DOI: 10.1111/1471-0528.

15925
www.bjog.org

Safety of acupuncture during pregnancy: a

retrospective cohort study in Korea
H-Y Moon,a M-r Kim,b D-S Hwang,c J-B Jang,c J Lee,a J-S Shin,a I Ha,b YJ Leeb
a
Jaseng Hospital of Korean Medicine, Seoul, Korea b Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea
c
College of Korean Medicine, Kyung Hee University, Seoul, Korea
Correspondence: YJ Lee, Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 538 Gangnam-daero, Gangnam-gu, Seoul,
Korea. Email: goodsmile8119@gmail.com

Accepted 15 August 2019. Published Online 20 September 2019.

Objective The present study aimed to analyse the Korean National
Health Insurance Service (NHIS) cohort data to examine the
safety of acupuncture therapy during pregnancy.
Design Retrospective cohort.
Setting Korea.
Population or sample Women with confirmed pregnancy between
2003 and 2012 from the 2002–13 NHIS sample cohort
(n = 20 799).
Methods Women with confirmed pregnancy were identified and
divided into acupuncture or control group for comparison of
their outcomes. Differences in other factors such as age, and rate
of high-risk pregnancy and multiple pregnancy were examined. In
the acupuncture group, the most frequent acupuncture diagnosis
codes and the timing of treatment were also investigated.
Results Of 20 799 pregnant women analysed, 1030 (4.95%) and
19 749 were in the acupuncture and control groups, respectively.
Both overall [odds ratio (OR) 1.23; 95% CI 0.98–1.54], and in the
stratified analysis of high-risk pregnancies (OR 1.09; 95% CI 0.73–
1.64), there was no significant difference between acupuncture and
control groups in preterm deliveries. No stillbirths occurred in the
acupuncture group and 0.035% of pregnancies resulted in
stillbirths in the control group.
Conclusion No significant difference in delivery outcomes
(preterm delivery and stillbirth) was observed between confirmed
pregnancies in the acupuncture and control groups. Therefore, in
pregnancy, acupuncture therapy may be a safe therapeutic
modality for relieving discomfort without an adverse delivery
outcome.
Keywords Acupuncture, pregnancy, pregnancy outcome.

Main outcome measures Incidence of full-term delivery, preterm Tweetable abstract In pregnancy, acupuncture therapy may be a
delivery and stillbirth by pregnancy duration and among the high- safe therapeutic modality for relieving discomfort without an
risk and multiple pregnancy groups. adverse outcome.

Please cite this paper as: Moon H-Y, Kim M-r, Hwang D-S, Jang J-B, Lee J, Shin J-S, Ha I, Lee YJ. Safety of acupuncture during pregnancy: a retrospective
cohort study in Korea. BJOG 2019; https://doi.org/10.1111/1471-0528.15925.

As reported, AT, acupressure therapy, aromatherapy, chi-

Introduction
Pregnant women struggle with various health issues that can
affect normal delivery and fetal development.1 As a result of
the need for caution by pregnant women about medication
use, they are more proactive in finding safe treatment modal-
ities, hence, the increasing demand for complementary and
alternative medicine (CAM).2 CAM refers to ‘a broad range
of healing philosophies (schools of thought), approaches,
and therapies that mainstream Western (conventional) med-
icine does not commonly use, accept, study, understand, or
make available’.3 Available CAM types are broad and diverse,
including acupuncture therapy (AT), aromatherapy, herbal
concoctions and homeopathy.4
ropractic, homeopathy, massage and yoga are popular
among pregnant women.5 An awareness survey showed that
many women believe that CAM treatments have similar effi-
cacy but are safer than conventional pain therapy methods.6
However, reliable evidence supporting the safety of CAM use
during pregnancy is still lacking,7 and conflicting views on
the use of each CAM therapy during pregnancy exist even
among experts.8–10 A systematic review of recently published
articles (2008–13) on use of CAM during pregnancy con-
cluded that most of the studies reviewed had clear limitations
in their study designs or in the reporting.11
Further studies, especially well-executed randomised com-
parative clinical trials, are needed for specific conclusions on

ª 2019 Royal College of Obstetricians and Gynaecologists 1

 Moon et al.
clinical recommendations about AT.12 However, randomised
comparative clinical trials on pregnant women face difficul-
ties because of the ethical issues associated with the interven-
tion used. Considered to be very safe by the general
population,13,14 AT can be a useful CAM modality for preg-
nant women. However, because of the lack of definitive evi-
dence of its safety, some obstetrics and gynaecology
specialists and primary physicians are reluctant to prescribe
AT during pregnancy.15 A systematic review revealed the ten-
dency for mild adverse events with AT during pregnancy, but
serious adverse events tend to be rare.1 Furthermore,
although some evidence supports the benefits of AT for nau-
sea and vomiting during early pregnancy,16 pelvic or lower
back pain,17 and in breech presentation or other pain,18 its
application in actual clinical practice is limited by concerns
about safety.
Accordingly, the present study aimed to analyse the
safety of AT during pregnancy. Since there are no reports
to date on the use of large-scale data in providing evidence
on the safety of AT during pregnancy, the present study
analysed Korean National Health Insurance Service (NHIS)
cohort data to investigate the safety of AT during
pregnancy.
Methods
Data source
The present study used the NHIS sample cohort database,
which contains data of one million national health insur-
ance subscribers and medical-aid recipients (excluding for-
eigners), representing approximately 2% of the total
Korean population in 2002. The participants were selected
by stratified random sampling and followed up until 2013.
Data for the participants include socio-economic status
variables (including disability and death), and data on
healthcare use (medical examinations and health screen-
ings) and use of long-term-care facilities.19 The health
insurance system in Korea works in the following manner:
when a subscriber uses the services of a medical institution,
the Health Insurance Review and Assessment Service
(HIRA) reviews the medical fees claimed by the medical
institution and notifies the NHIS, which reimburses the
amount to the medical institution.20 Therefore, all treat-
ment-related data accumulated in the HIRA and NHIS
databases are highly reliable. Before public release, the per-
sonal information of the participants is de-identified by the
NHIS. Therefore, the study design and core outcome set
did not involve patient or public involvement.
Study design
The study identified women with a pregnancy diagnosis code
in the NHIS database from 1 January 2002 to 31 December
2013. For accurate analysis on pregnancy and delivery,
2 ª 2019 Royal College of Obstetricians and Gynaecologists
women with confirmed pregnancy in 2002 and 2013 were
excluded based on consideration of the conception time-
point and duration of pregnancy. For identification of preg-
nancy, International Classification of Diseases, Tenth Revi-
sion, Clinical Modification (ICD-10-CM) diagnosis codes
Z32.1, Z33, Z34.00, Z34.80, Z34.90, Z35* and O30* were
selected in consultation with obstetrics and gynaecology spe-
cialists. Detailed diagnosis codes descriptions are shown in
the Supplementary material (Table S1). To obtain more
accurate results, only the first pregnancy of each woman was
considered. To set the duration of pregnancy in the claims
data, existing studies on estimation of gestational age (in
weeks) were referenced21–23 and the duration of pregnancy
was estimated from the day when pregnancy was first
recorded to the gestational age of 38 weeks. Typically,
women first visit obstetric clinics to confirm their pregnancy
at around 2–6 weeks. Therefore, the pregnancy period was
calculated at 38 weeks from the time of the first diagnosis.
For comparison of delivery outcomes, women with diag-
nosis code O0 and sub-diagnosis codes were classified as
cases of termination of pregnancy and excluded from the
analysis on pregnancy outcomes. To determine the effect of
AT on termination of pregnancy, the relationship between
acupuncture and termination of pregnancy in women with
a diagnosis code of termination of pregnancy was examined
separately. Moreover, women with confirmed pregnancy-re-
lated diagnosis code, but no pregnancy outcome data on
termination of pregnancy, full-term delivery, preterm deliv-
ery and stillbirth, were also excluded. In other words, only
women with a confirmed diagnosis of pregnancy with no
subsequent diagnosis of termination of pregnancy and who
had a confirmed diagnosis code for full-term delivery, pre-
term delivery or stillbirth were included in the analysis.
The women were classified first into the acupuncture or
control group depending on whether they received AT
between the first day of pregnancy and 38 weeks of gesta-
tion. However, misclassification could occur in women
who received AT after childbirth and within the 38-week
period (estimated as the duration of pregnancy), because
acupuncture was not administered during pregnancy.
Accordingly, those first classified into the acupuncture
group in whom the first day of AT was after childbirth
were subsequently reclassified into the control group. Anal-
ysis of AT was based on NHIS claim treatment codes
40011* and 40012*.
The ICD-10-CM diagnosis codes Z37.02, Z37.09, Z37.22,
Z37.29, Z37.32, Z37.39, Z37.52, Z37.59, Z37.62, Z37.69,
Z37.92, Z37.99, O80*, O81*, O83*, O84* and O60.2 for
full-term delivery and (O42* OR O60.1) and O60.3 for
preterm delivery were selected in consultation with obstet-
rics and gynaecology specialists. Diagnosis codes Z37.1*,
Z37.3*, Z37.4*, Z37.6*, Z37.7* and O36.4 were selected for
stillbirths. If diagnosis codes for full-term delivery, preterm
 Safety of acupuncture during pregnancy

delivery and stillbirth were recorded together, the code with

the latest date was used for classification. However, for the
same diagnosis code dates, full-term delivery + preterm
delivery was classified as preterm delivery groups; and full-
term delivery + stillbirth, full-term delivery + preterm
delivery + stillbirth, and preterm delivery + stillbirth were
all classified as stillbirth group. High-risk pregnancies are
those that can threaten the health and life of the mother,
fetus or newborn during pregnancy or childbirth; hence,
such cases require even closer scrutiny during pregnancy
and childbirth. For high-risk pregnancy, ICD-10-CM diag-
nosis codes O1*, O24*, O32*, O34*, O40&O41.0, O44*
and O45* were selected based on the ‘2016 High-Risk Preg-
nancy Classification’ by the Korean Society of Obstetrics
and Gynaecology.24

Statistical analysis
All continuous variables were expressed as mean  stan-
dard deviation (SD), whereas all categorical variables were
expressed as frequency, n (%). Comparisons of the demo-
graphic characteristics according to acupuncture and con-
trol groups and between the full-term delivery, preterm
delivery and stillbirth groups were performed using chi-
square test and Student’s t test. The effect of AT on full-
term delivery, preterm delivery and stillbirth was analysed
using logistic regression analysis. The statistical software
used was SAS version 9.4 (SAS Institute, Cary, NC, USA)
and STATA 14 (StataCorp LP, College Station, TX, USA).

Ethical considerations
The current study was reviewed and qualified as an exemp-
tion by the Institutional Review Board of Jaseng Hospital
of Korean Medicine, Seoul, Korea (JASENG 2018-05-010).
Because the study analysed publicly available data, no con-
sent was obtained from the participants by the authors; all
personal information was de-identified by the NHIS before
public release. The principles expressed in the Declaration
of Helsinki have been adhered to.
Results
The schematic diagram of the study design is shown in Fig-
ure 1. The total number of women actually analysed was
20 799; 1030 were confirmed to have received AT during
pregnancy (acupuncture group: 4.95%) while the rest,
19 749, had received no AT (control group: 95.05%).
Demographic characteristics
The majority of the women in the acupuncture and control
groups were aged between 30 and 39 years, followed in
order by 20–29 and 40–49 years; with no significant differ-
ence between groups. Income level followed the order: mid-
dle, upper and lower with no difference between the two
Figure 1. Schematic of the study design.
groups. Multifetal gestation occurred in 10 (0.97%) and 536
(2.71%) women in the acupuncture and control groups,
respectively. High-risk pregnancy groups showed similar
patterns in the acupuncture and control groups with 36.70
and 35.14%, respectively. The total duration of pregnancy
was longer by approximately 20 days in the acupuncture
group, and the number of obstetrics and gynaecology visits
was higher in the acupuncture group (Table 1).
Comparisons of preterm delivery and stillbirth
incidences between the acupuncture and control
groups
Among 1030 women in the acupuncture group, preterm
delivery occurred in 87 women, and there were no still-
births. Among the 19 749 women in the control group,
preterm delivery and stillbirth were reported in 1368 and 7

ª 2019 Royal College of Obstetricians and Gynaecologists 3

 Moon et al.

women, respectively. Logistic regression analysis results between the groups. Stratified analyses with age, income
showed crude odds ratio (OR) of 1.24 (95% CI 0.99–1.55, level and high-risk pregnancy were performed; however,
P = 0.063) and adjusted odds ratio of 1.23 (95% CI 0.98– with no women with stillbirth in the acupuncture group,
1.54, P = 0.077), indicating no significant difference only preterm delivery was stratified for analysis (Table 2).

Table 1. Demographic characteristics

Variables and levels Acupuncture (n = 1030) Control (n = 19 749) P-value*

n (%) n (%)

Age (years)
10–19 2 0.2 66 0.33 0.4797
20–29 329 31.94 6735 34.1
30–39 666 64.66 12 453 63.06
40–49 33 3.2 494 2.5
50–59 0 0 1 0.01
Income
Lower (0,1,2,3) 169 16.41 3297 16.7 0.3869
Middle (4,5,6,7) 504 48.93 9687 49.05
Upper (8,9,10) 357 34.66 6765 34.25
Multifetal gestation 10 0.97 536 2.71 0.0007
High-risk pregnancy 378 36.7 6939 35.14 0.306
Duration of pregnancy
Term delivery 223.39  33.52 (n = 943) 202.71  65.28 (n = 18 374) <0.0001
Preterm delivery 222.05  33.42 (n = 87) 208.24  49.21 (n = 1368) 0.0005
Stillbirth NA 91.14  45.90 (n = 7) NA
Number of visits by OBGYN 15.13  5.44 13.39  5.74 <0.0001

OBGYN, obstetrics and gynaecology.

*P value from chi-square test or Student’s t test.

Table 2. Analyses in acupuncture and control groups (preterm delivery and stillbirth)

Acupuncture Control OR 95% CI P value

Case (%) n Case (%) n

Preterm delivery (crude) 87 (8.45) 1030 1368 (6.93) 19 749 1.24 0.99, 1.55 0.063
Preterm delivery (adjusted)* 87 (8.45) 1030 1368 (6.93) 19 749 1.23 0.98, 1.54 0.077
Stratified analysis
Age (years)
10–34 75 (8.97) 836 1161 (7.32) 15 855 1.23 0.97, 1.58 0.091
35–59 12 (6.19) 194 207 (5.32) 3894 1.19 0.65, 2.17 0.573
Income
Lower (0–3) 11 (6.51) 169 207 (6.28) 3297 1.03 0.55, 1.93 0.929
Middle (4–7) 47 (9.33) 504 688 (7.10) 9687 1.33 0.97, 1.81 0.074
Upper (8–10) 29 (8.12) 357 473 (6.99) 6765 1.16 0.79, 1.72 0.447
Multifetal gestation
Not multifetal gestation 87 (8.53) 1020 1347 (7.01) 19 213 1.23 0.98, 1.55 0.07
Multifetal gestation 0 (0) 10 21 (3.92) 536 – – –
High-risk pregnancy
Normal 60 (9.20) 652 912 (7.12) 12 810 1.3 0.98, 1.70 0.064
High-risk pregnancy 27 (7.14) 378 456 (6.57) 6939 1.09 0.73, 1.64 0.664
Stillbirth 0 (0) 1030 7 (0.04) 19 749 – – –

*Logistic regression adjusted by age, income, multifetal gestation, high-risk pregnancy.

4 ª 2019 Royal College of Obstetricians and Gynaecologists


In the age stratified analysis, being aged ≥35 years (1.19;
95% CI 0.65–2.17) and <35 years (1.23; 95% CI 0.97–1.58)
showed no significant difference in preterm delivery
between the two groups. In the income-level stratified anal-
ysis, there was no significant difference in preterm delivery
between the two groups in the lower (1.03; 95% CI 0.55–
1.93), middle (1.33; 95% CI 0.97–1.81) and upper (1.16;
95% CI 0.79–1.72) income groups. Stratified analysis based
on multifetal gestation was impossible because the ten mul-
tifetal gestations occurred in the acupuncture group with
full-term delivery but none with preterm delivery. Among
non-multifetal gestations, both groups showed no signifi-
cant difference in incidence of preterm delivery (OR 1.23;
95% CI 0.98–1.55). In the high-risk pregnancy stratified
analysis, non-high-risk (OR 1.3; 95% 0.98–1.70) and high-
risk (OR 1.09; 95% CI 0.73–1.64) pregnancy groups
showed no significant difference in incidence of preterm
delivery. In general, preterm delivery was more likely to
occur in high-risk pregnancy and low-income women, but
further analysis is needed.
Acupuncture therapy among women with
incidence of termination of pregnancy
The Korean Standard Classification of Disorders and
Causes of Death recommends that the diagnostic code O0
be used in termination of pregnancy before 22 weeks of
gestation. Of 28 717 women diagnosed with pregnancy, ter-
mination of pregnancy occurred in 2987 (10.4%). Of these
2987 women, the number who received AT between the
diagnosis of pregnancy and termination of pregnancy was
48 (1.61%), whereas the number of those who did not
receive AT during the same period was 2939 (98.39%). To
investigate the association between AT and termination of
pregnancy diagnosis, the date(s) of AT and date of termi-
nation of pregnancy were compared. The results showed
that the number of days between AT and termination of
pregnancy was ≤7, 8–29 and ≥30 days for 11, 15 and 22
women, respectively. Eleven women experienced termina-
tion of pregnancy within 7 days of AT. Therefore, the
Table 3. Analysis for termination of pregnancy
Group Variable
Acupuncture From the date of first diagnosis of pregnancy
to the date of termination of pregnancy
From the date of acupuncture to the date of
termination of pregnancy
Control From the date of first diagnosis of pregnancy
to the date of termination of pregnancy
SD, Standard deviation.
ª 2019 Royal College of Obstetricians and Gynaecologists
Safety of acupuncture during pregnancy
number of cases with AT relatively proximal to termination
of pregnancy was relatively low (Table 3).
Number of acupuncture therapy sessions and
related diagnosis codes
The mean numbers of AT sessions were 3.58  5.68 and
4.28  4.73 in the full-term acupuncture delivery and pre-
term delivery groups, respectively, showing no significant
difference (P > 0.05). In the full-term acupuncture delivery
group, the most frequent acupuncture diagnosis codes were
K30 (functional dyspepsia), M54.56 (low back pain, lumbar
region) and S33.50 (sprain and strain of lumbar spine) in
that order, whereas in the preterm acupuncture delivery
group, the percentage with K30 diagnosis codes was appre-
ciably higher than for M54.56 and S33.50 (see Supplemen-
tary material, Tables S2 and S3).
Percentage by high-risk pregnancy diagnosis codes
In the full-term and preterm acupuncture and control
delivery groups, high-risk pregnancy diagnosis codes were
highest with O24* (diabetes mellitus in pregnancy) (see
Supplementary material, Table S4).
Discussion
Main findings
The present study used the Korean NHIS claims data to
determine the safety of AT as a treatment modality in preg-
nant women. The present study is meaningful because it is
the first study attempting to identify the safety of AT during
pregnancy using large-scale insurance claims data from the
real world. No significant differences were shown in demo-
graphic characteristics such as age, income level and high-
risk pregnancy. Delivery outcomes were not significantly dif-
ferent between acupuncture and control groups with preterm
delivery, similar to observations on stratified analysis of the
high-risk pregnancy group with preterm delivery. Although
no stillbirth cases occurred in the acupuncture group, a still-
birth rate of 0.035% was observed in the control group.
N MeanSD Days Days Number of acupuncture
Minimum Maximum treatments (mean  SD)
48 88.02  74.79 4 262 5.56  9.43
48 50.15  56.94 1 260
2939 25.53  36.43 0 266 –
5
 Moon et al.
Among acupuncture diagnosis codes, K30 (functional dys-
pepsia) accounted for the highest percentage; others included
musculoskeletal diagnoses, including low back pain.
A higher percentage of multifetal gestation was observed
in the control group than in the acupuncture group (2.71
versus 0.97%). As women with multifetal gestations gener-
ally have a higher risk of preterm delivery and termination
of pregnancy than do women with non-multifetal gesta-
tions, they may have exercised more restraint in AT use.
Therefore, the findings may be insufficient to determine
whether AT is safe in women with multifetal gestation. The
duration of pregnancy was longer by approximately 20 days
in the acupuncture group than in the control group. The
longer pregnancy period can cause more musculoskeletal
disorders in pregnancy. Women with a long pregnancy per-
iod may receive more acupuncture. The durations of preg-
nancy in the preterm and full-term delivery groups in both
acupuncture and control groups were similar. This may
have been due to differences between the actual date of
conception and date of registration based on diagnosis
codes for pregnancy, as well as to limitations due to errors
in the claims data.
With respect to the diagnosis codes associated with high-
risk pregnancy, diabetes mellitus in pregnancy accounted
for the highest percentage, in full-term and preterm deliv-
ery, in both the acupuncture and control groups. In partic-
ular, the preterm delivery group showed higher percentages
in both the acupuncture and control groups. Gestational
diabetes mellitus is a major gestational disease that occurs
in approximately 5% of all pregnant women worldwide.25
Although there are no definitive reports on its prevalence
in Korea,26 results of NHIS data analysis seem to suggest a
rapidly increasing trend, from 4.1% in 2007 to 10.5% in
2011.27 In view of the rising proportions of high-risk preg-
nancy in Korea,28 there are concerns about the use of AT
during pregnancy. However, the pregnancy outcomes based
on AT use in high-risk pregnancy in this study were not
substantially different to those in the non-high-risk preg-
nancy group.
Strengths and limitations
A strength of this study was that it analysed large-scale
real-world data and demonstrated that there were no sig-
nificant differences in delivery outcomes between the
acupuncture and control groups. It also provides informa-
tion regarding the reasons for acupuncture treatment in
pregnant women.
The limitations in the present study included the follow-
ing. Due to the small number of women who received AT
during pregnancy, there was a large difference in the size of
the acupuncture and control groups, which is a limitation
when comparing the two groups. Although comparison of
the groups based on propensity matching was considered,
6 ª 2019 Royal College of Obstetricians and Gynaecologists
it was not performed because it was considered impossible
to identify and adjust for various factors that may have
affected pregnancy outcomes in the current Korean insur-
ance claims data.
Moreover, women with a diagnosis code for pregnancy,
but no diagnosis code for termination of pregnancy, full-
term delivery, preterm delivery, or stillbirth were excluded
when selecting the study population. As a result, 4951
women were excluded from the study. Hence, induced ter-
mination of pregnancy, termination of pregnancy not iden-
tified by insurance claims data, and delivery outside
medical institutions may be suspected. Induced termina-
tion of pregnancy in Korea was estimated to be approxi-
mately 15.8% in 201029; hence, the reason for some
women to not have delivery outcomes, such as termination
of pregnancy, full-term delivery, preterm delivery, or still-
birth, may have been due to these factors. The present
study may have limitations related to the data used; how-
ever, considering that conducting a large-scale randomised
control trial on actual pregnant women is virtually impos-
sible, it is of importance that the results of the present
study were derived from a large number of pregnant
women. Finally, because insurance claims data are retro-
spective and there is a limitation in verifying the variables
included in the claims data, the analysis in the present
study is also limited. Hence, more definitive results need
to be presented through a prospective registry study, for
clearer conclusions.
Interpretation
The present study analysed women who experienced termi-
nation of pregnancy separately, to investigate whether AT
affected termination of pregnancy. The study analysed the
period between the date of AT and date of termination of
pregnancy among those who received AT sometimes
between becoming pregnant and experiencing termination
of pregnancy. AT does not use chemical drugs but involves
the stimulation of acupoints. Generally, only short stimula-
tions, within 20–30 minutes, are applied, so its effect is not
expected to be sustained for a long time. Therefore, if the
period between the date of AT and date of termination of
pregnancy is not short, the probability of termination of
pregnancy being caused by AT is low. In the present study,
there were not many cases with a short period between the
date of AT and date of termination of pregnancy. Further-
more, considering that termination of pregnancy may
occur during early pregnancy because of various factors, it
was highly unlikely that AT affected it. However, in the
group that experienced termination of pregnancy, the mean
duration of pregnancy in those who received AT was
88 days, which was much shorter than that in the control
group. Therefore, additional data may be needed to estab-
lish a conclusion.

Among acupuncture diagnosis codes, functional dyspep-
sia showed the highest percentage in both full-term and
preterm delivery groups. Nausea and vomiting are typical
symptoms during early pregnancy and various treatments
can be suggested. Survey results showed that natural thera-
peutic modalities, such as acupuncture, homeopathy, mas-
sage, dietary intervention and emotional support that are
recognised as being safer or having lower risk than drug
therapy, are gradually becoming more popular.30 Hence, in
this study, functional dyspepsia was shown to be the most
frequently treated condition. In addition, diagnosis codes
for musculoskeletal and respiratory diseases accounted for
higher percentages in women who chose to receive AT dur-
ing pregnancy. Pain in the lower back and pelvic region is
common during pregnancy, with 45–75% of women expe-
riencing low back pain at some stage of pregnancy,31,32 and
up to 70% of women experiencing pelvic pain during late
pregnancy.33–35 Under such circumstances, AT during preg-
nancy can provide faster relief from functional limitations
than physical therapy,36 while improving the ability to per-
form activities of daily living.37 In addition to these previ-
ous results, the findings in the present study can be added
as evidence of safety. Large, well-designed and recent ran-
domised controlled trials demonstrating benefit from AT
are lacking and further research is needed to characterise
the benefits and safety of acupuncture in pregnancy.
Conclusions
The present study analysed the NHIS sample cohort database
to assess the effects of AT during pregnancy on delivery out-
comes to determine the safety of AT. The analysis results
revealed that there were minimal differences between the
acupuncture and control groups in demographics including
high-risk pregnancy and in delivery outcomes (full-term
delivery, preterm delivery and stillbirth). Our findings sug-
gested that AT during pregnancy may be a safe therapeutic
modality for relieving discomfort in pregnant women with-
out negatively affecting delivery outcomes.
Disclosure of interests
None declared. Completed disclosure of interest forms are
available to view online as supporting information.
Contribution to authorship
Conceptualisation was by H-YM, IH and YJL; data cura-
tion was by H-YM and YJL; formal analysis was by H-YM,
JL, J-SS and YJL; and writing was by H-YM, M-rK, D-SH,
J-BJ and YJL.
Details of ethics approval
The current study was reviewed and qualified as an exemp-
tion by the Institutional Review Board of Jaseng Hospital
ª 2019 Royal College of Obstetricians and Gynaecologists
Safety of acupuncture during pregnancy
of Korean Medicine, Seoul, Korea (JASENG 2018-05-010)
on 30 May 2018. Because the study analysed publicly avail-
able data, no consent was obtained from the women by the
authors; all personal information was de-identified by the
NHIS before public release. The principles expressed in the
Declaration of Helsinki have been adhered to.
Funding
No funding.
Acknowledgements
None.
Supporting Information
Additional supporting information may be found online in
the Supporting Information section at the end of the
article.
Table S1. Detailed diagnosis code descriptions.
Table S2. Diagnosis codes in acupuncture group.
Table S3. The most frequent acupuncture diagnosis
codes.
Table S4. High-risk pregnancy. &
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