Raspberry Leaf and Hypoglycemia in Gestational Diabetes Mellitus

Raspberry Leaves and Extracts-Molecular Mechanism of Action and Its Effectiveness on Human Cervical Ripening and the Induction of Labor

The gestational period is an incredibly stressful time for a pregnant woman. Pregnant patients constantly seek effective and reliable compounds in order to achieve a healthy labor. Nowadays, increasing numbers of women use herbal preparations and supplements during pregnancy. One of the most popular and most frequently chosen herbs during pregnancy is the raspberry leaf (Rubus idaeus). Raspberry extracts are allegedly associated with a positive effect on childbirth through the induction of uterine contractions, acceleration of the cervical ripening, and shortening of childbirth. The history of the consumption of raspberry leaves throughout pregnancy is vast. This review shows the current status of the use of raspberry leaves in pregnancy, emphasizing the effect on the cervix, and the safety profile of this herb. The majority of women apply raspberry leaves during pregnancy to induce and ease labor. However, it has not been possible to determine the exact effect of using raspberry extracts on the course of childbirth and the perinatal period. Additionally, it is unclear whether this herb has only positive effects. The currently available data indicate a weak effect of raspberry leaf extracts on labor induction and, at the same time, their possible negative impact on cervical ripening.

Survey of Raspberry Leaf Tea in pregnancy

BACKGROUND

Raspberry leaf tea (RLT) is a traditional herb purported to help with many pregnancy-related outcomes including reducing the duration of labour. No experimental data exist to support these claims.

AIMS

This study aims to determine how common use and knowledge of RLT are during pregnancy. It also aims to explore whether it would be possible to recruit women for a trial of raspberry leaf in the future.

MATERIALS AND METHODS

Postnatal women were asked to fill in a survey about their use of RLT during pregnancy, and their knowledge of its purported benefits. They were asked whether they would consider being part of a randomised controlled trial of raspberry leaf in the future.

RESULTS

One hundred and twenty-one women completed the survey. Of these, 88 (73%) were aware of herbal tea use in pregnancy and 46 (38%) reported using raspberry leaf during pregnancy. Of all women surveyed, 79% indicated they would be happy to participate in a trial of RLT in pregnancy if they were asked.

CONCLUSIONS

Despite no scientific evidence of the efficacy of RLT in pregnancy, 38% of women surveyed used it during pregnancy. Further studies are required to determine whether the claims made about RLT are correct. Clinicians should base their advice on available evidence.

Raspberry (Rubus idaeus L.), a Promising Alternative in the Treatment of Hyperglycemia and Dyslipidemias

Raspberry production and consumption have increased in recent years due to its polyphenol content such as anthocyanins and ketones, bioactive compounds that have been studied to reduce blood glucose levels and stabilize the blood lipid profile. The objective of this study was to systematically recover and review scientific evidence regarding the consumption of raspberry or its bioactive compounds and the action mechanisms involved in the hypoglycemic and lipid-lowering effects they present. Original articles from in vitro and in vivo enzyme inhibition studies, animal models, and human clinical studies were compiled in PubMed, Web of Science, and Science Direct databases. Studies showed satisfactory results regarding blood glucose level reduction after consumption of frozen or lyophilized raspberry, infusion of raspberry leaves, seed oil, as well as compounds, extracted from the fruit by inhibiting enzymes such as α-glucosidase and dipeptidyl peptidase-4 (DPP-4) and other mechanisms that increase insulin production and insulin sensitivity. However, regarding the lipid-lowering effect, the results were heterogeneous, mainly in terms of stabilization in triglyceride levels. However, a reduction in cholesterol and low-density lipoprotein levels is reported, as well as an increase in high-density lipoproteins. According to the results, raspberry can be included in the nonpharmacological treatment of hyperglycemia and dyslipidemias; however, further research is considered necessary.

Use of Herbal Medicines for the Treatment of Mild Mental Disorders and/or Symptoms During Pregnancy: A Cross-Sectional Survey

Little is known about the treatment of mild mental disorders and/or symptoms (MDS) during pregnancy. Our main purpose was to compare the use of herbal medicines during pregnancy in women with and without MDS. A questionnaire consisting of 21 multiple-choice questions was distributed in the participating obstetrics clinics or birth centers in the Canton of Zurich, in Switzerland, from August 2018 to March 2019; 398 questionnaires were considered in the analysis. The use of any type of herbal medicines-including pharmaceutical herbal products as well as teas-during pregnancy was reported by 358 women (out of 398, 89.9%). Of these, 272 participants used pharmaceutical herbal products, whereby ginger (49.2%), raspberry leaf (42.7%), bryophyllum (37.8%), chamomile (27.2%), lavender (22%) and iron-rich herbs (12.3%) were the ones most commonly mentioned. More than half (207/398, 52.0%) of all participants reported suffering from MDS during pregnancy; only a few took (synthetic) psychoactive medications (5/398, 1.3%). The percentage of use of pharmaceutical herbal medicines was higher among women reporting MDS than among the remaining women (90.0 vs 75.9%; p < 0.001). At the same time, the prevalence of MDS was higher among users of pharmaceutical herbal products than among non-users (59.6 vs 34.0%; p = 0.001). Specific questions on candidate herbal medicines for the treatment of mild MDS revealed that bryophyllum (mentioned by 107 women), lavender (56 women) and valerian (20 women) were used to reduce stress, restlessness, sleep disorders and others, in part with perceived good to very good effectiveness and tolerability. The large majority of the pregnant women participating in the survey make use of herbal medicines. The particularly high prevalence of MDS among herbal medicine-users and the very rare use of synthetic psychoactive medications suggest that pregnant women rely on herbal medicines for treatment of mild MDS. The reported good effectiveness and tolerability of a few candidate herbal medicines deserve particular attention.

Effects of Dietary Red Raspberry Consumption on Pre-Diabetes and Type 2 Diabetes Mellitus Parameters

Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition characterized by glucose clearance abnormalities and insufficient insulin response. Left uncontrolled, T2DM can result in serious complications and death. With no cure available currently and the prevalence of major risk factors such as pre-diabetes and the metabolic syndrome continuously increasing, there is an urgent need for effective treatments with limited or no side effects. Red raspberries (RR) contain various phytonutrients with potential for modulating insulin function, glucose, and lipid metabolism. The objective of this literature review was to investigate the potential metabolic benefits of dietary RR in individuals with T2DM and pre-diabetes. A search of major scientific databases was employed to identify peer-reviewed, in vivo, or human studies that utilized whole RR or its functional constituents as treatment. The studies examined provide evidence that RR may offer clinically beneficial effects for the prevention and management of chronic diseases through improvements in glucose handling and insulin sensitivity, adiposity, lipid profiles, ectopic lipid accumulation, inflammation, oxidative stress, and cardiac health. More human trials and in vivo studies are needed to confirm the benefits of dietary RR in T2DM and pre-diabetes and to explore the dose-dependent relationships, optimal duration, and treatment modality.

Herbalism for Modern Obstetrics

More pregnant and nursing mothers are using herbal remedies than health care providers realize. Lack of familiarity with herbalism in addition to the sparsity of high-quality research for many complementary and alternative medicines are barriers for the western practitioner to engage a patient about herbal therapies. This review provides historical information and available evidence for Traditional Chinese and Western herbal medicines commonly sought by pregnant and nursing mothers. We will review herbs commonly used for: nausea and vomiting, constipation, gestational diabetes, threatened miscarriage, immune system support, parturition preparation, postpartum depression, postpartum bleeding and pain, wound healing, and lactation support.

Biophysical effects, safety and efficacy of raspberry leaf use in pregnancy: a systematic integrative review

Background

Childbearing women have been using various herbs to assist with pregnancy, labour and birth for centuries. One of the most common is raspberry leaf. The evidence base for the use of raspberry leaf is however under-developed. It is incumbent on midwives and other maternity care providers to provide women with evidence-based information so they can make informed choices. The aim of this study was to review the research literature to identify the evidence base on the biophysical effects, safety and efficacy of raspberry leaf in pregnancy.

Methods

A systematic, integrative review was undertaken. Six databases were searched to identify empirical research papers published in peer reviewed journals including in vitro, in vivo, human and animal studies. The search included the databases CINAHL, MEDLINE, Cochrane Library, Scopus and Web of Science Core Collection and AMED. Identified studies were appraised independently by two reviewers using the MMAT appraisal instrument. An integrative approach was taken to analysis.

Results

Thirteen studies were included. Five were laboratory studies using animal and human tissue, two were experiments using animals, and six were human studies. Included studies were published between 1941 and 2016. Raspberry leaf has been shown to have biophysical effects on animal and human smooth muscle including the uterus. Toxity was demonstrated when high doses were administered intravenously or intaperitoneally in animal studies. Human studies have not shown any harm or benefit though one study demonstrated a clinically meaningful (though non-statistically significant) reduction in length of second stage and augmentation of labour in women taking raspberry leaf.

Conclusions

Many women use raspberry leaf in pregnancy to facilitate labour and birth. The evidence base supporting the use of raspeberry leaf in pregnancy is weak and further research is needed to address the question of raspberry leaf’s effectiveness.

Phytotherapy in obstetrics - therapeutic indications, limits, and dangers

The wide access to varied, attractive, and aggressively promoted information can induce pregnant women to think that any form of complementary therapy can be a saving solution for a medical problem because these therapies are natural, therefore, harmless. Updated information from literature about indications, benefits, limits, and risks of phytotherapy in pregnancy was presented. Valuable therapeutic resources with proven clinical efficacy (evidence-based medicine) were presented for each trimester of pregnancy, during labor, postpartum, but also during breastfeeding. For some phytotherapeutics, there are scientific studies. There is also a detailed presentation about some possibilities for therapeutic errors, which should be avoided during pregnancy. Positive results of phytotherapy deserve to be known and applied by the obstetrician for the certain benefit of future mothers.

Screening active components from Rubus amabilis for pancreatic β-cells protection

CONTEXT

Rubus species (Rosaceae) have been used in folk medicine to treat diabetes due to their hypoglycaemic activity.

OBJECTIVE

To screen the active components that act as hypoglycaemic agents in Rubus amabilis Focke and the underlying mechanisms.

MATERIALS AND METHODS

Aqueous stem extract of R. amabilis was incubated with MIN6 β-cells, PBS was used as the blank control. Then the cells were washed, cell membrane-bound components were dissociated and identified by UPLC/MS. Total procyanidins (PCs) in R. amabilis was enriched and the cytotoxicity and anti-proliferation on β-cell were evaluated by MTT assay. PCs at 25, 50, and 75 μg/mL was applied for 24 h to determine its effects on palmitate (PA)-induced apoptosis and GSIS. Western blotting was employed to detect the protein expression of PI3K/Akt/FoxO1 signalling. The antioxidant indices were also measured.

RESULTS

β-Cell membrane-bound components were identified as three procyanidin B dimers and a C trimer. PCs showed no significant cytotoxicity up to a concentrations of 100 μg/mL. PCs treatment reversed the elevated apoptosis rate and impaired GSIS induced by PA. PCs markedly decreased the intracellular ROS and MDA production and increased the SOD activity. Moreover, PCs promoted the phosphorylation of Akt and FoxO1, and regulated Pdx-1 and Bax expression in MIN6 cells. Discussion and conclusion: The active components that act as hypoglycaemic agents in R. amabilis are procyanidins, which protected MIN6 cells against PA-induced apoptosis by activating PI3K/Akt/FoxO1 signalling. These results indicate that β-cell extraction, combined with UPLC/MS, is a valid method for screening antidiabetic components from herbal medicines.

Hypoglycemic effect of the fruit extracts of two varieties of Rubus rosifolius

Oral glucose tolerance test on male Sprague-Dawley rats was done to determine the hypoglycemic effect of the n-hexane, ethyl acetate and methanol fruit extracts (50 mg/kg BW; oral administration) of two varieties of Rubus rosifolius. Metformin was used as a positive control (15 mg/kg BW; intravenous administration). The n-hexane extract was most potent and was investigated phytochemically to yield compound 1, a mixture of triacylglycerols. In its oxidized state compound 1 produced a significant hypoglycemic effect which was more effective than metformin for the first 30 min of the assay (p = .03) and not significantly different for up to 120 min. Mechanisms through which the oxidized triacylglycerol species could form were explored and presented. This is the first account of the hypoglycemic activity of R. rosifolius and it is also the first account of this activity being credited to compounds other than polyphenols and terpenes in Rubus plants. PRACTICAL APPLICATIONS: A significant percentage of the world's population is affected by diabetes and diabetes-related illnesses. One of the most popular antidiabetic drug on the market is metformin which is used to lower blood glucose concentrations. The findings of this study indicate that an oxidized mixture of triacylglycerols is more fast-acting than metformin for the first 30 min of an oral glucose tolerance test. This effect was also not significantly different from that of the popular drug up to 120 min. These results demonstrate the hypoglycemic activity of an oxidized R. rosifolius fruit extract and indicate its potential use in applications such as functional food product development and drug discovery. Therapeutic applications can also include the plant extract as a potential primary treatment or as adjunct therapy to conventional medications.

Herbal Medicine Use During Pregnancy: A Review of the Literature With a Special Focus on Sub-Saharan Africa

Herbal medicine use has grown considerably worldwide among pregnant women, and is particularly widespread in sub-Saharan Africa. However, herbal medicines used across sub-Saharan Africa are associated with important research gaps and a lack of regulatory framework. This is particularly problematic, as herbal medicine use during pregnancy raises several concerns attributed to the herbal ingredient itself, conventional drug-herbal medicine interactions, and contamination or adulteration of herbal remedies. Moreover, several local herbal remedies used by sub-Saharan African pregnant women have never been botanically identified. In this review, an overview of the practice of herbal medicine, including the regulations, challenges and overall safety, is provided. Then, we discuss the prevalence of herbal medicine use during pregnancy across different sub-Saharan African countries, as well as the indications, adverse outcomes, and effectiveness of the most commonly used herbal medicines during pregnancy in that region.

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.

Herbal Medicinal Product Use During Pregnancy and the Postnatal Period: A Systematic Review

Synthesis of pooled data on herbal medicinal products used during and after pregnancy highlights the need for robust safety studies.

OBJECTIVE:

To report the incidence and nature of herbal medicinal products' adverse events and herb–drug interactions used by some pregnant and postnatal women.

DATA SOURCES:

The Allied and Complementary Medicine Database, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, the Cochrane Library, MEDLINE, Scopus, Web of Science, and ClinicalTrials.gov were searched from inception until August 2018.

METHODS OF STUDY SELECTION:

Any studies reporting adverse events, herb–drug interactions or absence thereof associated with herbal medicinal products used during pregnancy or the postnatal period were included. Conference abstracts, pilot studies, and nonhuman studies were excluded. All included studies were critically appraised by two independent reviewers.

TABULATION, INTEGRATION AND RESULTS:

Database searches retrieved 3,487 citations. After duplicate removal and review of titles, abstracts, and full-text, 115 articles were critically appraised. After excluding irrelevant and low-quality articles, 74 articles were included for data extraction and synthesis. Adverse drug reactions, congenital malformations, fetal growth retardation or herb–drug interactions were the primary study objective reported by 19 of the 74 included studies, 16 cohort studies, one cross-sectional survey, and two randomized controlled trials. A total of 47 herbal medicinal products and 1,067,071 women were included in this review. Use of almond oil was associated with preterm birth (odds ratio 2.09, 95% CI 1.07–4.08), oral raspberry leaf was associated with cesarean delivery (adjusted odds ratio [AOR] 3.47, 95% CI 1.45–8.28); heavy licorice use was associated with early preterm birth by 3.07-fold (95% CI 1.17–8.05). African herbal medicine mwanaphepo was associated with maternal morbidity (AOR 1.28; 95% CI 1.09–1.50), and neonatal death or morbidity. Fourteen studies reported absence of adverse events. Four studies reported herb–drug interactions, but none studied adverse events arising from them.

CONCLUSION:

The use of herbal medicinal products during pregnancy and the postnatal period should be discouraged until robust evidence of safety is available.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42017081058.

Neutralization of cholera toxin by Rosaceae family plant extracts

BACKGROUND

Cholera is one of the most deadly diarrheal diseases that require new treatments. We investigated the neutralization of cholera toxin by five plant extracts obtained from the Rosaceae family that have been traditionally used in Poland to treat diarrhea (of unknown origin).

METHODS

Hot water extracts were prepared from the dried plant materials and lyophilized before phytochemical analysis and assessment of antimicrobial activity using microdilution assays. The ability of the plant extracts to neutralize cholera toxin was analyzed by measurement of cAMP levels in cell cultures, enzyme-linked immunosorbent assay and electrophoresis, as well as flow cytometry and fluorescence microscopy studies of fluorescent-labeled cholera toxins with cultured human fibroblasts.

RESULTS

The antimicrobial assays displayed modest bacteriostatic potentials. We found that the plant extracts modulate the effects of cholera toxin on intracellular cAMP levels. Three plant extracts (Agrimonia eupatoria L., Rubus fruticosus L., Fragaria vesca L.) suppressed the binding of subunit B of cholera toxin to the cell surface and immobilized ganglioside GM₁ while two others (Rubus idaeus L., Rosa.canina L.) interfered with the toxin internalization process.

CONCLUSIONS

The traditional application of the Rosaceae plant infusions for diarrhea appears relevant to cholera, slowing the growth of pathogenic bacteria and either inhibiting the binding of cholera toxin to receptors or blocking toxin internalization. The analyzed plant extracts are potential complements to standard antibiotic treatment and Oral Rehydration Therapy for the treatment of cholera.

Evaluating Traditional Chinese Medicine and Herbal Products for the Treatment of Gestational Diabetes Mellitus

Gestational diabetes mellitus is the most common metabolic disorder during pregnancy with health consequences for both lives during and after pregnancy. Studies found that many pregnant women turn to complementary and alternative medicine for health maintenance or symptom relief, such as herbal medicine and acupuncture from traditional Chinese medicine. With the growing popularity of traditional Chinese medicine, we conducted a systemic search in PubMed, Web of Science, and Embase databases on research studies that investigated traditional Chinese medicine during pregnancy. The resultant hits were further searched in relation to all diabetes mellitus. In total, we found three major herbal medicine/herbal products that were associated with glycemic control in gestational diabetes, including Zuo Gui Wan, red raspberry leaves, and Orthosiphon stamineus. We further reviewed them and their relatives in relation to type 2 diabetes mellitus and found more evidence of metabolic benefits. None of the herbal medicine and products examined reported toxicity in the experimental models. Overall, treatments of gestational diabetes by western or alternative interventions are grossly understudied. It is critical to have a standardized protocol when evaluating efficacy of herbal medicine and produce quality results for women and their health-care providers to make informed treatment decisions.