Do No Harm: Avoidance of Herbal Medicines During Pregnancy

A population-based cohort of drug exposures and adverse pregnancy outcomes in China (DEEP): rationale, design, and baseline characteristics

The DEEP cohort is the first population-based cohort of pregnant population in China that longitudinally documented drug uses throughout the pregnancy life course and adverse pregnancy outcomes. The main goal of the study aims to monitor and evaluate the safety of drug use through the pregnancy life course in the Chinese setting. The DEEP cohort is developed primarily based on the population-based data platforms in Xiamen, a municipal city of 5 million population in southeast China. Based on these data platforms, we developed a pregnancy database that documented health care services and outcomes in the maternal and other departments. For identifying drug uses, we developed a drug prescription database using electronic healthcare records documented in the platforms across the primary, secondary and tertiary hospitals. By linking these two databases, we developed the DEEP cohort. All the pregnant women and their offspring in Xiamen are provided with health care and followed up according to standard protocols, and the primary adverse outcomes - congenital malformations - are collected using a standardized Case Report Form. From January 2013 to December 2021, the DEEP cohort included 564,740 pregnancies among 470,137 mothers, and documented 526,276 live births, 14,090 miscarriages and 6,058 fetal deaths/stillbirths and 25,723 continuing pregnancies. In total, 13,284,982 prescriptions were documented, in which 2,096 chemicals drugs, 163 biological products, 847 Chinese patent medicines and 655 herbal medicines were prescribed. The overall incidence rate of congenital malformations was 2.0% (10,444/526,276), while there were 25,526 (4.9%) preterm births and 25,605 (4.9%) live births with low birth weight.

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.

Assessing the safety and use of medicinal herbs during pregnancy: a cross-sectional study in São Paulo, Brazil

Background: Despite the lack of evidence supporting the safety and clinical efficacy of herbal medicine (HM), its use among pregnant women continues to increase. Given the high prevalence of contraindicated herbs among the pregnant population in Brazil, it is crucial to examine the use of HM and evaluate its safety based on the current scientific literature to ensure that women are using HM appropriately. Methods: A cross-sectional study was conducted from October 2022 to January 2023 at a public teaching hospital in São Paulo, Brazil. A total of 333 postpartum women in the postnatal wards and postnatal clinic were interviewed using a semi-structured questionnaire. The survey instrument consisted of 51 items covering the use of HM during pregnancy, sociodemographic and health-related characteristics, COVID-19 experiences, and pregnancy outcomes. For data analysis, chi-square and multivariate logistic regression were conducted using SPSS ver. 26.0. Results: Approximately 20% of respondents reported using HM during their most recent pregnancy, with a higher use observed among women from ethnic minority groups and those with prior HM experience. Among the 20 medicinal herbs identified, 40% were found to be contraindicated or recommended for use with caution during pregnancy. However, only half of the women discussed their HM use with obstetric care providers. Conclusion: This study emphasizes the continued public health concern regarding the use of contraindicated or potentially harmful HM among pregnant women in Brazil, highlighting the need for sustained efforts to reduce the risk of inappropriate HM use. By updating antenatal care guidelines based on the latest scientific evidence, healthcare providers can make informed clinical decisions and effectively monitor pregnant women's HM use, ultimately promoting safer and more effective healthcare practices.

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.

Complementary and Alternative Medicine Use in a Pregnant Population, Northwest Ethiopia

Background

Complementary and alternative medicine (CAM) appears to be the source of healthcare particularly in the majority of pregnant communities of Africa due to its intrinsic qualities as well as its accessibility and affordability. Despite acknowledged benefits of CAM use in pregnancy, majority of users are unaware of its safety and effects on fetal development. The present study was aimed at examining CAM use among pregnant women in Northwest Ethiopia to provide an opportunity for future investigations on the effectiveness of CAM modalities in the management of pregnancy-related complications across the country.

Methods

This was an institution-based cross-sectional study which was conducted at Poly Clinic Health Center in the Northwest part of Ethiopia between March and May 2018. Two hundred and eighty two Ethiopian women were conveniently recruited to take part in the study. Structured questioners were used for the survey. Descriptive statistics of sociodemographic and CAM use characteristics were expressed in frequencies and proportions. Chi-square test was performed to determine the difference between CAM user and nonuser. Besides, binary logistic regression analyses were performed to examine predictors of CAM use in the study population. The result was considered statistically significant if P value ≤ 0.05.

Results

The prevalence rate of CAM use in pregnant women was 89.36% with the commonest practice of spiritual healing (65.2%) and herbal supplement (51.8%) CAM therapies. Use of CAM positively associated with marital status and previous number of children. The odds of using CAM among single/not married women were 3.22 times higher (COR: 3.22, CI: 1.07-9.64) as compared to married women. Pregnant women with no children were 3.30 times more likely (COR: 3.30, CI: 0.92-11.84) to use CAM than those women having ≥3 children. Lower odds of using CAM significantly associated with educational level (COR: 0.20, CI: 0.046-0.93) and antenatal care (COR: 0.45, CI: 0.18-1.13) in a binary logistic regression model.

Conclusions

A considerable number of pregnant women were utilizing CAM including herbal products as part of their maternity care. This finding provides a reference on the use of CAM for policy-makers, health professionals, and parents. Further studies are needed to investigate the effectiveness and safety of specific CAM modalities with particular focus on herbal medicinal products.

Predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior in Kashan, Iran

BACKGROUND

The incidence of application of medicinal herbs during pregnancy has increased significantly among women over the past years; however, the safety and efficacy of medicinal herbs during pregnancy are still unclear. The aim of the present study was to categorize the predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior (TPB).

METHODS

The present descriptive-analytical study was conducted on 300 pregnant women referred to Kashan health center to receive prenatal care services in 2020. The study participants were randomly selected using stratified random sampling with proportional allocation. The data collection tool was a two-part researcher made questionnaire. The first part of the questionnaire included demographic information, midwifery information, and questions related to women's awareness about herbal medicine. The second part of the questionnaire was designed based on the theory of planned behavior including attitudes, perceived behavioral control, subjective norms, intention, and behavior performance. Data were analyzed using descriptive statistics, regression analysis, and SPSS version 18.0.

RESULTS

The mean age of participants was 28. 7±5.4 years (range, 15-45 years), the majority were housewives (88.3%) and had secondary education (39.3%). A total of 164 women (57. 1%) used medicinal herbs during pregnancy. The individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with behavioral intention (P < 0.05). Similarly, subjective norms were the most predictor of using herbal medicine among pregnant women (P < 0.05).

CONCLUSION

The findings revealed that more than 50 % of pregnant women used medicinal herbs during pregnancy. The present study showed that the individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with intention of herbal medicine use among pregnant women. Likewise, subjective norms were the most predictor of herbal medicine use among pregnant women. The TPB should be addressed in planning health education programs and modifying health behaviors, including self-medication, especially during pregnancy.

Reproductive Toxicity of Theobroma cacao: Increase in Survival Index, Nongenotoxic, and Proimplantation Potential

Unsweetened natural cocoa (UNCP) was evaluated for reproductive toxicity in rats. A preliminary genotoxic potential was evaluated by the DNA comet assay test using C57Bl/6 mice. Both therapeutic dose (TD; 900 mg/kg) and high dose (HD; 9000 mg/kg) of UNCP were used. White Wistar rats were used in two experimental groups. The females received UNCP 15 days before crossing with untreated males. The males received UNCP for 48 days before mating with untreated females. Subacute toxicity was observed during a 14-day oral administration of UNCP. Results show that a high tail DNA% was observed with methyl mesylate administration in all tissues analysed. The lowest tail DNA% value was observed in the liver (1.64 ± 0.26) and kidney (1.63 ± 0.30) during UNCP (TD) administration. UNCP did not induce observable physical congenital malformations on the pubs of treated female and male rats, lacks genotoxic potential, and did not adversely affect pregnancy index, pub weights, and survival index, but UNCP exhibited proimplantation potential (p > 0.05).

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.

Factors associated with local herb use during pregnancy and labor among women in Kigoma region, Tanzania, 2014-2016

Background

Despite research suggesting an association between certain herb use during pregnancy and delivery and postnatal complications, herbs are still commonly used among pregnant women in sub-Sahara Africa (SSA). This study examines the factors and characteristics of women using local herbs during pregnancy and/or labor, and the associations between local herb use and postnatal complications in Kigoma, Tanzania.

Methods

We analyzed data from the 2016 Kigoma Tanzania Reproductive Health Survey (RHS), a regionally representative, population-based survey of reproductive age women (15–49 years). We included information on each woman’s most recent pregnancy resulting in a live birth during January 2014–September 2016. We calculated weighted prevalence estimates and used multivariable logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with use of local herbs during pregnancy and/or labor, as well as factors associated with postnatal complications.

Results

Of 3530 women, 10.9% (CI: 9.0–13.1) used local herbs during their last pregnancy and/or labor resulting in live birth. The most common reasons for taking local herbs included stomach pain (42.9%) and for the health of the child (25.5%). Adjusted odds of local herb use was higher for women reporting a home versus facility-based delivery (aOR: 1.6, CI: 1.1–2.2), having one versus three or more prior live births (aOR: 1.8, CI: 1.4–2.4), and having a household income in the lowest versus the highest wealth tercile (aOR: 1.4, CI: 1.1–1.9). Adjusted odds of postnatal complications were higher among women who used local herbs versus those who did not (aOR: 1.5, CI: 1.2–1.9), had four or more antenatal care visits versus fewer (aOR: 1.4, CI: 1.2–1.2), and were aged 25–34 (aOR: 1.1, CI: 1.0–1.3) and 35–49 (aOR: 1.3, CI: 1.0–1.6) versus < 25 years.

Conclusions

About one in ten women in Kigoma used local herbs during their most recent pregnancy and/or labor and had a high risk of postnatal complications. Health providers may consider screening pregnant women for herb use during antenatal and delivery care as well as provide information about any known risks of complications from herb use.

Effect of Libidibia ferrea bark and seed in maternal reproductive and biochemical outcomes and fetal anomaly in rats

BACKGROUND

Unhealthy pregnant women living in underdeveloped regions are usually treated by traditional healers, inadvertent of the potential toxic effects of plant-derivative substances. Thus, we investigated whether exposure to a hydroalcoholic extract of bark and seed of Libidibia ferrea during pregnancy results in fetotoxicity and maternal toxicity. The main constituents of both extracts were analyzed by High Performance Liquid Chromatography (HPLC).

METHODS

Pregnant rats were divided into three groups: control (C), group exposed to extract of bark (Lfb-1.0 g/kg/day), and group exposed to extract of the seed (Lfs-1.0 g/kg/day). Biochemical parameters, reproductive capacity, morphological effects in the offspring were analyzed.

RESULTS

HPLC fingerprint confirmed the presence of ellagic in both bark and seed extracts, and the absence of detectable concentrations of gallic and catechin. Fetuses exposed to L. ferrea extracts presented shorter mean lengths for head and body sections when compared to those in C and exhibited visceral and skeletal anomalies. Pregnant rats exposed to Lfs extracts show alterations in serum creatinine levels and yield amniotic fluid with abnormal biochemical composition.

CONCLUSION

Bark or seed extracts of L. ferrea do not exhibit safety level compatible to be used in the gestational period.

Combining and Using the Utrecht Method and the Analytic Hierarchy Process to Facilitate Professional and Ethical Deliberation and Decision Making in Complementary and Alternative Medicine: A Case Study among a Panel of Stakeholders

Background

In daily practice, healthcare practitioners face many challenges in ethical and professional decision making. Currently, little is known on the ethical and professional deliberations and weighing benefits against risks in daily complementary and alternative medicine (CAM) practice. The aim of this study was to combine the Utrecht method and the Analytic Hierarchy Process (AHP) in deliberations, weighing benefits against risks of using ginger for a pregnant woman suffering nausea and vomiting of pregnancy (NVP) along with other comorbidities.

Methods

A hypothetical case was constructed using the twelve tips for constructing dilemma case-based assessment. Three CAM practitioners, two physicians, three pharmacists, and two patients were recruited, and the Utrecht and the AHP methods were combined and used to deliberate and weigh benefits against risks of using ginger for the presented case.

Results

Responses from the ten panelists were obtained. Priority ratings showed significantly higher scores (p-value < 0.001) for alleviating symptoms of NVP (30.7%  ± 16.6%) compared to other potential benefits. Increasing the risk of bleeding was given significantly higher (p-value < 0.0001) weight scores (24.7%  ± 13.5%) than other potential side effects. Potential risk of spontaneous abortion and risk of impairment of fetal development were given higher (p-value < 0.001) weight scores than risk of fetal hypoglycemia. When benefits were compared against side effects and risks to the fetus and pregnancy, potential benefits were given higher (p-value < 0.001) weight scores (72.3%  ± 5.2%).

Conclusions

Considering the anticipated benefits and risks, a shared decision was made to use ginger in the case presented. The woman should also be informed of the potential side effects and risks of using ginger. The use of this combined method might promote openness and transparency in making shared decisions for healthcare providers and patients.

Herbal medicine use by pregnant women in Bangladesh: a cross-sectional study

Background

Herbal medicines in pregnancy are increasingly used worldwide with prevalence of up to 67%. Although this popularity is mainly because of the common belief that these medicines are safe, recent reports suggest that several herbal medicines are potentially harmful to mother and fetus if used in pregnancy.

Methods

This cross-sectional study was conducted in July and August of year 2017, at maternity wards of two public hospitals in Dhaka, Bangladesh. Postpartum women were interviewed via the structured questionnaire to collect information regarding socio-demographic and health characteristics, patterns of herbal medicines used in the previous pregnancy, and outcome of pregnancy.

Results

Two hundred forty-three postpartum women participated in the study, with 70% of them using at least one modality of herbal medicines in previous pregnancy. Ginger, black seed, lemon tea, prune, and mustard oil were most commonly used herbal medicines. Herbal medicines were mostly used for pregnancy-related symptoms such as nausea, vomiting, and cold. Fifteen (8.8%) herbal medicine users reported side effects.

Conclusions

This study highlights popularity of herbal medicines during pregnancy in Bangladesh. Previous herbal medicine users and unemployed women turned significantly more to herbal medicines during pregnancy. Reports of side effects and use of some potentially harmful modalities warrant awareness regarding proper use of herbal medicines in pregnancy and its pharmacovigilance.

Electronic supplementary material

The online version of this article (10.1186/s12906-018-2399-y) contains supplementary material, which is available to authorized users.

Evaluation of Reproductive Toxicology of Aqueous Extract of Yerba Mate (Ilex paraguariensis A. St.-Hil.), a Traditional South American Beverage

Yerba mate (Ilex paraguariensis A. St.-Hil.; Aquifoliaceae) is a popular tonic and stimulant beverage that is widely consumed in different South American countries. Estimates indicate the consumption of >1 L per day in southern Brazil and Uruguay. Despite its relatively high consumption, data on reproductive toxicity during critical periods of gestation remain unclear. Thus, we evaluated the effects of an aqueous extract of I. paraguariensis leaves ("chimarrão" [IPC]) at two critical periods of gestation in Wistar rats: preimplantation embryonic stage and fetal organogenesis. Pregnant Wistar rats were orally treated with IPC (3, 30, and 300 mg/kg) from days 1 to 7 or 8 to 21 of pregnancy. The respective control groups received vehicle. During treatment, clinical signs of maternal toxicity, maternal body weight, and food and water intake were monitored. The rats were killed on days 8 and 20 of pregnancy, and the following parameters were evaluated: weight of the maternal uterus, weight of the liver, weight of the kidneys, weight of the spleen, total embryo implantation, preimplantation loss, the mean of live fetuses, the percentage of dead fetuses, fetus weight, and fetal malformation. The aqueous extract of the leaves of I. paraguariensis L. did not present any deleterious effects on preimplantation embryos or the organogenesis of offspring from female Wistar rats. These safety data provide evidence that IPC may be safe for consumption during gestation.

The use of complementary and alternative medicines during breastfeeding: results from the Herbal supplements in Breastfeeding InvesTigation (HaBIT) study

AIMS

The use of complementary and alternative medicines (CAMs) during breastfeeding is increasing, mainly because of their presumed greater safety compared with conventional medications. However, CAMs can cause serious adverse effects, and there is limited high-quality evidence supporting their use during lactation. In Italy, specific investigations on the attitude of lactating women towards CAMs are lacking. The Herbal supplements in Breastfeeding InvesTigation (HaBIT) study aimed to explore attitudes to and knowledge on CAMs among lactating women.

METHODS

A web-based survey was conducted over a 6-year period among lactating women resident in Tuscany, Italy. Data on lactating behaviour, CAMs use during pregnancy or breastfeeding, and women's knowledge about the efficacy and safety of CAMs were collected.

RESULTS

A total of 388 lactating women answered the questionnaire. The majority of them were primiparae, with a high educational level. Of these, 204 women declared themselves to have used CAMs during breastfeeding. Moreover, 61% and 48% of subjects reported also using CAMs before and during pregnancy, respectively. A significant proportion of subjects were unable to identify correctly the types of CAMs they were using. Seventy-three per cent of women were convinced that CAMs were equally safe or safer than conventional medications; nevertheless, 65% of women admitted to have no scientific information about the potential risks of CAMs, and 14 CAMs users reported that they had experienced side effects.

CONCLUSIONS

These results demonstrate the need for healthcare providers to increase the awareness of breastfeeding women about CAMs. Further research is needed to support the evidence base for nonpharmaceutical approaches for symptom control during breastfeeding.

Safety classification of herbal medicines used among pregnant women in Asian countries: a systematic review

Background

High prevalence of herbal medicines used in pregnancy and the lack of information on their safety is a public concern. Despite this, no significant research has been done regarding potential adverse effects of using herbal medicines during pregnancy, especially among developing Asian countries.

Methods

Cross-sectional studies were searched up to year 2016 on PubMed/Medline and EMBASE, the data were extracted and quality of studies was assessed using the quality appraisal tool. The findings are reported in accordance to the PRISMA checklist (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Classification on safety of identified herbal medicines was done based on current scientific literature.

Results

This study included eight cross-sectional studies (2729 participants) from seven different Asian countries, of which 1283 (47.01%) women used one or more herbal medicines during pregnancy. Peppermint (22.8%), aniseed (14.7%), olibanum (12.9%), flixweed seed (12.2%) and ginger (11.5%) were the most frequently used herbal medicines. Out of the 33 identified herbal medicines, 13 were classified as safe to use, five as use with caution, eight were potentially harmful to use in pregnancy and information on seven herbal medicines was not available in the current literature.

Conclusions

Several herbal medicines identified in this review were classified to be potentially harmful or the information regarding safety in pregnancy was missing. It is recommended that contraindicated herbal medicines should be avoided and other herbals should be taken under supervision of a qualified health care practitioner. The classification regarding safety of herbal medicines in pregnancy can be utilized to create awareness on prevention of adverse effects.

Electronic supplementary material

The online version of this article (10.1186/s12906-017-1995-6) contains supplementary material, which is available to authorized users.

Applicability of plant-based products in the treatment ofTrypanosoma cruziandTrypanosoma bruceiinfections: a systematic review of preclinicalin vivoevidence

Chagas disease and sleeping sickness are neglected tropical diseases closely related to poverty, for which the development of plant-derived treatments has not been a promising prospect. Thus, we systematicaly review the preclinicalin vivoevidence on the applicability of plant-based products in the treatment ofTrypanosoma cruziandTrypanosoma bruceiinfections. Characteristics such as disease models, treatments, toxicological safety and methodological bias were analysed. We recovered 66 full text articles from 16 countries investigating 91 plant species. The disease models and treatments were highly variable. Most studies used native (n= 36, 54·54%) or exotic (n= 30, 45·46%) plants with ethnodirected indication (n= 45, 68·18%) for trypanosomiasis treatment. Complete phytochemical screening and toxicity assays were reported in only 15 (22·73%) and 32 (48·49%) studies, respectively. The currently available preclinical evidence is at high risk of bias. The absence of or incomplete characterization of animal models, treatment protocols, and phytochemical/toxicity analyses impaired the internal validity of the individual studies. Contradictory results of a same plant species compromise the external validity of the evidence, making it difficult determine the effectiveness, safety and biotechnological potential of plant-derived products in the development of new anti-infective agents to treatT. cruziandT. bruceiinfections.

Which potential harms and benefits of using ginger in the management of nausea and vomiting of pregnancy should be addressed? a consensual study among pregnant women and gynecologists

BACKGROUND

Nausea and vomiting of pregnancy (NVP) affect approximately 80-90% of the pregnant women. Ginger (Zingiber officinale Roscoe) is the most widely used herbal therapy in the management of NVP. Like conventional therapies, herbal therapies have potential harms and benefits that patients need to be informed about in order to develop their therapy preferences. The aim of this study was to achieve consensus among women who suffered NVP and physicians often consulted by pregnant women on a core list of potential harms and benefits of using ginger to manage NVP to be addressed during clinical consultations.

METHODS

In this study, the Delphi technique was used to achieve consensus on a core list of important harms and benefits of using ginger in the management of NVP to be addressed during the clinical consultation. A Delphi process was followed in two panels in parallel sessions. One panel was composed of 50 gynecologists and other physicians who are often consulted by pregnant women suffering NVP and the other panel was composed of 50 women who suffered NVP.

RESULTS

Consensus was achieved on 21 (75%) of the 28 potential harms presented to the panelists. Panelists agreed that potential harms of the anticoagulant effects of ginger, risk with other co-morbidities, and risk of potential allergic reactions are important to address during the clinical consultation. Of the 14 potential benefits presented to the panelists in both panels, consensus was achieved on 13 (92.9%). Partial consensus on 7 potential harms and 1 potential benefit was achieved in both panels.

CONCLUSIONS

Addressing important potential harms and benefits of using ginger for the management of NVP during the clinical consultations is important in promoting congruence and reducing patient dissatisfaction in clinical practice. Consensus was achieved on a core list of important harms and benefits of using ginger for the management of NVP to be addressed during the clinical consultations by a panel of women and a panel of physicians. Further studies are still needed to investigate what is being addressed during clinical consultations.

Assessment of an aqueous seed extract of Parkia clappertoniana on reproductive performance and toxicity in rodents

ETHNOPHARMACOLOGICAL RELEVANCE

The seeds of Parkia clappertoniana Keay (Family: Fabaceae) are extensively used in food in the form of a local condiment called 'Dawadawa' in Ghana and consumed by all class of people including sensitive groups such as pregnant women and children. Also, crudely pounded preparations of P. clappertoniana seeds are used as labor inducing agent in farm animals by local farmers across northern Ghana where nomadism is the livelihood of most indigenes. Ecologically, P. clappertoniana is extensively distributed across the savannah ecological zone of many African countries where just like Ghana it enjoys ethnobotanical usage. Although, many studies have investigated some aspects of the pharmacological activity of P. clappertoniana, none of these studies focused on the reproductive system, particularly its effects on reproductive performance and toxicity. To contribute, this study assessed the effect of aqueous seed extract of P. clappertoniana (PCE) on reproductive performance and toxicity in Sprague-Dawley rats and ICR mice.

METHODS

After preparation of PCE, it was then tested on rodents at different gestational and developmental windows (1-7, 8-14, and 15-term gestational days) to assess the following: mating behavior, implantation rate, maternal and developmental toxicities. Generally, animals were randomly grouped into five and treated as follows: normal saline group (5ml/kg po), cytotec (misoprostol) group (200mg/kg po), folic acid group (5mg/kg po), and PCE groups (100, 200, and 500mg/kg po), however, these groupings were varied to suit the specific requirements of some parameters. For acute toxicity, animals were orally administered PCE (3 and 5g/kg for mice and rats respectively).

RESULTS

PCE-treated rats showed improved mating behavior compared to control rats. PCE improved implantation rate compared to misoprostol-treated rats. On the average, PCE-treated rats delivered termed live pubs at 21 days compared to that of folic acid-treated rats at 23 days. Also, PCE-treated rats showed no observable maternal and developmental toxicities compared to folic acid and control rats. PCE (3-5g/kg po) was orally tolerated in rodents.

CONCLUSION

Oral administration of Parkia clappertoniana seed extract improves reproductive performance in rodents with no observable maternal and developmental toxicity.

'Asking the Right Question'. A Comparison of Two Approaches to Gathering Data on 'Herbals' Use in Survey Based Studies

Background

Over the last decade academic interest in the prevalence and nature of herbal medicines use by pregnant women has increased significantly. Such data are usually collected by means of an administered questionnaire survey, however a key methodological limitation using this approach is the need to clearly define the scope of ‘herbals’ to be investigated. The majority of published studies in this area neither define ‘herbals’ nor provide a detailed checklist naming specific ‘herbals’ and CAM modalities, which limits inter-study comparison, generalisability and the potential for meta-analyses. The aim of this study was to compare the self-reported use of herbs, herbal medicines and herbal products using two different approaches implemented in succession.

Methods

Cross-sectional questionnaire surveys of women attending for their mid-trimester scan or attending the postnatal unit following live birth at the Royal Aberdeen Maternity Hospital, North-East Scotland. The questionnaire utilised two approaches to collect data on ‘herbals’ use, a single closed yes/no answer to the question “have you used herbs, herbal medicines and herbal products in the last three months”; and a request to tick which of a list of 40 ‘herbals’ they had used in the same time period.

Results

A total of 889 responses were obtained of which 4.3% (38) answered ‘yes’ to herbal use via the closed question. However, using the checklist 39% (350) of respondents reported the use of one or more specific ‘herbals’ (p<0.0001). The 312 respondents who reported ‘no’ to ‘herbals’ use via the closed question but “yes” via the checklist consumed a total of 20 different ‘herbals’ (median 1, interquartile range 1–2, range 1–6).

Conclusions

This study demonstrates that the use of a single closed question asking about the use of ‘herbals’, as frequently reported in published studies, may not yield valid data resulting in a gross underestimation of actual use.

Chinese herbal medicines for unexplained recurrent miscarriage

BACKGROUND

Recurrent miscarriage affects 1% to 3% of women of reproductive age and mostly occurs before the 10th week of gestation (and around the same gestational week in subsequent miscarriages). Although most pregnant women may not recognise a miscarriage until uterine bleeding and cramping occur, a repeat miscarriage after one or more pregnancy loss and the chance of having a successful pregnancy varies. To date, there is no universally accepted treatment for unexplained recurrent miscarriage. Chinese herbal medicines have been widely used in Asian societies for millennia and have become a popular alternative to Western medicines in recent years. Many clinical studies have reported that Chinese herbal medicines can improve pregnancy outcomes for pregnant women who had previously suffered recurrent miscarriage. This systematic review evaluated the efficacy of Chinese herbal medicines for recurrent miscarriage.

OBJECTIVES

To assess the effectiveness and safety of Chinese herbal medicines for the treatment of unexplained recurrent miscarriage.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (01 June 2015), Embase (1980 to 01 June 2015); Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 01 June 2015); Chinese Biomedical Database (CBM) (1978 to 01 June 2015); China Journal Net (CJN) (1915 to 01 June 2015); China Journals Full-text Database (1915 to 01 June 2015); and WanFang Database (Chinese Ministry of Science & Technology) (1980 to 01 June 2015). We also searched reference lists of relevant trials and reviews. We identified and contacted organisations, individual experts working in the field, and medicinal herb manufacturers.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials, including cluster-randomised trials, with or without full text, comparing Chinese herbal medicines (alone or combined with other intervention or other pharmaceuticals) with placebo, no treatment, other intervention (including bed rest and psychological support), or other pharmaceuticals as treatments for unexplained recurrent miscarriage. Cross-over studies were not eligible for inclusion in this review.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed all the studies for inclusion in the review, assessed risk of bias and extracted the data. Data were checked for accuracy.

MAIN RESULTS

We included nine randomised clinical trials (involving 861 women). The trials compared Chinese herbal medicines (various formulations) either alone (one trial), or in combination with other pharmaceuticals (seven trials) versus other pharmaceuticals alone. One study compared Chinese herbal medicines and other pharmaceuticals versus psychotherapy. We did not identify any trials comparing Chinese herbal medicines with placebo or no treatment, including bed rest.Various Chinese herbal medicines were used in the different trials (and some of the classical the formulations were modified in the trials). The Western pharmaceutical medicines included tocolytic drugs such as salbutamol and magnesium sulphate; hormonal supplementation with human chorionic gonadotrophin (HCG), progesterone or dydrogesterone; and supportive supplements such as vitamin E, vitamin K and folic acid.Overall, the methodological quality of the included studies was poor with unclear risk of bias for nearly all the 'Risk of bias' domains assessed.Chinese herbal medicines alone versus other pharmaceuticals alone - the live birth rate was no different between the two groups (risk ratio (RR) 1.05; 95% confidence interval (CI) 0.67 to 1.65; one trial, 80 women). No data were available for the outcome of pregnancy rate (continuation of pregnancy after 20 weeks of gestation).In contrast, the continuing pregnancy rate (RR 1.27 95% CI 1.10 to 1.48, two trials, 189 women) and live birth rate (average RR 1.55; 95% CI 1.14 to 2.10; six trials, 601 women, Tau² = 0.10; I² = 73%) were higher among the group of women who received a combination of Chinese herbal medicines and other pharmaceuticals when compared with women who received other pharmaceuticals alone.For Chinese herbal medicines and psychotherapy versus psychotherapy alone (one study) - there was a higher live birth rate (RR 1.32; 95% CI 1.07 to 1.64; one trial, 90 women) in the group of women who received a combination of Chinese herbal medicines and psychotherapy compared to those women who received psychotherapy alone. No data were available on the continuing pregnancy rate for this comparison.Other primary outcomes (maternal adverse effect and toxicity rate and the perinatal adverse effect and toxicity rate) were not reported in most of the included studies. Two trials (341 women) reported that no maternal adverse effects were found (one trial compared (combined) medicines with other pharmaceuticals, and one trial compared combined Chinese herbal medicine alone versus other pharmaceuticals). One trial (Chinese herbal medicine alone versus other pharmaceuticals alone) reported that there were no abnormal fetuses (ultrasound) or after delivery.There were no data reported for any of this review's secondary outcomes.

AUTHORS' CONCLUSIONS

We found limited evidence (from nine studies with small sample sizes and unclear risk of bias) to assess the effectiveness of Chinese herbal medicines for treating unexplained recurrent miscarriage; no data were available to assess the safety of the intervention for the mother or her baby. There were no data relating to any of this review's secondary outcomes. From the limited data we found, a combination of Chinese herbal medicines and other pharmaceuticals (mainly Western medicines) may be more effective than Western medicines alone in terms of the rate of continuing pregnancy and the rate of live births. However, the methodological quality of the included studies was generally poor.A comparison of Chinese herbal medicines alone versus placebo or no treatment (including bed rest) was not possible as no relevant trials were identified.More high-quality studies are needed to further evaluate the effectiveness and safety of Chinese herbal medicines for unexplained recurrent miscarriage. In addition to assessing the effect of Chinese herbal medicines on pregnancy rate and the rate of live births, future studies should also consider safety issues (adverse effects and toxicity for the mother and her baby) as well as the secondary outcomes listed in this review. This review would provide more valuable information if the included studies could overcome the problems in their designs, such as lacking of qualified placebo-controlled trials, applying adequate randomisation methods and avoiding potential bias.

A randomized controlled trial comparing Pentazocine and Chamomilla recutita for labor pain relief

BACKGROUND

Traditional birth attendants in Pakistan sometimes use a homeopathic remedy, Chamomilla for labor pain relief. Our study compares this homeopathic remedy for pain relief in labor with a commonly used parenteral analgesic in a hospital setting. No systematic study has been conducted previously to study the effect of chamomile, which may be affordable and available in community settings.

METHODS

A double blind randomized controlled trial was carried out at Islamic International Medical College Trust. Ninety-nine normal pregnant women were randomly assigned into three groups. Each group received one of the three trial drugs; Chamomile, Pentazocine or placebo. The efficacy of labor analgesia was assessed by using Visual Analogue Scale (VAS) for pain intensity. Indicators of maternal and child health were recorded as were adverse effects of the drugs.

RESULTS

Mean pain scores in the three groups were calculated and compared. The difference in mean VAS scores in Pentazocine and Chamomilla recutita group as compared with placebo was not statistically significant. No significant adverse effects were noticed in any group except slight headache and dizziness in three parturients in Pentazocine group.

CONCLUSION

Neither Pentazocine, or Chamomilla recutita offer substantial analgesia during labor.

Herbal Medicines Use During Pregnancy: A Review from the Middle East

The prevalence of the herbal medicines use is on the rise across the world, especially amongst pregnant women. The scenario in the Middle Eastern region was reviewed to explore the prevalence, usage pattern, motivation, and attitude towards use of herbal medicine by pregnant women. Literature published up to December 2012 showed the prevalence of herbal medicine use varied between 22.3-82.3%, implying a rising trend in the utilization of herbal medicine during pregnancy. The most common herbs used were peppermint, ginger, thyme, chamomile, sage, aniseed, fenugreek, and green tea. The most common reasons for use included the treatment of gastrointestinal disorders and cold and flu symptoms. The majority of women used these products during their first trimester, and did not reveal this information to their physician. Most women were advised by family and friends to use herbal medicines and believed they were more effective and had fewer side effects than modern medicine especially during pregnancy. In conclusion, the use of herbal medicine is prevalent among pregnant women in the Middle Eastern region and healthcare providers need to seek information pertaining to their use.

Reproductive and Developmental Toxicity of Orally Administered Botanical Composition, UP446-Part III: Effects on Fertility and Early Embryonic Development to Implantation in Sprague Dawley Rats

In recent years, high prevalence of adverse effects associated to the use of traditional medicines during pregnancy is becoming alarming due to the self-medication of oral supplements by expecting mothers without supervision. Many expectant mothers use alternative and complementary medicines as a supplement to conventional pregnancy management with an inherent belief of considering herbal remedies as harmless. To the contrary, herbal remedies could incur a potential teratogenic risk both to the child bearing mother and the developing fetuses when consumed before or at the time of gestation. Here, we describe the potential adverse effects of orally administered UP446, a standardized bioflavonoid composition from the roots of Scutellaria baicalensis and the heartwoods of Acacia catechu, on fertility and early embryonic development to implantation in Sprague Dawley rats at doses of 250, 500, and 1000 mg/kg. Besides body weight and food consumption, reproductive functions, sperm motility and morphology, estrus cycle, and fertility rate were monitored. There were no statistically significant differences in reproductive function in all UP446 treated groups in both genders. Test substance impacts on reproductive parameters were very minimal. Neither sperm motility nor morphology was affected as a result of oral UP446 administrations in males. There were no treatment-related effects on estrus cycle stages in females. No significant changes in necropsy or histopathology were observed for all the groups. Therefore, the no observed adverse effect level (NOAEL) of UP446 was considered to be 1000 mg/kg, the highest dose tested, in both genders.

Pregnancy outcomes, embryonic and fetal development in maternal exposure to Chinese medicines

Chinese medicine is a common name for a collection of Chinese Materia Medica with therapeutic properties for medical treatment and healing. Similar to Western pharmaceuticals, Chinese medicines are not free of risk, and have the potential to cause adverse pregnancy outcomes and affect embryonic and fetal development. However, most clinical data concerning safety of maternal exposure to Chinese medicines during pregnancy are not available and the conclusion remains elusive. Some individual clinical trials of Chinese medicines reported some minor adverse effects during pregnancy, whereas few animal studies identified some adverse maternal and perinatal effects, as well as embryotoxic potentials. Basic research and mechanistic studies of the teratogenicity of Chinese medicines are still lacking. There is an urgent need for testing the safety of Chinese medicines before recommendation and commercialization. Until more reliable and scientific research data become available, clinicians should consider both the risks and benefits before recommending Chinese medicines to pregnant women. More systematic investigations of the safety implications of the use of Chinese medicines are highly recommended, in addition to more clinical trials with a larger sample size to confirm its safety during pregnancy. This review includes a critical overview of available clinical and experimental data and provides directions to study the safety issue of Chinese medicines for pregnancy.

Complementary and Alternative Medicines Use during Pregnancy: A Systematic Review of Pregnant Women and Healthcare Professional Views and Experiences

Aims. To undertake a systematic review of the recent (2008-2013) primary literature, describing views and experiences of CAM use during pregnancy by women and healthcare professionals. Method. Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Review Library and Allied, and Complementary Medicine Database were searched. Studies reporting systemic CAM products (homeopathic preparations, herbal medicines, Vitamins and minerals, homeopathy, and special diets) alone or in combination with other nonsystemic CAM modalities (e.g., acupuncture) were included. Results. Database searches retrieved 2,549 citations. Removal of duplicates followed by review of titles and abstracts yielded 32 relevant studies. Twenty-two reported the perspectives of women and their CAM use during pregnancy, while 10 focused on healthcare professionals. The majority of studies had significant flaws in study design and reporting, including a lack of appropriate definitions of CAM and associated modalities, absence of detailed checklists provided to participants, the use of convenience sampling, and a general lack of scientific robustness in terms of data validity and reliability. Conclusion. To permit generalisability of study findings, there is an urgent need to expand the evidence base assessing CAMs use during pregnancy using appropriately designed studies.

A systematic review of the evidence for complementary and alternative medicine in infertility

BACKGROUND

The use of complementary and alternative medicine (CAM) by patients and physicians has increased markedly in recent years. Many case reports, case series, and uncontrolled trials of varying quality have been completed; however, there is now a slowly increasing number of randomized controlled trials (RCTs) examining the use of CAM.

OBJECTIVES

To identify, survey, and review RCTs investigating the use of CAM for infertility treatment.

SEARCH STRATEGY

The MEDLINE and Cochrane databases were electronically searched.

SELECTION CRITERIA

RCTs examining modalities for treatment or improvement of health status were reviewed.

DATA COLLECTION AND ANALYSIS

RCTs were included based on use of objective measures, articles written in English, availability through the University of Michigan database, and clear published clinical outcomes.

MAIN RESULTS

Thirty-seven articles assessing a variety of CAM modalities met inclusion criteria. Acupuncture, selenium supplementation, weight loss, and psychotherapeutic intervention had 3 or more studies demonstrating beneficial effect. Other interventions had been studied less and evidence for them was limited.

CONCLUSIONS

Although there is preliminary evidence of the effectiveness of some CAM interventions among infertile patients, many of these interventions require further investigation before they can be considered for routine clinical use.

Medicinal plants with teratogenic potential: current considerations

The aim of this study was to present the implications of the use of herbs during pregnancy, pointing out those that should be avoided during this condition because of their abortifacient and/or teratogenic potential. We carried out searches in the databases ScienceDirect, Scielo and Google Scholar, adopting as criteria for inclusion: book chapters and/or complete articles (with abstract), available in English, Portuguese or Spanish, published from 1996 to in 2011. After a pre-selection of 83 articles, 49 bibliographies were used in the manufacturing end of the article, where 25 were from the Scielo database, 18 from ScienceDirect and 6 from Google Scholar. From the articles studied, we identified the four most commonly used plants as emmenagogue/abortifacient agents by patients of the Department of Prenatal SUS: senne, arruda, boldo and buchinha-do-norte or cabacinha. Thus, we conclude that people often adhere to the maxim "if it's natural, it does no harm" in their rational use of natural products, without the right guidance, believing that these products are safe to use. This usage is even more worrisome among the elderly, pregnant women and children. Regarding the safety of these products, some information and reliable data are scarce or contradictory.

Herbal supplements in pregnancy: unexpected results from a multicentre study

STUDY QUESTION

How common is the use of herbal supplements during pregnancy and does it adversely affect the pregnancy outcome?

SUMMARY ANSWER

The use of herbal products during pregnancy is very common and daily almond oil spreading is associated with preterm birth (PTB).

WHAT IS KNOWN AND WHAT THIS PAPER ADDS

Herbal drugs are often promoted as 'natural' and 'safe' and such claims attract pregnant women. More than a quarter of Italian pregnant women consume herbs every day for at least 3 months during pregnancy. We raise an alert over the habit of daily almond oil spreading since it seems to be associated with PTB.

DESIGN

A multicenter retrospective cohort study performed over a 15-month period.

PARTICIPANTS AND SETTING

Seven hundred women interviewed within 3 days of childbirth, in three public hospitals in northern Italy.

MAIN RESULTS AND ROLE OF CHANCE

One hundred and eighty-nine women were considered 'regular users', since they consumed herbs every day, for at least 3 months. Almond oil, chamomile and fennel were the most commonly used herbs. Both length of gestation and birthweight were affected by herb consumption. Almond oil users showed more pre-term birth (29 of 189) than non-users (51 of 511). After adjusting for multiple pregnancies, smoking, advanced age and drug intake, almond oil users maintained an increased risk to give birth <37th week (odds ratio = 2.09, 95% confidence interval: 1.08-4.08).

BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION

The association between daily spreading of almond oil and PTB only raises a hypothesis that requires confirmation in larger trials devoted to this topic. The relatively small sample size did not allow the investigation of other adverse pregnancy outcomes in herb users.

GENERALIZABILITY TO OTHER POPULATIONS

The population under investigation did not significantly differ from the general population attending the same hospitals.

STUDY FUNDING/COMPETING INTEREST(S)

No conflict of interest exists. The study has been supported by a public grant from the University of Modena and Reggio Emilia.

TRIAL REGISTRATION NUMBER

None.

Safety evaluation of commonly used Chinese herbal medicines during pregnancy in mice

BACKGROUND

It is unclear how safe the use of Chinese herbal medicine is during pregnancy and if the herbal medicines do any harm to pregnancy, embryo-fetal development and prenatal and post-natal growth. A large-scale preclinical study was conducted to detect the adverse effects of Chinese herbal medicines during pregnancy.

METHODS

Twenty of the most commonly used Chinese herbal medicines prescribed for pregnancy were selected and the crude extract was administered to pregnant mice at clinical doses during five different gestational stages, namely post-implantation, gastrulation, organogenesis, maturation and whole gestation periods. Maternal effects on side effects, weight loss, litter reduction, implantation failure and fetal resorption and perinatal effects on growth restriction, developmental delay, congenital malformations and post-natal mortality were determined.

RESULTS

Adverse pregnancy outcomes were commonly observed after maternal exposure to the herbal medicines, particularly during early pregnancy. Major events included maternal and perinatal mortality were recorded. Maternal weight gain, embryo growth and post-natal weight gain were significantly decreased. Fetal resorption and skeletal malformations were significantly increased.

CONCLUSIONS

Reproductive toxicity of Chinese herbal medicines commonly used during pregnancy was identified in mice. Caution should be taken in the clinical use of herbal medicines during pregnancy.

Self-reported Use and Attitudes Regarding Herbal Medicine Safety During Pregnancy in Iran

BACKGROUND

Despite the vast use of herbal medicines in the world, little is known about their use in pregnancy and the attitudes of pregnant women regarding their safety during pregnancy.

OBJECTIVES

The aim of this study was to evaluate the use and attitudes of pregnant women toward herbal medicine use in pregnancy in Iran.

MATERIALS AND METHODS

A questionnaire was completed by 400 women selected by convenience sampling from postnatal and prenatal wards of two hospitals. Data were analyzed using the SPSS software version 13.5. Chi2 test was used to analyze the data.

RESULTS

The median age was 26.4 (± 5.2) years and the mean number of pregnancies was 1.9 (± 0.98). The use of herbal remedies during pregnancy was positive in 22.3% of patients. They took herbal medicines recommended by their physician (46.1%), through self-medication (44.9%), or with the advice of family members or friends (9%). Additionally, 39.8% believed that it was safe to use herbal remedies during pregnancy, 32.3% believed that it was harmful for both mother and fetus, and 22% did not know whether it was safe or not.

CONCLUSIONS

Herbal medicine use was not high among our subjects but was significantly affected by age. The level of education, place of living, and number of pregnancies significantly affected the attitudes of the subjects. Women with higher education mostly relied on their own information, whereas those with lower education relied on physician advice. Further educational programs are required to increase the information for this group of susceptible individuals.

Gestational medication use, birth conditions, and early postnatal exposures for childhood asthma

Our aim is to explore (1) whether gestational medication use, mode of delivery, and early postnatal exposure correlate with childhood asthma, (2) the dose responsiveness of such exposure, and (3) their links to early- and late-onset asthma. We conducted a matched case-control study based on the Taiwan Children Health Study, which was a nationwide survey that recruited 12-to-14-year-old school children in 14 communities. 579 mothers of the participants were interviewed by telephone. Exclusive breastfeeding protected children from asthma. Notably, childhood asthma was significantly associated with maternal medication use during pregnancy, vacuum use during vaginal delivery, recurrent respiratory tract infections, hospitalization, main caregiver cared for other children, and early daycare attendance. Exposure to these factors led to dose responsiveness in relationships to asthma. Most of the exposures revealed a greater impact on early-onset asthma, except for vacuum use and daycare attendance.

Potential reproductive toxicity of Largehead Atractylodes Rhizome, the most commonly used Chinese medicine for threatened miscarriage

BACKGROUND

Largehead Atractylodes Rhizome (LAR) is the most commonly used Chinese medicine to prevent early pregnancy loss due to threatened miscarriage. However, its safety profile during pregnancy is still not available. Here we aimed to identify the potential adverse effects of LAR on embryo-fetal development as well as prenatal and post-natal growth.

METHODS

Pregnant mice, rats and rabbits were orally administered with LAR extracts in various doses (from 1×, 2×, 3× and up to 6× clinical doses) at different gestational periods (implantation, gastrulation, organogenesis, maturation and whole gestation). Maternal effects on weight loss, implantation failure and fetal resorption and perinatal effects on developmental delay, growth restriction and congenital malformations were studied.

RESULTS

In mice, with early LAR exposure, a significant decrease in fetal growth parameters and a significant increase in post-implantation loss were identified. With late LAR exposure, significant increases in gestational duration as well as prenatal and post-natal mortality were found. At high clinical doses, congenital skeletal malformations were recorded. In rabbits, fetal resorption, hydrops fetalis and short ear anomaly were observed. No significant adverse effects were found in rats.

CONCLUSIONS

Potential reproductive toxicity of LAR in pregnant animals was identified within the clinical dose. Caution should be taken in clinical applications of LAR during pregnancy.

The use of complementary and alternative medicine during pregnancy: a longitudinal study of Australian women

BACKGROUND

The use of complementary and alternative medicine is increasingly prevalent in contemporary Western societies. The objective of this study was to explore trends and patterns in complementary and alternative medicine practitioner consultations and the use of complementary and alternative medicine consumption before, during, and after pregnancy and between pregnancies.

METHODS

Analysis focused on data from 13,961 women from the younger cohort of the Australian Longitudinal Study on Women's Health collected between 1996 and 2006. Chi-square tests were employed for the cross-sectional analysis of categorical variables and t tests for continuous variables. Generalized estimating equations were used to conduct multivariate longitudinal analysis.

RESULTS

Complementary and alternative medicine use among pregnant and nonpregnant women continued to increase over the 10-year period. Although pregnancy status was not predictive of the use of alternative treatments, pregnant women employed these therapies or modalities for the relief of pregnancy-related complaints and symptoms. Analysis also revealed that women used complementary and alternative treatments selectively during pregnancy.

CONCLUSIONS

This study highlights the need for further research that is sensitive to the consumption of specific complementary and alternative therapies or modalities and to the wider contexts within which women perceive risk associated with their use of complementary and alternative treatments.

Obstetrician-gynaecologist knowledge of and access to information about the risks of medication use during pregnancy

OBJECTIVE

To assess opinions, knowledge, and informational resources of obstetrician-gynaecologists regarding the safety of medication use during pregnancy.

METHODS

A questionnaire was mailed to 770 members of the American College of Obstetricians and Gynecologists who participate in the Collaborative Ambulatory Research Network.

RESULTS

The response rate was 58%. Of these, 305 respondents provide both routine gynecologic and obstetric care and are the focus of the study. There was wide variation in obstetrician-gynaecologists' assessments of the safety for the foetus of medications ranging from aspirin to valproic acid. The Physicians' Desk Reference was most frequently (75%) cited as a source of information about medication safety. Forty-two percent of obstetrician-gynaecologists selected lack of sufficient information on medications as the greatest barrier to counselling pregnant women about their use, while only 4% selected lack of access to information as the greatest barrier. Most (79%) obstetrician-gynaecologists indicated they would be willing to participate in pregnancy exposure registries, but far fewer (24%) reported having done so.

CONCLUSION

These results emphasise the need for safety information about the effects of medication use during pregnancy and suggest that pregnancy exposure registries are underutilised.

Management of prescription and nonprescription drug use during pregnancy

OBJECTIVE

To assess screening and treatment patterns of obstetrician-gynecologists regarding medication use during pregnancy.

METHODS

A questionnaire was mailed to 770 members of the American College of Obstetricians and Gynecologists who participate in the Collaborative Ambulatory Research Network.

RESULTS

The response rate was 58%. Most respondents reported always asking pregnant patients about use of over-the-counter (OTC) (86%) and prescription (98%) drugs; 24% reported not always asking about alternative medications. Far fewer reported always asking nonpregnant patients about use of alcohol (67%), illegal drugs (51%) and OTC medications (52%) than pregnant patients. Two-fifths (41%) reported prescribing a medication during pregnancy for which they had insufficient information about potential effects on the fetus; nearly half (47%) reported that there are medical conditions for which they would like to prescribe medications but do not due to insufficient safety information. Physician responses indicate that they are less likely to refer pregnant than nonpregnant patients to a specialist for treatment of certain conditions.

CONCLUSIONS

These results indicate that obstetrician-gynecologists sometimes prescribe medications for pregnant patients under less than optimal conditions and emphasize the importance of generating up-to-date information on effects of medications during pregnancy and having it readily available to health care providers.

Use of herbal treatments in pregnancy

OBJECTIVE

Interest in herbal treatments has increased without data on safety, efficacy, or rates of use in pregnancy. We examined antenatal herbal and natural product use among mothers of nonmalformed infants in 5 geographic centers.

STUDY DESIGN

We used data on nonmalformed infants from the Slone Epidemiology Center's case-control surveillance program for birth defects to examine rates and predictors of herbal use. Exposures were identified through maternal interview. In addition to overall use, 5 categories based on traditional uses and 2 natural product categories were created; topical products and herbal-containing multivitamins were excluded.

RESULTS

Among 4866 mothers of nonmalformed infants, 282 (5.8%) reported use of herbal or natural treatments. Use varied by study center and increased with increasing age.

CONCLUSION

Although rates of use are low, there remains a need for investigation of the safety of these products. Given sparse data on efficacy, even small risks might well outweigh benefits.

Complementary medicine in the primary care setting: Results of a survey of gender and cultural patterns in Israel

OBJECTIVE

The purpose of this study was to examine the use of complementary and alternative medicine (CAM) in a primary care practice in Israel to determine prevalence and patterns of use.

METHODS

Trained research assistants invited all patients attending the administrative, medical, pharmaceutical, or nursing services of 7 clinics in urban and rural areas of northern Israel over a 16-month period, from April 1, 2005, through August 1, 2006, to complete a 13-item written questionnaire about CAM use and beliefs about CAM safety and efficacy. CAM was defined as therapies often referred to as alternative, complementary, natural, or folk/traditional medicine, and which are not usually offered as part of the medical treatment in the clinic, including herbal medicine, Chinese medicine (including acupuncture), homeopathy, folk and traditional remedies, dietary/nutritional therapy (including nutritional supplements), chiropractic, movement/manual healing therapies (including massage, reflexology, yoga, and Alexander and Feldenkrais techniques), mind-body techniques (including meditation, guided imagery, and relaxation), energy and healing therapies, and other naturopathic therapies. The Pearson chi(2) test and multivariate logistic regression were used to assess univariate associations with the odds ratios of CAM use among Arab and Jewish women. A t test was performed to determine whether there were any differences in the continuous variables between the 2 groups.

RESULTS

Of 3972 consecutive patients who received the questionnaire, 3447 responded; 2139 respondents (62%) were women. Of the female respondents, 2121 reported their religion (1238 respondents [58%] self-identified as being Arab, and 883 [41.6%] as being Jewish). Compared with men, more women used CAM during the previous year (46.4% vs 39.4%; P < 0.001). Women were more likely to use CAM and to be interested in receiving CAM at primary care clinics. Arab women reported less CAM use than Jewish women but were more interested in experiencing CAM, had a higher degree of confidence in CAM efficacy and safety, and more frequently supported the integration of CAM practitioners in primary care clinics.

CONCLUSIONS

In this study, women visiting primary care clinics in northern Israel used CAM more often than men did. Arab women reported less use of CAM than did Jewish women but also reported greater confidence in CAM efficacy and safety.