Acupuncture for induction of labor in uncomplicated term pregnancies and the role of the acupoint selection: A systematic review and meta-analysis.

Introduction: Acupuncture is increasingly used for inducing labor; however, its effects on labor progression and birth outcomes remain inconclusive, and differences in acupuncture techniques are not fully considered by previous reviews. This study aims to evaluate the effects of acupuncture for induction of labor (AC-IOL) after 37 weeks of gestation on labor progression and birth outcomes, with a particular focus on comparing the combined stimulation of local and distant (L-D) acupoints with the selective use of either local or distant acupoints.

Material and methods: Following PRISMA 2020 guidelines, we searched PubMed, Embase, Web of Science, and three Chinese databases for randomized controlled trials (RCTs) evaluating AC-IOL in uncomplicated pregnancies. Outcomes included onset of spontaneous labor, labor duration, use of epidural analgesia, mode of delivery, and Apgar score at 5 min. Meta-analyses were performed for each outcome, with subgroup analyses based on acupoint selection strategies. Quality assessment for the included studies was conducted using the Cochrane RoB 2 tool, and certainty of evidence using GRADEpro GDT. The protocol was registered in PROSPERO (CRD42024497859).

Results: Ten studies including 1,432 participants were included. Five studies used combined L-D acupoint stimulation, and five used distant acupoints only; none used local acupoints alone. No significant differences were found between the acupuncture and control groups (sham acupuncture or usual care) in the onset of spontaneous labor, use of epidural analgesia, mode of delivery, or neonatal Apgar score ≤7 at 5 min. No significant differences in these outcomes were found in comparisons between the acupuncture group using a combination of L-D acupoints and the control group, nor between the acupuncture group using distant-only acupoints and the control group.

Conclusions: Moderate to very low-quality evidence suggests that AC-IOL was not associated with labor progression or birth outcomes in uncomplicated full-term pregnancies.