The use of complementary and alternative medicine by pregnant women: a literature review

Reproductive and developmental safety evaluation of Thymelaea hirsuta (L.) leaves aqueous extract in Wistar albino rats

ETHNOPHARMACOLOGICAL RELEVANCE

The popularity of herbal medicine is expanding globally due to the common belief that herbal products are natural and nontoxic. Thymelaea hirsuta leaves are traditionally used for the treatment of recurrent abortion in humans and animals. However, a lack of safety evaluation of the plant, particularly in pregnant women, raises serious concerns regarding its potential embryotoxic effects.

AIM OF THE STUDY

Therefore, the present study investigated the safety of Thymelaea hirsuta leaves aqueous extract (THLE) during pregnancy and lactation following maternal rat treatment.

MATERIALS AND METHODS

THLE phytochemical compounds were identified using high-performance liquid chromatography (HPLC). THLE was orally administered to pregnant rats and lactating dams at dosages of 0, 250, 500, and 1000 mg/kg/day. At the end of the study, dam s' and pups' body weights, serum biochemical and hematological indices, and histopathological changes were investigated. For the fetal observation and histopathological changes were also evaluated.

RESULTS

Our findings revealed that THLE is rich in different phenolic and flavonoid compounds. However, biochemical and hormonal parameters such as ALT, AST, and prolactin were significantly increased in dams treated with a higher dosage of THLE when compared to the control dams (P ≤ 0.05). Additionally, external, visceral and skeletal examinations of fetuses revealed a marked increase of malformation rates in treated fetuses.

CONCLUSIONS

The results revealed that higher oral dosing of THLE during pregnancy could affect embryonic development in rats, while lower doses are safe and can be used during pregnancy and lactation to attain its beneficial effects.

Nutraceuticals in Pregnancy: A Special Focus on Probiotics

The placenta is crucial to fetal development and performs vital functions such as nutrient exchange, waste removal and hormone regulation. Abnormal placental development can lead to conditions such as fetal growth restriction, pre-eclampsia and stillbirth, affecting both immediate and long-term fetal health. Placental development is a highly complex process involving interactions between maternal and fetal components, imprinted genes, signaling pathways, mitochondria, fetal sexomes and environmental factors such as diet, supplementation and exercise. Probiotics have been shown to make a significant contribution to prenatal health, placental health and fetal development, with associations with reduced risk of preterm birth and pre-eclampsia, as well as improvements in maternal health through effects on gut microbiota, lipid metabolism, vaginal infections, gestational diabetes, allergic diseases and inflammation. This review summarizes key studies on the influence of dietary supplementation on placental development, with a focus on the role of probiotics in prenatal health and fetal development.

Medication use before and during pregnancy in Japan: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

PURPOSE

To elucidate the status of medication use among pregnant women in Japan, by means of a multigenerational genome and birth cohort study: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study (TMM BirThree Cohort Study).

METHODS

Questionnaires were distributed to pregnant women participating in the TMM BirThree Cohort Study (from July 2013 to March 2017) around 12 weeks (early pregnancy) and 26 weeks (middle pregnancy). We analysed medication use over three periods: (1) 12 months prior to pregnancy diagnosis, (2) the period between pregnancy diagnosis and around week 12 of pregnancy, and (3) post around week 12 of pregnancy.

RESULTS

In total, 19,297 women were included in the analysis. The proportion of pregnant women using medications was 49.0% prior to pregnancy diagnosis, 52.1% from diagnosis to week 12, and 58.4% post week 12 of pregnancy. The most frequently prescribed medications were loxoprofen sodium hydrate (5.5%) prior to pregnancy diagnosis, magnesium oxide (5.9%) from diagnosis to week 12, and ritodrine hydrochloride (10.5%) post week 12 of pregnancy. The number of women who used suspected teratogenic medications during early pregnancy was 96 prior to pregnancy diagnosis, 48 from diagnosis to week 12, and 54 post week 12 of pregnancy.

CONCLUSION

We found that ~ 50% of the pregnant women used medications before and during pregnancy and some took potential teratogenic medications during pregnancy. In birth genomic cohort study, it is expected that investigations into the safety and effectiveness of medications used during pregnancy will advance.

Risk of Major Congenital Malformations Associated with the Use of Japanese Traditional (Kampo) Medicine Containing Ephedra During the First Trimester of Pregnancy

BACKGROUND

Japanese traditional (Kampo) medicines containing ephedra may be used to treat colds during pregnancy. There are reports that ephedrine, a component of ephedra, has a risk of teratogenicity; however, the evidence remains equivocal.

OBJECTIVE

This study aimed to evaluate the risk of major congenital malformations (MCMs) associated with exposure to Kampo medicines containing ephedra during the first trimester of pregnancy using the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study (TMM BirThree Cohort Study).

METHODS

To 23,730 mother-infant pairs who participated in the TMM BirThree Cohort Study from July 2013 to March 2017, questionnaires in early and middle pregnancy were distributed approximately at weeks 12 and 26 of pregnancy, respectively. Infants' risk of MCMs in women who used Kampo medicines containing ephedra or acetaminophen during the first trimester was assessed, and the odds ratios (ORs) were estimated with unadjusted and adjusted analyses.

RESULTS

Among 20,879 women, acetaminophen and Kampo medicines containing ephedra were used in 665 (3.19%) and 376 (1.80%) women, respectively, in the first trimester. Among the infants born to the mothers who used acetaminophen or Kampo medicine containing ephedra during the first trimester, 11 (1.65%) and 8 (2.13%), respectively, had overall MCMs. OR of overall MCMs was higher in women who used Kampo medicines containing ephedra than in those who used acetaminophen in the first trimester (adjusted OR, 1.45; 95% confidence interval (CIs), 0.57-3.71); however, the difference was not statistically significant.

CONCLUSIONS

In this study, there was no statistically significant association between the use of Kampo medicines containing ephedra during the first trimester of pregnancy and the risk of MCMs. Although some point estimates of ORs exceeded 1.00, the absolute magnitude of any increased risks would be low.

Patient-physician communication on herbal medicine use during pregnancy: a systematic review and meta-analysis

INTRODUCTION

Lack of transparent communication between patients and physicians regarding the use of herbal medicine (HM) presents a major public health challenge, as inappropriate HM use poses health risks. Considering the widespread use of HM and the risk of adverse events, it is crucial for pregnant women to openly discuss their HM use with healthcare providers. Therefore, this systematic review and meta-analysis aims to estimate the pooled prevalence of pregnant women's HM use and disclosure to healthcare providers and to examine the relationship between HM disclosure and various maternal and child health (MCH) measures.

METHODS

A systematic search of five databases was conducted for cross-sectional studies on HM use during pregnancy published from 2000 to 2023. Data extraction followed a standardised approach, and Stata V.16.0 was used for data analysis. Also, Spearman's correlation coefficient was calculated to examine the association between use and disclosure of HM and various MCH indicators.

RESULTS

This review included 111 studies across 51 countries on the use of HM among pregnant women. Our findings showed that 34.4% of women used HM during pregnancy, driven by the perception that HM is presumably safer and more natural than conventional medical therapies. However, only 27.9% of the HM users disclosed their use to healthcare providers because they considered HM as harmless and were not prompted by the healthcare providers to discuss their self-care practices. Furthermore, a significant correlation was observed between HM disclosure and improved MCH outcomes.

CONCLUSION

Inadequate communication between pregnant women and physicians on HM use highlights a deficiency in the quality of care that may be associated with unfavourable maternal outcomes. Thus, physician engagement in effective and unbiased communication about HM during antenatal care, along with evidence-based guidance on HM use, can help mitigate the potential risks associated with inappropriate HM use.

Antenatal Care Practices: A Population-Based Multicenter Study from Saudi Arabia

Background

Antenatal care (ANC) is the care women receive during pregnancy before birth and represents a cornerstone of maternal and child health. Previously, Saudi women faced various barriers to practicing ANC, including challenges related to transportation, low maternal education, poor communication with healthcare centers, and incorrect maternal beliefs. In line with Saudi Vision 2030, this multicenter cross-sectional study aimed to investigate the timing of ANC contact, coverage of service utilization in public hospitals among Saudi mothers, sociodemographic factors and antenatal health care utilization, and beliefs about prenatal vitamins, and supplement use among pregnant Saudi women.

Methods

Data was collected from 1230 pregnant women across 11 Ministry of Health (MOH) facilities. The study assessed the timing of ANC initiation, beliefs about prenatal vitamins, and the use of folic acid, calcium, and iron during pregnancy. Chi-square tests were employed to analyze associations between variables.

Results

The findings revealed that 14.55% of participants initiated ANC within the first 8 weeks of pregnancy, with 85.44% starting later. However, the majority 88.78% received prenatal care during pregnancy, regardless of the timing of ANC initiation. Beliefs about prenatal vitamins varied, with 20.08% agreeing that prenatal vitamins were only indicated for malnourished mothers, 72.35% disagreeing, and 7.56% uncertain. Moreover, 51.30% believed ANC should begin before pregnancy, 29.83% after pregnancy confirmation, and 13.57% during the first trimester, with no significant correlation between beliefs and ANC timing. Regarding prenatal care, 95.20% would recommend starting prenatal care with every pregnancy, regardless of the timing of their own ANC initiation.

Conclusion

This study offers a comprehensive analysis of factors impacting late ANC contact and inadequate ANC contacts among pregnant Saudi women. These findings contribute to the broader understanding of ANC practices among Saudi women and underscore the importance of considering various determinants for tailored interventions and health education programs.

Prevalence, motivation, and associated factors of medicinal herbs consumption in pregnant women from Eastern Mediterranean Regional Office: a systematic review

CONTEXT

Worldwide access to medication remains a major public health problem that forces pregnant women to self-medicate with several sources, such as medicinal plants. This alternative medicine is increasing in many low- and high-income countries for several reasons.

OBJECTIVE

This a systematic literature review on the prevalence of herbal use during pregnancy from the World Health Organization (WHO) Eastern Mediterranean Regional Office.

METHODS

Cross-sectional studies were searched from January 2011 to June 2021 on PubMed, Scopus, and Web of Science. We used the Rayyan website to identify the relevant studies by screening the abstracts and titles. These were followed by reading the full texts to identify the final studies to be included. The data were extracted, and the quality of the studies was assessed using the quality appraisal tool.

RESULTS

Of the 33 studies included in this review, 19 were conducted in Iran, 5 in Saudi Arabia, 4 in Palestine, 2 in Egypt, and 1 each in Oman, Iraq, and Jordan; the prevalence of herbal medicine use among pregnant women varied from 19.2% to 90.2%. Several plants were mentioned for pain management during the pregnancy period. The findings suggest family and friends are major motivating sources for the use of herbal medicine.

CONCLUSIONS

The wide variety of herbal products used in this study reflects the traditions and geographic diversity of the region. Despite the importance of literature-based data about the use of herbal medicine, it is necessary to obtain knowledge, attitude, and motivation for herbal consumption among pregnant women.

Complementary and alternative medicine use by pregnant women in Japan: a pilot survey

BACKGROUND

Complementary and alternative medicine (CAM) are popular among women, and are used during their pregnancy in Japan. This study aimed to survey the prevalence of CAM use by healthy pregnant women as a health-care prescribed therapy or self-care and to investigate the factors associated with CAM use in Japan.

METHODS

In this cross-sectional study, pregnant women after 34 weeks of gestation were asked to respond to a questionnaire at the clinic or online. The questionnaire comprised questions on the participants' characteristics and their use of CAM for therapy and self-care. Descriptive statistics were calculated in the analyses, and bivariate and multivariate logistic analyses were performed to evaluate the associations between factors and CAM use.

RESULTS

A total of 394 women responded from three hospitals, two clinics, and two midwifery birth centers. CAM was received as treatment by practitioners during pregnancy by 75 women (19.0%). The following therapies were used: traditional Chinese medicine (7.9%), chiropractic (6.9%), moxibustion (6.4%), and acupuncture (5.3%). One or more types of therapy were used as self-care by 348 women (88.3%). Highly used CAM for self-care were: folic acid supplementation (75.4%), other supplements (51.5%), herbs (20.8%), and yoga (19.0%). Multiple logistic regression analyses revealed that the factors associated with CAM use as a therapy were midwifery birth centers for planned childbirth settings (adjusted odds ratio [AOR] 3.64, 95% confidence interval [CI] [1.69-7.83]) and pregnancy complications diagnosed (AOR 2.46, 95%CI [1.38-4.39]). The factors associated with CAM use for self-care were age 30-39 years (AOR 4.48, 95%CI [2.14-9.73]) and over 40 years (AOR 3.92, 95%CI [1.10-13.91]), junior college education or above (AOR 2.30, 95%CI [1.18-4.51]), and primiparas (AOR 3.82, 95%CI [1.86-7.86]). The most common source of information was the "Internet" (43.8%).

CONCLUSIONS

Approximately 20% of Japanese pregnant women received CAM as therapy by practitioners, and the related factors were: tended to have baby at midwifery birth center and pregnancy complications. Almost 90% of respondents used CAM as self-care and the related factors were: older, had a higher educational level and tended to be primiparas. They used the Internet as their main source of information about CAM. Health care providers need to provide evidenced-based information on CAM and to help decision making to ensure safe and effective CAM utilization by pregnant women.

Maternal-fetal toxicity of Strychnos pseudoquina extract treatment during pregnancy

ETHNOPHARMACOLOGICAL RELEVANCE

Plants and herbs have been used by women throughout history for therapeutic purposes. Strychnos pseudoquina, a plant used in the treatment of various diseases, can also function as an abortive herb. There is no scientific confirmation of its effects during pregnancy, and the activity of this plant needs to be substantiated or refuted with experimental evidence.

AIM OF THE STUDY

Evaluating the effect of the S. pseudoquina aqueous extract on maternal reproductive toxicity and fetal development.

MATERIALS AND METHODS

The aqueous extract of S. pseudoquina bark was evaluated in Wistar rats. Pregnant rats were distributed into four experimental groups (n = 12 rats/group): Control = treated with water (vehicle); Treated 75, Treated 150, and Treated 300 = treated with S. pseudoquina at dose 75, 150 and 300 mg/kg, respectively. The rats were treated by an intragastric route (gavage) from day 0 to day 21 of pregnancy. At the end of pregnancy, maternal reproductive outcomes, organs, biochemical and hematological profiles, fetuses, and placentas were analyzed. Maternal toxicity was evaluated through body weight gain, water, and food intake. With knowledge of the harmful dosage of the plant, other rats were used on gestational day 4 for the evaluation of morphological analyses before embryo implantation. P < 0.05 was considered as statistically significant.

RESULTS

The S. pseudoquina treatment showed elevated liver enzymatic activities. The Treated 300 group presented toxicity with reduced maternal body weight, water and food intake, and increased kidney relative weight compared to those of the Control group. At a high dosage, the plant presents an abortifacient activity, confirmed by embryo losses before and after implantation and degenerated blastocysts. In addition, the treatment contributed to an increased percentage of fetal visceral anomalies, decreased ossification sites, and intrauterine growth restriction (300 mg/kg dose).

CONCLUSION

In general, our study showed that an aqueous extract of S. pseudoquina bark caused significant abortifacient activity that testified to its traditional use. Furthermore, the S. pseudoquina extract caused maternal toxicity that contributed to impaired embryofetal development. Therefore, the use of this plant should be completely avoided during pregnancy to prevent unintended abortion and risks to maternal-fetal health.

Herbal medicine use among pregnant women at antenatal clinic in Ethiopia

Background

Herbal medicines are raw or processed plant-derived ingredients. Their use during pregnancy may contributed to several adverse effects that could be lethal to the mother and their unborn children.

Aims

This study aims to assess the prevalence of herbal medicine use and associated factors among pregnant women at Woldia General Comprehensive Specialized Hospital (WGCSH) in Ethiopia.

Samples

The sample size in this study was 272.

Methods

A facility-based cross-sectional study was conducted among 270 pregnant mothers from March 2 to April 2, 2021, at WGCSH in the antenatal care clinic. A standardized, structured questionnaire-based interviewer was used to collect the socio-demographic variables; obstetrics variables; and other related variables for this study. The prevalence of herbal medicine use and associated factors were determined using descriptive and logistic regression analysis, with p < 0.05 considered statistically significant.

Results

The prevalence of herbal medicine use in this study was 22.6%. Most of the pregnant women used Ocimum lamiifolium and Rutachalepensis. The use of herbal medicines during pregnancy in rural areas was higher than in urban areas (OR 2.51; 95% CI 1.35-3.54). The place of residence (AOR 3.66; 95% CI 1.83-4.74), perception of needing to use herbal medicine (AOR 2.20; 95% CI 4.99-9.86), stage of pregnancy (AOR 2.56; 95% CI 1.16-9.36), distance from the health facility (AOR 2.90; 95% CI 1.52-12.65), and previous use of herbal medicine (AOR 3.23; 95% CI 2.74-7.56) were significantly associated with herbal medicine use.

Conclusions

Nearly one-fourth of pregnant mothers at WGCSH used herbal products and preparations.

A multicenter study on practices and related factors of traditional medicinal plant use during pregnancy among women receiving antenatal care in East Gojjam Zone, Northwest Ethiopia

Background

Little is known about the practice of traditional medicinal plant use, especially during pregnancy in Ethiopia. Moreover, there has been no previous studies conducted on practices and related factors of medicinal plant use among pregnant women in Gojjam, northwest Ethiopia.

Methods

A multicentered facility-based cross-sectional study was conducted from July 1 to 30 2021. A total of 423 pregnant mothers receiving antenatal care were included in this study. To recruit study participants, multistage sampling techniques were used. Data were collected using a semi-structured interviewer-administered questionnaire. SPSS version 20.0 statistical package was used for statistical analysis. Univariable and multivariable logistic regression analysis was performed to identify factors related to the medicinal plants' utilization status in pregnant mothers. The study results were presented in both descriptive statistics (percents, tables, graphs, mean, and dispersion measurements like standard deviation) and inferential statistics (odds ratio).

Results

The magnitude of traditional medicinal plants' utilization during pregnancy was 47.7% (95%CI: 42.8-52.8%). Pregnant mothers residing in rural areas [Adjusted Odds Ratio (AOR) = 3.13; 95% Confidence Interval (CI):1.53, 6.41], who are illiterate (AOR = 2.99; 95%CI:1.097, 8.17), have illiterate husbands (AOR = 3.08; 95%CI:1.29, 7.33), married farmers (AOR = 4.92; 95%CI:1.87, 12.94), married merchants (AOR = 0.27; 95%CI:0.09, 0.78), have a divorced and widowed marital status (AOR = 3.93; 95%CI:1.25, 12.395), have low antenatal care visits (AOR = 4.76; 95%CI:1.93, 11.74), substance use history (AOR = 7.21; 95%CI:3.49, 14.9), and used medicinal plants in previous pregnancy (AOR = 4.06; 95%CI:2.03, 8.13) had statistically significant association with medicinal plant use during current pregnancy.

Conclusions

The present study revealed that a relatively large number of mothers used medicinal plants of various types during their current pregnancy. Area of residence, maternal educational status, husband's education level, husband's occupation status, marital status, number of antenatal care visits, use of medicinal plants in previous pregnancies, and substance use history were among the factors which were significantly associated with the use of traditional medicinal plants during the current pregnancy. Overall, the current finding provides scientific evidence useful for health sector leaders and healthcare professionals on the utilization of unprescribed medicinal plants during pregnancy and the factors associated with the utilization of the plants. Hence, they may consider creating awareness and providing advice on the careful use of unprescribed medicinal plants among pregnant mothers, especially those residing in rural areas, who are illiterate, who have divorced and widowed marital status, and who have a previous history of herbal and substance use. This is because using traditional medicines without prior discussion with a healthcare expert may harm pregnant mothers and their unborn child, as the safety of the utilized plants in the current study area is not scientifically proven. Prospective studies which need to confirm the safety of the plants used are recommended mainly in the present study area.

Women's reasons for taking complementary medicine products in pregnancy and lactation: Results from a national Australian survey

BACKGROUND

and purpose: Pregnant and breastfeeding women commonly use complementary medicine products (CMPs), including dietary supplements and herbal medicines. This study investigated women's reasons for use.

MATERIALS AND METHODS

A national, cross-sectional, online survey conducted between July-September 2019 investigated reasons for CMP use during pregnancy and lactation. Australian women who were currently pregnant and/or breastfeeding participated. Data analysis included descriptive statistics, Chi-square and principal component analyses.

RESULTS

Of the 810 women surveyed (n = 354 pregnant; n = 456 breastfeeding), most reported prior CMP use and felt that CMPs had been beneficial to maintaining and optimising their own and their children's health. However, when ill, they preferred medicines prescribed by doctors or pharmacists. Perceived benefits to their unborn or breastfeeding babies' health and their own health (both cohorts), the health of their pregnancy (pregnant participants), and benefits to the breastfeeding process and breastmilk supply (breastfeeding participants) were important reasons for women's CMP use.

CONCLUSION

Women's reasons for CMP use centred on perceived benefits to their own health and the health of their babies. Women's prior positive experiences with CMP use, combined with preferences for pharmaceutical use when ill, indicates their use of CMPs can be considered complementary, rather than alternative, to biomedical health care.

Analysis of the Use of Herbal Therapy to Reduce Labor Pain (Literature Review)

Abstract Background:.   labor pain can stress the mother and cause pain impulses to multiply and potentially weaken uterine muscle contractions. Pain can cause distress to the baby. One way to reduce pain is by giving herbal therapy or aromatherapy. Aromatherapy is one of the non-pharmacological methods to reduce labor pain. Aromatherapy often used to reduce labor pain is Lavender, Rose, Jasmine, Citrus Aurantium.   AIM: This study aims to determine the use of herbal therapy to reduce labor pain.The purpose of this study is to analyze the challenges in implementing health education in elementary schools in Banda Aceh   Methods: the design in this study was a literature review article. Search for articles using relevant ones obtained from data based on Pubmed, Proquest, Ebsco, ScienceDirect, and Google Scholar in the past ten years (2011–2021) received 121 articles. Results: The study results show several challenges in implementing health education. Lack of understanding about School Health Services, School Health Services is not considered a strategic program, Low attention from policymakers, School Health Services Program has not been understood as part of the national target, Implementation of UKS program in schools is only a formality, Implementation and development School Health Services program is not evenly distributed. Barriers to the Implementation of School Health Services in  Elementary School are the lack of optimal inter-sectoral cooperation, lack of trained personnel, high workload, and the impact of conflicting health issues, causing various School Health Services activities to be hampered in their Implementation   CONCLUSION: Utilization of herbal therapies such as Lavender, Mawar, Jasmine, Citrus, Aurantium has been proven to reduce labor pain which can be used in various methods such as inhalation, bath, massage, and foot soak. The easy use of aromatherapy can be an alternative to reduce labor pain.

[Perinatal beliefs: Neurocognitive mechanisms and cultural specificities]

Perinatal beliefs contribute to the experience of pregnancy and the process of parenthood. Many of these perinatal beliefs have been perpetuated and evolved over time and throughout the world, exerting their influence on the behavior of pregnant women in interaction with medical recommendations. These beliefs generally offer explanations for gravidic and puerperal phenomena, helping to reduce the uncertainty of parents faced with the biological, psychological and social transitions of pregnancy. But certain beliefs can also be harmful, and alter the maternal experience of pregnancy and postpartum. In this paper, we provide an overview of the beliefs associated with the perinatal period. We successively detail the beliefs concerning fertility, pregnancy, childbirth, and postpartum, specifying the cultural beliefs from other cultures interacting with medical recommendations. Finally, we propose a neurocognitive model of perinatal beliefs generation, and we show the need to know these beliefs to improve care in midwifery, obstetrics, and fetal medicine.

Magnitude and Determinant Factors of Herbal Medicine Utilization Among Mothers Attending Their Antenatal Care at Public Health Institutions in Debre Berhan Town, Ethiopia

Background

World health organization defined herbal medicines as the practice of herbs, herbal materials, herbal preparations, and finished herbal products. Globally women are the primary utilizer of herbal medicine and even they consume it during their pregnancy period. The World health organization reported that the majority of the global population used traditional medicine. This study aimed to assess the magnitude and determinant factors of herbal medicine utilization among pregnant mothers attending their antenatal care at public health institutions in Debre Berhan town, Ethiopia.

Methodology

Institution-based cross-sectional study was conducted among pregnant mothers who attended their antenatal care at public health institutions in Debre Berhan town, Ethiopia from 12 February 2021 to 12 April 2021. A systematic random sampling method was used to get selected pregnant mothers. Epi data version 3.1 and SPSS version 25 were used for data entry and analysis, respectively. P-value ≤0.05 was used as a cut point of statistical significance in multivariable binary logistic regression.

Results

A total of 422 pregnant mothers were included with a 100% response rate and 277 (65.6%) of them used an herbal medicine during their current pregnancy. Educational level up to primary school [AOR 2.21, 95% CI: 1.17 – 4.18], monthly family income of &lt;2,800 ETB [AOR 1.72, 95% CI: 1.01–2.92], and lack of awareness of the complication of herbal medicine utilization [AOR 10.3, 95% CI: 6.27–16.92] were determinant factors of herbal medicine utilization.

Conclusion

The utilization of herbal medicine among pregnant mothers in this study is high and almost all of them did not disclose their utilization of herbal medicine to their healthcare providers. The ministry of health should integrate traditional medicine with conventional medicines. Midwives and obstetricians should openly discuss regarding benefits and complications of herbal medicine utilization for those pregnant mothers during their antenatal care counseling sessions as routine care.

The prevalence of using complementary and alternative medicine products among patients with pressure ulcer

Background

The use of complementary and alternative medicine (CAM) therapies has increased in recent years throughout the world and in Iran. Nonetheless, there are limited data about the prevalence of their use. This study aimed to assess the prevalence of using CAM therapies among patients with pressure ulcer (PU).

Methods

This cross-sectional study was conducted in 2019–2020. Participants were 299 patients with PU conveniently selected from wound clinics and healthcare settings in Shiraz, Iran. A demographic questionnaire and the International Questionnaire to Measure Use of CAM were used for data collection. The data were analyzed using the SPSS software (v. 22.0).

Results

All 299 participants completed the study. Their mean age was 59.56 ± 18.76 years. The most common CAM therapies used for PU management were herbal products (100%), vitamin supplementation therapy (45.2%), spiritual therapies (21.7%), wet cupping therapy (16.4%), leech therapy (9.4%), acupuncture (1.7%), dry cupping therapy (1.3%), and massage therapy (1.3%). The most common herbal product used for PU management was Pistacia atlantica gum either alone or in combination with other herbal products (15.5%). The use of CAM therapies had significant relationship with participants’ age, underlying conditions, and PU stage (P < 0.05) and the most significant predictor of using herbal products for PU was educational level (P < 0.05, OR = 5.098).

Conclusions

The use of CAM therapies, particularly herbal products, for PU management is high in Iran. Quality public education and close professional supervision are needed for the safe use of these products.

Potential benefits versus hazards of herbal therapy during pregnancy; a systematic review of available literature

The use of herbal medicine has considerably grown worldwide in the past two decades. Studies have shown that the prevalence of herbal diet therapy in pregnancy ranged from 1% to 60% in different societies. Many clinical reports have shown that some herbal medicines may have toxic effects on pregnant women and their fetuses because active ingredients of some medicinal plants can readily pass through the biological barriers (e.g., placental barrier). In the present study, we aimed to systematically review the literature to discover potential benefits versus the hazards of herbal therapy during pregnancy. For this purpose, a comprehensive literature review was performed, and after the literature search and selection of the appropriate documents, the desired data were extracted and reported. From 35 articles with a total of 39,950 study population, the results showed that some medicinal plants could cause severe toxicity on mothers and fetuses, in addition to abortion during pregnancy. It was also shown that some plants may lead to developmental abnormalities or fetal death. Findings of this survey showed that some herbal medicines have toxic, teratogenic, and abortive potential, particularly in the first trimester of pregnancy because active ingredients of some medicinal plants are able to pass through the placental barrier and reach the fetus.

Herbal Medicines-Are They Effective and Safe during Pregnancy?

Since the teratogenicity of Thalidomide has been proven, herbal products are more commonly used in pregnancy to not only relieve morning sickness but also to fight infections. These products are frequently considered as natural and therefore harmless. However, herbs contain a number of active substances that, when used during pregnancy, can affect the development of the fetus. Often, pregnant women do not consult the usage of herbal medicines with a physician. The access to these products is easy and treatment of certain ailments with the use of herbs is common in many countries. The aim of the present literature review was to discuss available data regarding the efficacy and safety of cranberry, chamomile, Echinacea purpurea, garlic, ginger, Ginkgo biloba, and peppermint, which are used to counteract the most common ailments during pregnancy, i.e., infections and pregnancy-related ailments (e.g., nausea and vomiting, dizziness, and headache). Analysis of available data showed that ginger is one of the most extensively analyzed herbal remedies. The dose of ginger below 1000 mg per day may help to relief hypereremesis gravidarum, and such an amount of ginger did not increase frequency of adverse effects for either woman or developing fetus. Data regarding other herbs are most often heterogeneous and give conflicting results with no clear conclusions. However, all herbal products should be used with a special caution in pregnancy. Further high-quality human studies should be determined to confirm the safe doses of herbal products which could be used by pregnant or breast-feeding women.

Demographics, health literacy and health locus of control beliefs of Australian women who take complementary medicine products during pregnancy and breastfeeding: A cross-sectional, online, national survey

Background

Pregnant and breastfeeding women's use of complementary medicine products (CMPs) is common, and possibly associated with autonomous health care behaviours. However, the health literacy levels and health locus of control (HLOC) beliefs of women who use CMPs in pregnancy and lactation have not been previously assessed in a large Australian sample.

Aim

The aim of this study is to determine the health literacy levels and HLOC beliefs of women who use CMPs in pregnancy and lactation and determine the types of CMPs used.

Methods

A cross‐sectional, national, online survey of Australian pregnant or breastfeeding women aged 18 years and older, and currently using CMPs was conducted.

Results

A total of 810 completed surveys (354 pregnant and 456 breastfeeding women) were analysed. Most had adequate functional health literacy levels (93.3%). Health care practitioners (HCPs) HLOC mean scores were the highest for the sample, followed by Internal HLOC beliefs mean scores. Almost all (n = 809) took at least one dietary supplement, the most popular being pregnancy and breastfeeding multivitamins, iron supplements and probiotics. Use was generally in line with clinical recommendations, except for low rates of iodine supplementation. Herbal medicine use was lower for the total sample (57.3%, n = 464), but significantly higher (p < .0001) for the breastfeeding cohort, with consumers taking one to four herbal medicines each. The most popular herbs were raspberry leaf, ginger, peppermint and chamomile (pregnant respondents) and chamomile, ginger and fenugreek (breastfeeding respondents).

Conclusions

Respondents were health literate, with high scores for Internal and HCP HLOC scales, suggesting that they are likely to demonstrate self‐efficacy, positive health behaviours and work well in partnership with HCPs. HCPs can facilitate discussions with pregnant and breastfeeding women using CMPs, while considering women's health literacy levels, health beliefs and goals.

Influence of Cultural and Religious Practices on the Management of Pregnancy at Mbombela Municipality, South Africa: An Explorative Study

Background:

Cultural norms bring substantial weight in women’s decision-making, especially concerning the choice of the birth location. Cultural and religious practices may influence how pregnant women respond to Antenatal Care (ANC) services, feel confident about which questions to ask, or participate in the discussions about their care plan or birth options.

Purpose:

The study aimed to explore and describe the influence of cultural practices on the management of pregnancy in the Mbombela Municipality of Mpumalanga Province.

Methods:

Using a qualitative approach, pregnant women who failed to completely attend ANC services were purposively sampled, and individual unstructured in-depth interviews were employed to collect data. The study consisted of a sample size of 18 pregnant women, and data saturation was reached. Tech’s method of analysis was followed for data analysis.

Results:

Study findings revealed a significant theme: cultural practices and pregnancy management, encompassing three sub-themes: cultural practices in pregnancy, cultural medication taken by pregnant women, and the effects of cultural practices on pregnancy management.

Conclusion:

It is recommended that women should be given health education concerning ANC services every day while they wait in primary health care clinics. Accordingly, the healthcare professionals should encourage the active involvement of all pregnant women in health promotion gatherings and offer chances for clarity seeking. Despite the availability of free maternal healthcare services in primary healthcare clinics, women still consult traditional healers during pregnancy and believe in cultural practices. It is therefore important that programs developed for maternal services be congruent to the cultural practices of women to be serviced.

Medicinal plants used among pregnant women in a tertiary teaching hospital in Jimma, Ethiopia: a cross-sectional study

OBJECTIVE

The aim of this study was to investigate and describe the use of medicinal plants during pregnancy among women admitted in the Maternity and Gynaecology wards at Jimma University Medical Centre (JUMC) in the southwest Ethiopia.

DESIGN

Cross-sectional study.

SETTING

Maternity and Gynaecology wards at JUMC.

PARTICIPANTS

1117 hospitalised pregnant women or postpartum women.

MAIN OUTCOME MEASURES

Our primary outcomes of interest were the prevalence of use, types of medicinal plants used and their utilisation among pregnant women.

METHODS

Data were collected through structured face-to-face interviews of pregnant women or postpartum women and review of patient medical records between February and June 2017.

RESULTS

Overall, 28.6% of the women reported use of at least one medicinal plant during the pregnancy. Twenty-seven different types of medicinal plants were used. The most commonly used medicinal plants were Linum usitatissimum L. (flaxseed-use with caution) 22.0%, Ocimum lamiifolium L. (damakessie-safety unknown) 3.6% and Carica papaya L. (papaya-use with caution) 3.1%. The most common reason for use was preparation, induction or shortening of labour. Lack of access to health facility (mainly health posts), admission to maternity ward, khat chewing and alcohol consumption were the strongest predictors of medicinal plants use during pregnancy (OR >2). Only five medicinal plants used by women had sufficient evidence to be classified as safe to use in pregnancy.

CONCLUSIONS

Almost one-third of women at the tertiary hospital in Ethiopia reported use of medicinal plants during pregnancy, most frequently to prepare, induce, reduce the intensity or shorten duration of labour. Increased awareness about potential benefits or risks of medicinal plants use during pregnancy among healthcare professionals and patients, and increased access to childbirth providing healthcare facilities are important in order to promote safer pregnancies and better health outcomes for women and their unborn children.

Midwives knowledge and education/training in complementary and alternative medicine (CAM): A national survey

Despite the proliferation of research exploring complementary and alternative medicine (CAM) use in maternity care and midwifery practice, there is a gap on midwives' level of CAM knowledge and education/training. This national survey investigated Australian midwives' knowledge and education/training in CAM. A total of 571 midwives completed the survey (16%). Over half (54.3%) had some level of CAM education/training (self-learning to diploma) and with multiple CAM modalities. The top four modalities that midwives had received education/training were acupressure (66.5%), aromatherapy (60.3%), massage (45.5%), and reflexology (37.7%). There was a significant correlation between midwives attending a CAM workshop with competency-assessment (p < 0.000) and confidence to discuss CAM options with pregnant women compared with participants who have not. There are no other health-related therapies used by women consumers with such frequency where clinicians are not expected to have baseline knowledge and understanding. Midwifery education programs need to include evidence-based information on CAM modalities.

The use of complementary and alternative medicine during pregnancy: a cross-sectional study from Palestine

BACKGROUND

The use of complementary and alternative medicine (CAM) is increasing worldwide. To the best of knowledge, there is a lack of studies that assess CAM use by Palestinian women during pregnancy. This research aims to determine the prevalence of Palestinian women's use of CAM during pregnancy, the most frequently used CAM products during the pregnancy period, the main sources that encourage the use of CAM among pregnant women, and the causes of CAM use.

METHODS

A descriptive, cross-sectional study was conducted in Palestine using a questionnaire from April 2018 to March 2019. The samples were selected by convenience sampling, including currently pregnant or previously pregnant women in the Obstetrics and Gynecology (OBGYN) clinic at Rafedia Hospital and in primary health care clinics in Nablus city-Palestine. The questionnaire covered socio-demographic variables, health status, types and frequency of CAM used, patients' sources of information, causes of their usage, attitudes, and beliefs.

RESULTS

Four hundred currently or previously pregnant women participated. Three hundred fifty-five (91.5%) used at least one method of CAM during pregnancy. Most women used at least one method of biologically-based therapies during pregnancy (87.7%). One hundred and one pregnant women (26.7%) utilised at least one type of herb during pregnancy. The most-reported herb used by 12.3% of participants was anise. Of the mind-body therapies, prayer was the most commonly used method during pregnancy (8.3%). Two hundred and sixty-one (65.3%) participants used CAM because they believed CAM was not harmful to them or their babies during pregnancy. Participants gained most of their information about CAM from their families (43.8%) and friends (24.3%). Approximately two-thirds of participants (64.0%) thought that obstetricians should be able to advise on commonly used CAM.

CONCLUSIONS

During pregnancy, CAM products are commonly used, and it is important to determine what types are being used by women in Palestine. These findings supplement the body of knowledge on the use of CAM by pregnant women. Pregnancy care providers need to be aware to the familiar types of CAM that women use.

Why do chronic illness patients decide to use complementary and alternative medicine? A qualitative study

BACKGROUND AND PURPOSE

A substantial proportion of European and American people now use healthcare options known as complementary and alternative medicine (CAM). This study aimed to understand the processes and decisional pathways through which chronic illness patients choose treatments outside of regular allopathic medicine.

MATERIALS AND METHODS

This qualitative study used Charmaz's constructivist grounded theory methods to collect and analyze data. Using theoretical sampling, 21 individuals suffering from chronic illness and who had used CAM treatment participated in face-to-face in-depth interviews conducted in Miami/USA.

RESULTS

Seven overarching themes emerged from the data to describe how and why people with chronic illness choose CAM treatments. These themes included 1) influences, 2) desperation, 3) being averse to allopathic medicine and allopathic medical practice, 4) curiosity and chance, 5) ease of access, 6) institutional help, and 7) trial and error.

CONCLUSION

In selecting treatment options that include CAM, individuals draw on their social, economic, and biographical situations. Though exploratory, this study sheds light on some of the less examined reasons for CAM use.

Perinatal Depression: Challenges and Opportunities

Perinatal depression (PND) is a major depressive episode during pregnancy or within 4 weeks after childbirth up to a year. Risk factors for PND include stressful life events, history of depression, poor social support, unplanned and unwanted pregnancies, poor relationship quality, current or previous abuse, and low socioeconomic status. This mental disorder has been shown to have negative effects on mothers' quality of life and their intimate relationships, birth outcomes, and breastfeeding likelihood, as well as long-term effects on children's cognitive and emotional development. To date, no nationally representative study has examined whether there are socioeconomic and/or racial/ethnic differences in PND. This study discusses the prevalence and risk factors for PND, as well as its health consequences for mothers and children, the reasons for its underreporting and undertreatment, the evidence for different screening instruments and different treatment options, and the existing supportive policies to address this disorder in the United States. We conclude with outlining next steps in addressing the gaps in the literature on PND.

TCM use in pregnant women and nursing mothers: A study from Turkey

BACKGROUND

This study aimed to specify the frequency of traditional and complementary medicine (TCM) usage and the most commonly used methods by the pregnant.

MATERIALS AND METHODS

The cross-sectional and definitive study included 212 pregnant and 152 nursing women who applied to obstetric, pediatrics, and family practice polyclinics.

FINDINGS

Of the pregnant women, 38.7% applied to the TCM method during pregnancy, and of the nursing women, 63.2% during nursing. The most commonly used herbal products were mint, thyme and linden by the pregnant women while anise and mint were most commonly used by nursing.Women commonly used TCM methods to increase breast milk and for upper respiratory tract infection's symptoms.

CONCLUSIONS

Every health personnel who provides pregnancy care should be aware of the latest data published on the usage of TCM in the literature and educate patients about the usage of TCM which may have negative outcomes.

Disclosure of herbal medicine use to health care providers among pregnant women in Nepal: a cross-sectional study

Background

Pregnant women’s disclosure of herbal medicine (HM) use to their health care providers during pregnancy is crucial, as misuse of HM can have a detrimental effect on both pregnant woman and the fetus. However, the lack of disclosure of HM use to physicians remains a public health concern in developing countries such as Nepal.

Methods

A cross-sectional study was conducted among 400 postpartum women admitted at Maternity and Women’s Hospital located in Kathmandu, Nepal. The survey instrument included 30 questions on the use of HM during pregnancy, sociodemographic and health characteristics, and pregnancy outcomes. Chi-square test and logistic regression were conducted for data analysis using SPSS ver. 21.0., and a p-value of less than 0.05 was considered statistically significant for all analyses.

Results

60.3% of respondents used at least one herbal remedy during their previous pregnancy, and the overall disclosure rate of HM use to healthcare providers was 54.6%. Women with secondary education level and four or more antenatal care visits were more likely to disclose their HM use to healthcare providers.

Conclusions

This study highlights that despite the popular use of HM among pregnant women in Nepal, most women obtained HM-related information from informal sources and did not disclose their HM use to physicians. To ensure the safe use of HM, physicians should integrate questions regarding patients’ HM use into their routine patient assessments to facilitate active communication and improve the quality of care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-020-03142-9.

Dietary Choices of New Zealand Women during Pregnancy and Lactation

Dietary recommendations during pregnancy and lactation have become increasingly complex, and sources of information more numerous but not always reliable, potentially causing confusion and unsafe choices. Women were recruited during pregnancy or within six months postpartum and completed questionnaires on dietary choices, food safety, and sources of nutrition information. Women (n = 458) from around New Zealand participated in the study. They consumed a wide range of foods and beverages and reported various dietary changes. In pregnancy, women commonly avoided alcohol (92%), raw milk products (86%), and raw, smoked, or pre-cooked seafood and fish (84%), and made changes due to food safety concerns. Influential advice was acquired from a range of sources including midwives (37%) and the New Zealand pregnancy and breastfeeding guidelines (25%) during pregnancy. Food avoidance was less common in lactation. However, fewer women consumed milk products during lactation (64%) than pregnancy (93%). Potentially unreliable sources were used more frequently in lactation including alternative health practitioners (26%) and family or friends (12%), and dietary changes were often made in response to infant symptoms without supporting evidence. This study highlighted a need for good communication of evidence-based recommendations to women, especially during lactation.

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.

Australian massage therapists' views and practices related to preconception, pregnancy and the early postpartum period

BACKGROUND AND PURPOSE

Massage is commonly used by the Australian public and is often sought by expectant mothers. Despite its popularity there is no regulatory body to enforce minimum educational standards, guidelines or evidence-based best practice for massage therapists. The aim of this paper is to critically examine the views and practices of massage therapists who offer preconception, antenatal or postnatal massage.

MATERIALS AND METHODS

An online survey was administered to Australian massage therapists who provide massage in the preconception, antenatal or postnatal periods.

RESULTS

Ninety-nine therapists completed the survey. The majority of respondents had received training in pregnancy massage (n = 72; 72.7%) only. The most confident respondents were those that had both training and experience.

CONCLUSION

There are potential gaps in training for massage therapists including up-to-date curriculum and a fragmentation around industry training requirements for pregnancy massage, which may impact on the safety and benefits of pregnancy massage.

The Perceived Credibility of Complementary and Alternative Medicine: A Survey of Undergraduate and Graduate Students

The popularity of complementary and alternative medicine (CAM) appears to be increasing, especially among college students. We surveyed 146 undergraduate and graduate students with the CAM Health Belief Questionnaire and obtained credibility and frequency ratings for a select group of CAM therapies: yoga, meditation, massage, chiropractic medicine, biofeedback, hypnosis, acupuncture, spirituality/religion, therapeutic touch, the use of herbs/vitamins, and aromatherapy/essential oils. Graduate students held more favorable views about integrating CAM into conventional medical practice. Female students reported using a wider variety of therapies than male students. Spirituality/religion and herbs/vitamins were the most popular CAM approaches. Students rated yoga, meditation, and massage as being highly credible practices. They rated hypnosis and therapeutic touch low in credibility. We discuss hypnosis as an example of a therapy that suffers from poor public perception despite having a relatively strong evidentiary base.

The effect of late pregnancy date fruit consumption on delivery progress - A meta-analysis

OBJECTIVE

To summarize the available evidence exploring the influence of date fruit consumption on delivery outcomes.

METHODS

A search was conducted for relevant articles in three databases for manuscripts in English, with no time restrictions.

RESULTS

Four articles were eligible for inclusion. Women consuming date fruit were admitted with higher cervical dilatation (mean difference (MD) 1.1 cm [95% confidence interval (CI) 0.2-1.99 cm) and yielded a lower need for labor induction/augmentation (relative risk (RR) 0.6, 95% CI 0.43-0.83). Date fruit consumption was associated with shorter latent phase (MD -4.6 hours, 95% CI -7.77 to -1.4) and second stage duration (MD -7.7 minutes, 95% CI -12.0 to -3.4).

CONCLUSIONS

Although the overall quality of the included studies was weak due to high risk of bias, the results of our meta-analysis point to beneficial effects of date fruit consumption on labor process. fruit.

Psychological predictors of the use of complementary and alternative medicines during pregnancy within a sample of Swiss women

Past works have witnessed increased prevalence of complementary and alternative medicines (CAM) among women during pregnancy. This study aimed to identify psychological antecedents underlying CAM use through the exploration of various predictors. Drawing upon the literature on the use of CAM in contexts unrelated to pregnancy, this research explored the role of various predictors: perceived stress, beliefs about medicine, health locus of control (HLOC), health literacy, bullshit receptivity, and belief in conspiracy theories (CT). 376 Swiss women were recruited to complete a web-based questionnaire in which the use of different kinds of CAM was investigated. We performed hierarchical regression analyses with backward method to assess the overall variance explained by the predictors, as well as their unique contributions. We measured the number of CAM used during last pregnancy and frequency of use. Analyses showed that CAM use was positively associated with perceived stress, beliefs about medicine, internal HLOC, and belief in CT. In contrast, negative relationships were found with external HLOC, bullshit receptivity, and health literacy. By illuminating such factors, this research contributed to explaining why women may be tempted to choose CAM in place of conventional medicine, which may be of particular interest for health professionals in the planning of communication strategies aimed at limiting risks associated to their use during pregnancy.

The Effectiveness of Aromatherapy in the Management of Labor Pain and Anxiety: A Systematic Review

BACKGROUND

Aromatherapy as an alternative and complementary medicine is a well-known method for reducing the symptoms of various physiological processes such as labor experience. The aim of this study was to systematically review the currently available evidences evaluating the use of aromatherapy for management of labor pain and anxiety.

METHODS

In a systematic review, 5 databases (PubMed, SCOPUS, Web of Science, Google Scholar and Scientific Information Database [SID]) were searched, from database inception up to December 2019. Keywords used included (aromatherapy OR ""essential oil" OR "aroma*") AND (pain OR anxiety) AND (labor OR delivery). Using the Cochrane Collaboration's 'Risk of bias' method; the risk of bias in the included studies was evaluated.

RESULTS

A total of 33 studies were verified to meet our inclusion criteria. Most of the included studies were conducted in Iran. Aromatherapy was applied using inhalation, massage, footbath, birthing pool, acupressure, and compress. The most popularly used essential oil in the studies was lavender (13 studies), either as a single essential oil or in a combination with other essential oils. Most of included studies confirmed the positive effect of aromatherapy in reducing labor pain and anxiety.

CONCLUSION

The evidences from this study suggest that aromatherapy, as a complementary and alternative modality, can help in relieving maternal anxiety and pain during labor.

Midwives' perceptions of Complementary and Alternative Medicines' during pregnancy

Using Complementary and Alternative Medicine (CAMs) is growing worldwide. This study determined the midwives' attitude toward CAMs in general and their view on its safety and efficacy during pregnancy. Via a random sampling method, 344 midwives working in Mazandaran primary health centers (PHC) were recruited from March to November 2017. The data were analyzed using descriptive statistics. The majority of the midwives had positive view on the usefulness of CAMs in general (74.3 %) and thought they should have more knowledge about it (76.7 %). While 50-83 % of the midwives considered some CAM-therapies safe and beneficial, a small number of them referred the patients for CAM-therapy during pregnancy (1.2-5.4 %). A minority of the midwives stated that CAM may be a threat to public health (12.7 %). The midwives' perception toward the usefulness of CAM in general was positive; although, they approved the benefit of few CAMs during pregnancy. A small minority of the midwives considered CAMs as a threat to public health, and few of them advised the patients to use CAMs during pregnancy. As most midwives are interested in learning in this field, it is recommended to run some training programs on the benefit and side effects of CAMs.

Providing maternity care from outside the system: perspectives of complementary medicine practitioners

One in two women in Australia use complementary medicine (CM) during pregnancy including consulting with CM practitioners for pregnancy-related health concerns. Yet, very little is known about the everyday care and practice of this group of health professionals as it relates to the provision of care to childbearing women. As such, this study aims to examine the perceptions and experiences of CM practitioners who provide care to childbearing women. Semi-structured interviews were conducted with 23 practitioners from six CM professions (acupuncturists, doulas, chiropractors, massage therapists, naturopaths, and osteopaths) who identified as providing care to pregnant and birthing women in their clinical practice. The participants described professional issues affecting their provision of care to childbearing women including scope of practice, regulation and standards, and practice-specific issues, all of which they linked back to their profession and the reputation of their profession among other health professionals and the community. The study results draw attention to the importance of considering the perspectives of CM maternity care providers and place on interprofessional collaboration, as well as the barriers they face to achieving this collaboration. The insights afforded by this study have the capacity to inform new policy and practice initiatives to support improved interprofessional maternity care.

Frequently Used Herbal Teas During Pregnancy - Short Update

The prevalence of herbal medicine use during pregnancy varies depending upon the geographical location and socio-cultural factors. With the belief of "being natural is safe", use of herbs and herbal products has become popular worldwide and used more frequently including period of pregnancy. The potential unwanted effects of any substance is more important during pregnancy period, because cellular development and division of the rapidly growing fetus is vulnerable to these adverse effects. As with medicines, herbal products must at least interact with a component of the organism at the molecular level in order to exert a response. Herbal preparations most commonly used during pregnancy were teas or infusions (hot-water extracts of dried herbs) which usually have the lowest concentrations and contain the least amount of compounds. The purpose of this review is to summarize the herbs that are most commonly used as "herbal teas" during pregnancy and their potential toxic effects to highlight the importance of being cautious about their use.

Use of traditional and complementary medicine for maternal health and wellbeing by African migrant women in Australia: a mixed method study

BACKGROUND

Traditional medicine serves as a form of primary health care for more than 80% of African populations. Currently, there is no research documenting if and how African migrant communities engage with their traditional health practices and beliefs after they resettle in Western countries. The aim of this study was to examine African migrant women's experiences and perspectives about traditional and complementary medicine use in relation to their maternal health and wellbeing in Australia.

METHODS

We conducted a mixed method study between December 2016 and October 2017. Questionnaires were completed by 319 women and 15 in-depth interviews were conducted among African migrant women residing across the Sydney metropolitan area, Australia. Survey data were analysed using SPSS (version 23) and logistic regression model was used to test associations. Qualitative data were analysed thematically using NVivo 11 software to identify themes and conceptual categories in the participants' responses. The study was informed by Andersen's Socio-behavioural model of health service utilisation.

RESULTS

The findings indicated that use of traditional and complementary medicine was high and continued to be well used following African women's resettlement in Australia. The survey found that 232 (72.7%) women use some form of traditional and complementary medicine for maternal health and wellbeing purposes. Most women (179, 77.2%) reported that maintaining their maternal health and wellbeing was the most common reason for use. The interview findings indicated that access to traditional medicine included making requests from relatives and friends who travelled to Africa looking for a similar medicinal plant in Australia and preparing home remedies with advice from family members and healers back in Africa. Age ≥ 35 years (OR, 16.5; 95%CI, 6.58-41.5; p < 0.001), lower education (OR, 24; 95%CI, 8.18-71.1; p < 0.001), parity (OR, 7.3; 95%CI, 1.22-42.81; p = 0.029), and lower income (OR, 2.7; 95%CI, 1.23-5.83; p = 0.013) were strong predictors of traditional medicine use.

CONCLUSION

Use of traditional and complementary medicine among African migrant women in Sydney remained high following resettlement in Australia. As noted in Andersen's sociobehavioural model of health service utilisation, specific predisposing and enabling factors including age, education and income were associated with use of traditional and complementary medicine.

Maternal Prenatal Exposures in Pregnancy and Autism Spectrum Disorder: An Insight into the Epigenetics of Drugs and Diet as Key Environmental Influences

Autism spectrum disorder (ASD) is a rapidly growing global pandemic that affects an estimated 1 in 59-68 children. It is a complex disease with both genetic and environmental etiologies. Due to the rapid increase in the incidence of ASD, environmental causes for ASD are gaining attention. Efforts to probe several environmental exposures that could contribute to causing ASD are underway. In this regard, this chapter is directed towards understanding prenatal exposure to key environmental factors i.e., drugs and dietary nutrients that may act via the same molecular pathway - epigenetics as a potential etiological factor for ASD. Epigenetic regulation is a molecular mechanism known to be a significant contributor to neurodevelopmental disorders. It also offers a means to explain how environmental exposures can impact genetics. We discuss the impact of maternal exposures to certain drugs, and dietary intake, on the developing fetus during pregnancy. Maternal Exposure to some drugs during gestation are associated with a higher risk of ASD, while exposure to other dietary compounds may offer promise to rescue epigenetic regulatory insults related to ASD. However, more work in this important area is still required, nevertheless preliminary research already has important implications in the understanding, prevention and treatment of ASD.

Use of Herbal Medicine by Pregnant Women: What Physicians Need to Know

About 80% of the consumers worldwide use herbal medicine (HMs) or other natural products. The percentage may vary significantly (7%-55%) among pregnant women, depending upon social status, ethnicity, and cultural traditions. This manuscript discusses the most common HMs used by pregnant women, and the potential interactions of HMs with conventional drugs in some medical conditions that occur during pregnancy (e.g., hypertension, asthma, epilepsy). It also includes an examination of the characteristics of pregnant HM consumers, the primary conditions for which HMs are taken, and a discussion related to the potential toxicity of HMs taken during pregnancy. Many cultures have used HMs in pregnancy to improve wellbeing of the mother and/or baby, or to help decrease nausea and vomiting, treat infection, ease gastrointestinal problems, prepare for labor, induce labor, or ease labor pains. One of the reasons why pregnant women use HMs is an assumption that HMs are safer than conventional medicine. However, for pregnant women with pre-existing conditions like epilepsy and asthma, supplementation of conventional treatment with HMs may further complicate their care. The use of HMs is frequently not reported to healthcare professionals. Providers are often not questioning HM use, despite little being known about the HM safety and HM-drug interactions during pregnancy. This lack of knowledge on potential toxicity and the ability to interact with conventional treatments may impact both mother and fetus. There is a need for education of women and their healthcare professionals to move away from the idea of HMs not being harmful. Healthcare professionals need to question women on whether they use any HMs or natural products during pregnancy, especially when conventional treatment is less efficient and/or adverse events have occurred as herbal-drug interactions could be the reason for these observations. Additionally, more preclinical and clinical studies are needed to evaluate HM efficacy and toxicity.

Innovations in the Treatment of Perinatal Depression: the Role of Yoga and Physical Activity Interventions During Pregnancy and Postpartum

PURPOSE OF REVIEW

We review evidence for physical activity and yoga as interventions for depressed pregnant and postpartum women.

RECENT FINDINGS

Results from existing trials have generally indicated that physical activity and yoga interventions are acceptable to women during the perinatal period, and that these interventions can be effective in reducing depression. However, some studies have not found significant differences between intervention and control conditions. In addition, symptom improvements were not always maintained. The available research on physical activity and yoga as interventions for perinatal depression is encouraging with regard to feasibility, acceptability, patient safety, and preliminary efficacy. These interventions have the ability to reach a large number of women who may not engage in traditional treatment. Additional high quality, rigorous, randomized controlled trials are needed. Future research is also needed to examine the optimal dose of these interventions and how to best increase sustained engagement.

Evaluating the effects on steroidogenesis of estragole and trans-anethole in a feto-placental co-culture model

In this study, we determined whether estragole and its isomer trans-anethole interfered with feto-placental steroidogenesis in a human co-culture model composed of fetal-like adrenocortical (H295R) and placental trophoblast-like (BeWo) cells. Estragole and trans-anethole are considered the biologically active compounds within basil and fennel seed essential oils, respectively. After a 24 h exposure of the co-culture to 2.5, 5.2 and 25 μM estragole or trans-anethole, hormone concentrations of estradiol, estrone, dehydroepiandrosterone, androstenedione, progesterone and estriol were significantly increased. Using RT-qPCR, estragole and trans-anethole were shown to significantly alter the expression of several key steroidogenic enzymes, such as those involved in cholesterol transport and steroid hormone biosynthesis, including StAR, CYP11A1, HSD3B1/2, SULT2A1, and HSD17B1, -4, and -5. Furthermore, we provided mechanistic insight into the ability of estragole and trans-anethole to stimulate promoter-specific expression of CYP19 through activation of the PKA pathway in H295R cells and the PKC pathway in BeWo cells, in both cases associated with increased cAMP levels. Moreover, we show new evidence suggesting a role for progesterone in regulating steroid hormone biosynthesis through regulation of the StAR gene.

Complementary therapy and alternative medicine: effects on induction of labour and pregnancy outcome in low risk post-dates women

Background

Complementary therapy and Alternative medicine (CAM) is used worldwide for many ailments and is a popular option amongst pregnant women for general wellbeing and managing symptoms. Many studies investigating the use of CAM in the antenatal and intrapartum period have been conducted however there is a lack of evidence regarding its effects on induction of labour and delivery. We established a post-dates clinic comprising of an antenatal check and CAM for low risk pregnant women to determine the impact of CAM on these outcomes.

Methods

This was a cohort study with convenience sampling. A total of 1044 women were included. 397 received a combination of three CAM techniques (acupressure, reflexology and aromatherapy) and 647 women received standard clinical practice. The primary outcome was rate of induction of labour and secondary outcomes such as rates for epidural, length of labour, oxytocin use for induction or augmentation of labour, mode of delivery, blood loss during delivery, postpartum haemorrhage, significant perineal trauma, shoulder dystocia and admission of the baby to a special care unit were analysed.

Findings

CAM did not have an effect on rates of induction of labour in nulliparous or multiparous women attending the post-dates clinic. However, we noted that nulliparous women who received CAM had shorter labours (mean 8.4 vs 10 h, p = 0.0002), less oxytocin augmentation (23% vs 35%, p = 0.0002), lower epidural rates (41% vs 50.5%, p = 0.02) and reduced blood loss regardless of mode of delivery (mean reduction 82ml, p = 0.03; 95%CI = -159 to -5). There were no significant differences in secondary outcomes when CAM was used in multiparous women apart from a 5.3 times increased risk of significant perineal trauma (6% vs 2%, p = 0.004) and those who had their labours induced after CAM had a higher risk of requiring an emergency caesarean section (5% vs 1%, p = 0.012). There was no difference on shoulder dystocia and neonatal admissions rates with CAM.

Conclusion

There is no reduction in induction of labour rates with the use of CAM. The other effects of CAM on labour and delivery outcomes are varied and potentially only beneficial in a selected group of women. Further research must be carried out before making any clear recommendations on its use.

Health products' and substance use among pregnant women visiting a tertiary hospital in Belgium: A cross-sectional study

PURPOSE

To investigate the prevalence and type of health products used among pregnant women visiting a tertiary hospital in Belgium, as well as who advises these products, where women buy these products, which determinants are associated with medication and pregnancy vitamin intake, and preconception lifestyle changes such as folic acid intake and substance use.

METHODS

A cross-sectional study was performed at the outpatient obstetrics clinics of the University Hospital Leuven, Belgium between November 2016 and March 2017. All pregnant women 18 years and older and understanding Dutch, French, or English were asked to participate in an online survey.

RESULTS

In total, 379 pregnant women participated. Prevalence of medication use during the preceding week was 52%. Paracetamol (14%), levothyroxine (13%), and antacids (9%) were the most frequently used medicines. Pregnancy vitamins were used by 86% of women, and 97% had used a pregnancy vitamin somewhere during pregnancy. Only 56% initiated folic acid supplementation at least 1 month before pregnancy. Preconception use of folic acid among women following assisted reproductive technology was 73%. Inappropriate use of health products was observed among 3% of women. Prevalence of alcohol use and/or smoking during the preceding week was 6%. Alcohol and smoking cessation mainly occurred after pregnancy diagnosis.

CONCLUSION

Pregnant women living in Belgium frequently use medicines, pregnancy vitamins, and other health products. Preconception lifestyle changes such as folic acid intake and alcohol and smoking cessation are poorly implemented. Public campaigns and interventions are needed to improve preconception care and counselling.

Complementary medicine products information-seeking by pregnant and breastfeeding women in Australia

OBJECTIVE

Complementary medicine product use in pregnancy and lactation is common but little is known about women's health literacy and information-seeking regarding this. The objectives of this study were to identify and explore pregnant or breastfeeding women's sources of, and rationale for seeking complementary medicine products information, the types of information sought, and how women felt their health care practitioners can help them receive information that meets their needs.

DESIGN

A qualitative research design consisting of in-depth interviews and focus group discussions was conducted. Data were thematically analysed. Participants also completed two validated health literacy screening tools.

SETTING

Communities in regional and metropolitan settings in Sydney and Northern New South Wales, and South-East Queensland, Australia.

PARTICIPANTS

Twenty-five women (n = 7 pregnant, n = 17 breastfeeding, n = 1 both pregnant and breastfeeding) who currently used complementary medicine products participated. Eleven women were pregnant with or breastfeeding their first child; 14 had between one and four older children.

FINDINGS

Twenty-four participants had high health literacy according to the validated screening tools. Around half of the participants had used complementary medicine products for most of their lives and 17 had used complementary medicine products to resolve or manage complex health conditions in adulthood or childhood. Women sought complementary medicine products information from three main sources. 1) Practical and safety information on complementary medicine products was sought from health care practitioners and published research; 2) health care practitioners were also sources of information on reasons for complementary medicine products recommendations and physiological actions; and 3) sharing experiences of complementary medicine products use with other mothers appeared to help women understand what to expect when taking complementary medicine products, support social-emotional wellbeing and encourage participants to look after their own health. Participants strongly expressed the desire for their mainstream biomedical health care practitioners to be more informed in, and open to, complementary medicine product use in pregnancy and breastfeeding.

KEY CONCLUSIONS

Participants' high health literacy skills may have influenced them to seek comprehensive information on complementary medicine products from a variety of professional and lay sources. Their use of complementary medicine products in pregnancy and breastfeeding was a natural consequence from previous positive experiences with complementary medicine products and/or therapies.

IMPLICATIONS FOR PRACTICE

Maternity care practitioners can positively enhance their interactions with pregnant or breastfeeding women who use complementary medicine products by respectfully discussing use within the context of these women's values and health goals, and by furthering their own education in complementary medicine products' safety, efficacy and indications in pregnancy and breastfeeding.

A Pilot Study of Partner Chair Massage Effects on Perinatal Mood, Anxiety, and Pain

BACKGROUND

Women worldwide experience perinatal mood, anxiety, and pain contributing to pregnancy and birth challenges, maternal and infant bonding, and childhood development. Perinatal women seek massage therapy for relaxation, pain management, and emotional support, but may encounter socioeconomic barriers. Prior studies demonstrated improved perinatal health by teaching partners of pregnant women a side-lying massage.

PURPOSE

This study examined health effects to perinatal mood, anxiety, and pain, by teaching partners of pregnant (PG) women a chair massage.

SETTING

Participant's homes in Tucson, Arizona, USA.

PARTICIPANTS

Twelve PG women with minor mood, anxiety, and pain: 67% white, 33% Hispanic, college educated, married, aged 32 years (± 3.86 SD), 67% expecting a first child, annual incomes ≤ $50,000 (33%), > $50,000 (67%).

RESEARCH DESIGN

A pre/postintervention pilot study in a single group for eight weeks.

INTERVENTION

Twice weekly partner-delivered chair massage and its relation to perinatal mood, anxiety, and pain.

MAIN OUTCOME MEASURES

Pre/poststudy perinatal massage effects were measured with the Edinburgh Depression Scale (mood), the STAI-AD (anxiety), and the VAS (pain). Weekly text messaging tracked dose and frequency, follow-up surveys measured sustainability, and birth outcomes were acquired by texting.

RESULTS

Study retention was 86%, protocol compliance 94%, with couples averaging 10-minute, twice weekly chair massage over the eight-week study period. Paired-sample t tests indicated statistically significant improvements to perinatal mood and anxiety, Cohen's d, a large strength of effect size (p = .012, d = 0.87; p = .004, d = 1.03). A trend was observed for reduced pain, with a medium strength of effect size (p = .071; d = 0.58). Follow-up surveys indicated most couples were sustaining at least weekly massage. Birth outcomes showed healthy infants with no complications, mean birth weight of 7.26 pounds, and mean gestation of 39 weeks.

CONCLUSION

This is the first evidence of partner chair massage as safe and effective complementary home management of perinatal mood, anxiety, and pain.

Herbal medicines and pregnancy: A narrative review and anaesthetic considerations

The use of herbal medicines by pregnant women varies among different countries, ranging from 4.3% in Sweden to 69% in Russia. The aim of this narrative review is to evaluate the benefits and safety of common herbal medicines used during pregnancy. A systematic literature search (from 1995 to February 2018) was performed using a variety of electronic databases. The levels of evidence of the clinical studies were graded using the Oxford Centre for Evidence-Based Medicine levels of evidence guidelines. From the 736 articles retrieved, 69 articles were used for this review. Ginger has been investigated extensively and has been consistently found to decrease nausea and vomiting associated with pregnancy (Level 2). There is insufficient evidence concerning the efficacy of other herbal medicines such as garlic, cranberry and raspberry in pregnancy (Level 3–4). Much of the literature is based on case reports with limited pharmacodynamic/kinetic studies. There are no clear data on the adverse herb–drug interactions during anaesthesia. As the risks of these interactions are unknown, it would be prudent for anaesthetists to explicitly ask their patients about their use of herbal medicines before surgery and prior to labour and birth. The European Society of Anaesthesiology and American Society of Anesthesiologists recommend that patients cease taking herbal medicines two weeks before surgery.