Nausea and vomiting during pregnancy (NVP) is a common condition that affects up to 70% of pregnant women and can significantly diminish their quality of life. While vitamin B6 is frequently used, concerns about potential side effects have led to increased interest in natural alternatives like ginger. Research indicates that ginger may alleviate NVP symptoms with few and mild side effects. This systematic review aimed to compare the effectiveness and safety of ginger and vitamin B6 in managing NVP. We searched the databases of Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EBSCOhost, Web of Science, Ovid MEDLINE, Ovid Embase, and Scopus from their inception to May 2025 for RCTs evaluating ginger versus vitamin B6 for NVP. The risk of bias was assessed using the Cochrane Risk of Bias tool for RCT version 2 (RoB 2). Meta-analyses was done, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Eleven trials involving 1,049 participants met the inclusion criteria. The meta-analyses suggested statistically significant improvements with ginger in retching scores [standardised mean difference (SMD) –0.24; 95% confidence interval (CI) –0.47 to –0.01; moderate certainty] and vomiting scores (SMD –0.23; 95% CI –0.44 to –0.02; moderate certainty) when compared with vitamin B6. However, no significant differences were observed in nausea scores, the number of vomiting episodes, and overall NVP scores, with the certainty of evidence ranging from low to very low. Overall, ginger is a useful option for alleviating NVP and may serve as an alternative to vitamin B6. However, the existing evidence is limited and larger, more rigorous trials are necessary to strengthen these conclusions.