around one-third (34.1%) of the women had a history of retching or dry heaves Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 3: Scores of knowledge, lifestyle and practice before and after the educational program. Pre-scores Post-scores Scores of: SD Median SD Median P-value* Knowledge 0.95 3.00 0.00 14.00 < 0.001 Life-style 0.13 0.00 1.61 32.00 < 0.001 Practice (pyridoxine group) 0.00 0.00 0.00 5.00 < 0.001 Practice (capsule Ginger group) 0.00 0.00 0.00 5.00 < 0.001 Practice (Acupressure) 0.00 0.00 0.00 10.00 < 0.001 *By Wilcoxon-signed rank test. The results 0 of each Median and SD Based on the some questions just during first trimester that author created not related whole lifestyle also practices its related to some spe- cific questions https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.07 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article 62 Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 4: Assessment of pregnancy unique quantification of emesis Rhodes index by the program method at day zero. Pyridoxine Ginger capsule Acupressure Total P-value In the past 24 hours, how many times you felt nauseated? 1-3 times 20 (48.8) 20 (48.8) 30 (73.2) 70 (56.9) 4-7 times 21 (51.2) 21 (51.2) 11 (26.8) 53 (43.1) 0.036** In the past 24 hours, how many hours you remained nauseated or sick? 1-3 hours 41 (100.0) 41 (100.0) 41 (100.0) 123 (100.0) N/A In the past 24 hours, how many times you have thrown up? 1-3 times 40 (97.6) 38 (92.7) 38 (92.7) 116 (94.3) 4-7 times 1 (2.4) 3 (7.3) 3 (7.3) 7 (5.7) 0.697* In the past 24 hours, how many times do have period of retching or dry heaves without bringing anything up? 1-3 times 23 (56.1) 27 (65.9) 31 (75.6) 81 (65.9) 4-7 times 18 (43.9) 14 (34.1) 10 (24.4) 42 (34.1) 0.176** In the past 24 hours, the estimated amount of threw up was? Small 34 (82.9) 29 (70.7) 32 (78.0) 95 (77.2) Moderate 7 (17.1) 10 (24.4) 9 (22.0) 26 (21.1) Large 0 (0.0) 2 (4.9) 0 (0.0) 2 (1.6) 0.440* In the past 24 hours, did you feel distress from retching or dry heaves? Mild-moderate 22 (53.7) 14 (34.1) 24 (58.5) 60 (48.8) Great-severe 19 (46.3) 27 (65.9) 17 (41.5) 63 (51.2) 0.065** In the past 24 hours, did you feel distress from vomiting or throwing up? Mild-moderate 22 (53.7) 14 (34.1) 24 (58.5) 60 (48.8) Great-severe 19 (46.3) 27 (65.9) 17 (41.5) 63 (51.2) 0.065** In the past 24 hours, did you feel distress from nausea/sickness in your stomach? Mild-moderate 22 (53.7) 14 (34.1) 24 (58.5) 60 (48.8) Great-severe 19 (46.3) 27 (65.9) 17 (41.5) 63 (51.2) 0.065** Total 41 (100) 41 (100) 41 (100) 123 (100) **By Chi square test. *By Fisher’s exact test. N/A: Not applicable. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.07 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article This finding is in line with those of another study, which reported that 88.9% of those who could read and write consumed com- plementary.[31]However, these findings are not in agreement with those of a study carried out in Australia, in which women with higher educational levels consumed complementary more. Such discrepancy might be due to the fact that the practices followed in Australia differ from those of other countries. [33]A large number of pregnant women consume herbs quite fre- quently; therefore, they need to be provid- ed with a suitable source of relevant infor- mation. [34] To the best of our knowledge, the present study is the first investigation which has had a specific focus on the con- sumption of herbal medicine and supple- ments during pregnancy in Erbil City, Kur- distan Region of Iraq. The results of the current study demonstrated that limited number of the pregnant women used herbal supplements. This finding is in line with those of the study carried out by Zaki and Albarraq (2014), ho reported that only 4.6% of the pregnant women used herbal supplements during their pregnancy.[35] The pregnant women who participated in the present study mentioned that they needed complementary medicine practic- es. This finding is in line with those report- ed in the study by Al-Faris (2008), in which 86.9% of the women outlined their need for practices. [36] In an epidemiological study of herbal medicines carried out in Italy, 1,044 randomly selected women were studied. The results showed that, 47.0% of them used at least one herbal product during pregnancy.[37]Such differ- ences in the women's knowledge, experi- ence, and practice of using complementary medicine can be attributed to discrepan- cies in the advancement of health systems across the countries and scarcity in the availability and access of medical services. [38] Nausea and vomiting are a common com- plaint during pregnancy, and awareness of this discomfort and subsequent adherence to the management may alleviate the bur- den of this complaint. This is the first study conducted in Erbil City, Kurdistan Region, Iraq aimed at assessing the prevalence of nausea and vomiting among pregnant women during the first trimester, which was 68 %. Before the implementation of the program, the pregnant women's scores of knowledge, practice, and lifestyle regarding complementary and alternative medicine were low. As emphasized by the results, the pregnant women did not have the habit of consuming supplements dur- ing pregnancy. However, these scores in- creased significantly after the program. After their participation in the program, there was a remarkable increase in the pregnant women's use of complementary medicine and alternative medicine during their first trimester. Unlike this finding, the results of another study showed that the rate of using complementary among the pregnant women was high. As indicated by the results of that study, 97.5% of the par- ticipating women were previously aware. This high score of knowledge about com- plementary was related to the role of the media, friends, relatives, and family. [31] Moreover, these findings of the present study are not in agreement with those of some studies conducted in the USA, which reported high consumption of comple- mentary among middle-aged groups. [32] Discrepancy between the findings of the current study and other studies can be re- lated to differences between the partici- pants regarding their occupational, educa- tional, and cultural standards. According to the results of the current study, women with lower educational levels had higher scores for using complementary medicine. 63 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. DISCUSSION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.07 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article [7] Wulandari DA , Kustriyanti D , Aisyah R. MinumanJaheHangatUntukMengurangi Em- esis GravidarumPadaIbuHamil Di Puskesmas- NalumsariJepara.JournalSMARTKebidanan.2 019; 6(1): 42.https://doi.org/10.34310/ sjkb.v6i1.246. [8] World Health Organization. Hyperemesis gravidarum: current perspectives. Interna- tional Journal of Women’s Health. 2014 :6: 719–725.doi: 10.2147/IJWH.S37685. [9] Rahmawati NA, Rosyidah T, Marharani A. HubunganPelaksanaanSenamHamilDengan- KetidaknyamananIbuHamil Trimester Iii Di BidanPraktekMandiriSupadmi, KundenBulu, Sukoharjo. InvolusiJornalIlmuKebidanan. 2016; 7(12):42-50.: http:// dx.doi.org/10.32497bangunrekaprima.v5i1.1 404. [10] Viljoen E, VisserJ ,Koen N, Musekiwa A. A systematic review and meta-analysis of the effect our and safety of ginger in the treat- ment of pregnancy-associated nausea and vomiting. Nutritional Journal .2014; (19):13- 20.doi: 10.1186/1475-2891-13-20. [11] Dabaghian FH .Knowledge of pregnant wom- en about the efficacy and safety of herbal medicine and their practice during pregnan- cy .Complementary Medicine Journal.2012;2 (3): 246-256. http://cmja.arakmu.ac.ir/ article-1-149-en.html [12] Hemminki E, Mantyranta T, Malin M, Kopo- nen P. A survey on the use of alternative drugs during pregnancy. Scand Journal Social Medicine. 1991; 19(3): 199 - 204.doi: 10.1177/140349489101900310. [13] Forster D, Denning A, Wills G, Bolger M , McCarthy E. Herbal medicine use during pregnancy in a group of Australian women. BMC Pregnancy Childbirth.2006; 6: 21 30.doi:10.1186/1471-2393-6-21. [14] Hepner DL, Harnett M, Segal S, Camann W, Bader A, Tsen L. Herbal use in parturients. An International Journal of Obstetrics and Gynecology. 2002;94:690–3.doi: 10.1097/00000539-200203000-00039 [15] Maats F, Crowther C. Patterns of vitamin, mineral and herbal supplement use prior to and during pregnancy. Australian and NewZeland Journal of Obstetetrics and Gyne- cology .2002;42:4946.doi.org/10.1177/0310 057X19845786 [16] Nordeng H, Havnen G. Use of herbal drugs in pregnancy: a survey among 400 Norwegian women. Pharmacoepidemioly& Drug Safe- ty.2004;13:371–80. doi:10.1002/pds.945 As shown by the results of the current study, a remarkable number of pregnant women were consuming and including sup- plement products and herbal medicines as a part of their maternity care. It was also concluded that a large number of the par- ticipating women could have access to sufficient knowledge about consuming complementary medicine. These findings can be utilized by policymakers and health professionals as a reference for the use of in previous mention during pregnancy. The authors report no conflicts of interest or sources of financial support. [1] SuryaningrumKC ,Titisari I , Mediawati M. HubunganAntara Status GravidadanUsiaI- buDenganKejadian Emesis Gravidarum. JurnalIlmuKesehatan. 2018; 7(2): 12–20 doi.org/10.32831/jik.v7i2.213. [2] Kjeldgaard HK, VikanesA, Benth JS, Junge C, Garthus-Niegel S, Eberhard-Gran M.The as- sociation between the degree of nausea in pregnancy and subsequent posttraumatic stress.ArchivesWomens Mental Health. 2019; 22(4):493-501.doi.org/10.1007/s00737-018- 0909. [3] Fatwa T. PENGARUH REBUSAN JAHE TER- HADAP KELUHAN MUAL MUNTAH IBU HAM- IL. Jurnal Medika Hutama.2020; 2(1): 48–59. https://jurnalmedikahutama.com/index.php/ JMH/article/view/77. [4] Wahyuningsih S. Buku Ajar KeperawatanMa- ternitas .Bondowoso .2019 ; 188: doi :978- 602-51757-9-4 [5] RamdhaniIP,AyudiaF.PengaruhPemberianMi numanJahe (Zingiber Officinale Var. Rubrum) TerhadapPenurunan Emesis Gravidarum Tri- mester Pertama. JurnalIlmuKesehatan. 2019;3(2): 97. doi.org/10.33757/jik.v3i2.231 [6] Kallen B, Lundberg G, Aberg A. Relationship between vitamin use, smoking and nausea and vomiting of pregnanacy. ActaObstetri- ciaetGynecologicaScandinavica .2003;82:916 -920.:doi:10.1034/j.1600-0412.2003.00307 64 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. CONCLUSION CONFLICT OF INTEREST REFERENCES https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.07 Erbil j. nurs. midwifery, Vol. 8, No. (1), May2025 Original Article [28] Close C, SinclairM, LiddleSD, Madden E , McCullough J E , Hughes C .A systematic review investigating the effectiveness of Complementary and Alternative Medicine (CAM) for the management of low back and/ or pelvic pain (LBPP) in pregnancy. 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