Herbal medicines and pregnancy: A narrative review and anaesthetic considerations

Pregnant women's attitudes towards complementary and alternative medicine and the use of phytotherapy during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

Approximately 80% of individuals worldwide use various holistic complementary and alternative medicine (HCAM) methods, including herbal products, to prevent diseases and improve their general health. In this study, it was aimed to investigate complementary and alternative therapy (CAM) and the use of phytotherapy by pregnant women in the COVID-19 pandemic period.

METHODS

This is a cross-sectional and descriptive study. The study included 381 women who applied to a public hospital in Türkiye and used herbal products during this pregnancy. Purposive sampling method was used. The study data were collected through "Identifying Information Form", "Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ)" and "Information Form on the Use of Phytotherapy". In the analysis of the study data, descriptive statistics, the one-way ANOVA and multinomial logistic regression analyses were used.

RESULTS

The study was completed with 381 pregnant women. The average age, parity and gestational age of the pregnant women were 28.33±6.09, 2.17±0.95, 29.11±8.87, respectively. It was determined that 37.3% of pregnant women did not know the ingredients of the herbal products they used and 38.8% found them safer than the drugs. HCAMQ total mean score of the pregnant women was calculated as 34.62±16.22. It was found that the pregnant women used garlic the most (65.6%), followed by cumin (38.6%), curcuma (36.2%), and ginger (34.4%). HCAMQ total mean score was found to be lower in the pregnant women who found herbal products safer than drugs (p<0.001), who were not aware of the content of the herbal product they used (p<0.001), and who used herbal products so as to protect against COVID-19 (p = 0.041), to increase their physical resistance (p = 0.022), and to facilitate childbirth (p = 0.002). It was determined that among the pregnant women who knew the content of the herbal products they used (Odds Ratio (OR) 1.122; 1.095-1.149 95%CI; p<0.001) and who did not know (OR 1.114; 1.085-1.144 95%CI; p<0.001), as negative attitude towards HCAM increased, their status of finding traditional drugs safer increased. Among the pregnant women who used herbal products to protect against COVID-19 (OR 1.142; 1.111-1.174 95%CI; p<0.001) and to increase their physical resistance (OR 1.120; 1.094-1.147 95%CI; p<0.001), as negative attitude towards HCAM increased, their status of finding conventional drugs safer increased.

CONCLUSION

In today's world where the use of herbal products and CAM has become widespread, it is important to raise the awareness of pregnant women about the benefits and harms of these practices about which there is inadequate evidence.

Absence of maternal-fetal adverse effects of Alternanthera littoralis P. Beauv. following treatment during pregnancy in mice

Alternanthera littoralis P. Beauv is a plant native to Brazil that exhibits various beneficial activities including antioxidant, antibacterial, antifungal, antiprotozoal, anti-hyperalgesic, and anti-inflammatory properties. The aim of this study was to assess the impact of the ethanol extract of Alternanthera littoralis (EEAl) on reproductive outcomes, embryofetal development, and DNA integrity of pregnant female mice. Pregnant Swiss female mice were randomly assigned to three experimental groups (n = 10): controls were administered either 1% Tween 80 (vehicle), EEAl 100 mg/kg or EEAl 1000 mg/kg. Treatment was administered through gavage during the gestational period until day 18. On gestational days 16, 17, and 18, a peripheral blood sample from the tail vein was obtained for DNA integrity analysis (micronucleus test). After the last collection, animals were euthanized by cervical dislocation. Maternal organs and fetuses were collected, weighed, and subsequently analyzed. Reproductive outcome parameters were assessed by measurement of number of implants, live fetuses, and resorptions. Embryonic development was determined by adequacy of weight for gestational age as well as determination of external, visceral, and skeletal malformations. Data demonstrated that EEAl did not produce maternal toxicity at either dose associated with no marked alterations in any of the reproductive outcome parameters including implantation sites, live/dead fetuses ratio, fetal viability, post-implantation losses, resorptions, and resorption rate. However, EEAl 1000 group reduced embryofetal development by lowering placental weight. In addition, there was an increase in the frequency of external and skeletal malformations in the EEAl 1000 group, which could not be attributed to extract exposure as these values were within control levels. Based upon our findings, evidence indicates that the EEAl at the concentrations employed in our study may be considered safe for use during pregnancy and extracts of this plant show potential for development of phytomedicines to be used in pregnancy.

The effect of evening primrose oil on cervical ripening and birth outcomes: A systematic review and meta-analysis

Background and purpose

The results of various studies on the effect of evening primrose oil (EPO) on cervical ripening are controversial. The purpose of this systematic review and meta-analysis was to assess the effect of EPO on cervical ripening and birth outcomes.

Materials and methods

The Cochrane Library, Embase, PubMed, Scopus, Web of Science and Persian databases were searched for studies published from the inception of the databases up to February 2021 (search updated in May 2022). Full-text articles published in English or other languages, randomized controlled trials, and quasi experimental studies with control group were included. Studies published in form of conference proceedings, and those whose full texts were not available, as well as studies with control groups receiving other treatments for cervical ripening, and those in which the intervention group received drugs besides EPO were all excluded. The Cochrane handbook was used to determine the risk of bias of the included studies. All data were analyzed using Review Manager 5.4 and reported in forest plots.

Results

Seven trials involving 920 women were included in the meta-analysis. In five studies, including 652 participants, cervical ripening was evaluated using Bishop score. The use of EPO was found to significantly improved Bishop score (MD = 3.23; 95% CI: 3.17, 3.29). The meta-analysis showed no significant differences between two comparison groups in terms of 1-min Apgar score and length of the second stage of labor. However, the two groups were significantly different in terms of their 5-min Apgar score and the time interval between administration of EPO and birth. Based on subgroup analysis by route of administration, both vaginal and oral use of EPO increased Bishop score significantly in the intervention group compared to the placebo group.

Conclusion

This study showed that using EPO in term and post-term pregnant women was clinically effective in improving their Bishop score.

The Embodiment of Traditional Partería in the Colombian Pacific Region

A Traditional Partera refers to a woman who assists, by traditional practices, women during gestation, birth, and reproductive life, aside of the formal health care system. Their practice, Traditional Partería, is considered a key ancestral cultural component in marginalized communities in Colombia. A comprehensive description of the essence of Colombian Traditional Partería is currently missing, and this practice is facing the loss of its body of knowledge. Here, we describe the essence of being a Colombian Traditional Partera. Eight Traditional Parteras participated in phenomenological interviews and body maps focused on their embodied conscious experience of being a Traditional Partera in Colombia. Seventeen general meaning units were identified and grouped in three embodied components (Head, Heart, and Hands) related to practice, knowledge, feelings, perceptions, context, and culture. We discuss philosophical reflections and implications of knowing other's world perspectives, describing a sensitive triad central in the Traditional Partería practice.

Abatement of the Stimulatory Effect of Copper Nanoparticles Supported on Titania on Ovarian Cell Functions by Some Plants and Phytochemicals

The application of nanoparticles has experienced a vertiginous growth, but their interaction with food and medicinal plants in organisms, especially in the control of reproduction, remains unresolved. We examined the influence of copper nanoparticles supported on titania (CuNPs/TiO2), plant extracts (buckwheat (Fagopyrum esculentum) and vitex (Vitex agnus-castus)), phytochemicals (rutin and apigenin), and their combination with CuNPs/TiO2 on ovarian cell functions, using cultured porcine ovarian granulosa cells. Cell viability, proliferation (PCNA accumulation), apoptosis (accumulation of bax), and hormones release (progesterone, testosterone, and 17β-estradiol) were analyzed by the Trypan blue test, quantitative immunocytochemistry, and ELISA, respectively. CuNPs/TiO2 increased cell viability, proliferation, apoptosis, and testosterone but not progesterone release, and reduced the 17β-estradiol output. Plant extracts and components have similar stimulatory action on ovarian cell functions as CuNPs/TiO2, but abated the majority of the CuNPs/TiO2 effects. This study concludes that (1) CuNPs/TiO2 can directly stimulate ovarian cell functions, promoting ovarian cell proliferation, apoptosis, turnover, viability, and steroid hormones release; (2) the plants buckwheat and vitex, as well as rutin and apigenin, can promote some of these ovarian functions too; and (3) these plant additives mitigate the CuNPs/TiO2's activity, something that must be considered when applied together.