The effect of late pregnancy consumption of date fruit on labour and delivery

Is oral consumption of dates (Phoenix dactylifera L. fruit) in the peripartum period effective and safe integrative care to facilitate childbirth and improve perinatal outcomes: a comprehensive revised systematic review and dose-response meta-analysis

BACKGROUND

Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes.

METHODS

Eight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration's Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software.

RESULTS

Of 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention's safety was recorded only in four trials.

CONCLUSION

More well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care.

TRIAL REGISTRATION

PROSPERO Registration No: CRD42023399626.

Nutritional, medicinal and functional properties of different parts of the date palm and its fruit (Phoenix dactylifera L.) - A systematic review

Appraised for being one of the oldest staple nutritive foods mainly in the Arabian Peninsula, the date palm tree (Phoenix dactylifera L.), is a crop native to the subtropical and tropical regions of Southern Asia and Africa. Different parts of the date tree have been extensively studied for their nutritional and therapeutic properties. Despite an array of publications on the date tree, there has been no attempt to compile in a single study the traditional uses, nutritive value, phytochemical profile, the medicinal properties as well as the potential of the different plant parts as a functional food. Therefore, this review endeavors to systematically review the scientific literature to highlight the traditional uses of date fruit and parts around the world, the nutritional profile of several parts and the medicinal properties. A total of 215 studies was retrieved (traditional uses (n = 26), nutritional (n = 52), and medicinal (n = 84)). Scientific articles were further categorized as in vitro (n = 33), in vivo (n = 35), and clinical (n = 16) evidences. Date seeds were found to be effective against E. coli and Staphylococcus aureus. Aqueous date pollen was used to manage hormonal problems and boost fertility. Palm leaves showed anti-hyperglycemic effects via inhibition of α-amylase and α-glucosidase. Unlike previous studies, this study highlighted the functional roles of all the plant parts of the palm tree and provided insights into the various mechanism of action of their bioactive compounds. Although scientific shreds of evidence have been growing over the years, there is still a dearth of studies concerning the clinical validation of the date fruit and other plant parts to provide strong evidence on their medicinal uses. In conclusion, P. dactylifera can be regarded as a potent medicinal plant with prophylactic potential and should be further explored to alleviate the burden of both communicable and non-communicable diseases.

Onset and outcomes of spontaneous labour in low risk nulliparous women

OBJECTIVES

The objective of this study was to: 1. Establish the median gestational age of spontaneous labour for low-risk nulliparas. 2. Examine the variation in mode of delivery and short-term neonatal outcomes with gestation at onset of spontaneous labour.

STUDY DESIGN

This is a retrospective observational cohort study conducted at a tertiary obstetric unit. The study population was 12, 323 low risk nulliparous women with singleton pregnancies who experienced spontaneous onset of labour. The study period was over seven years, from Jan 1st 2011 to 31st Dec 2017. Exclusion criteria were multiparity, multi-fetal pregnancy, booking after 14 weeks gestation, antepartum or intrapartum death, or any obstetric or fetal indication for delivery with the exception of post-maturity. Gestation of onset of spontaneous labour, demographic variables and maternal and neonatal outcomes were collected. The primary outcome was median gestational age at onset of spontaneous labour and its distribution at term. Secondary outcomes were mode of delivery and neonatal outcomes including low-apgar score and NICU admission.

RESULTS

12, 323 patients were eligible for inclusion. Median gestation for onset of labour was 40.1 weeks gestation, with 80.5% of spontaneous labour occurs by 41 + 0 weeks gestation. The risk of assisted delivery (RR 1.32, 95% CI 1.23 - 1.42), caesarean section (RR 2.17, 95% CI 1.88-2.51) and low-apgar scores (RR 3.13 95% CI 1.50-6.55) increased significantly with spontaneous labour after 41 weeks' gestation.

CONCLUSIONS

Nulliparous women with low-risk pregnancies are most likely to experience spontaneous labour between 40 + 0 and 40 + 6. 80.5% of spontaneous labour occurred by 41 + 0 weeks gestation. Assisted vaginal delivery, caesarean section and low-apgar scores were significantly more likely with spontaneous labour after 41 weeks' gestation.

The Use of Complementary Medicine During Childbearing Years: A Multi-Country Study of Women From the Middle East اس نه الطب التكميلي خلال سنوات الإنجاب: دراسة متعددة البلدان لنساء من الشرق الأوسط

The prevalence of self-prescribed complementary medicine (CM) use is an area of concern across the Middle East. We conducted a descriptive qualitative study to describe women’s use of CM during their childbearing years in Egypt, Jordan, Saudi Arabia and Iran. The study conducted using face to face audio-recorded interviews with 70 participants. Our findings showed that women used several herbal plants to ease pain and discomfort during menstruation and/or during pregnancy and in postpartum care. Acupuncture, meditation, and massage were less likely to be used by women. The impact of CM was often described in relation to perceived usefulness and safety of herbs. Cultural beliefs and roles of women contributed to the use of herbs among women. Given the high use of herbal medicine, there is a need for discussion about the potential of adverse effects of some plants or their metabolites following self-medication during the childbearing years.

The Effects of Date Fruit Consumption on Breast Milk Quantity and Nutritional Status of Infants

Background: Date fruit is a popular natural galactagogue among breastfeeding Muslim mothers. However, there is no evidence to support the effectiveness of date fruit in increasing the quantity of breast milk. Objective: This research aimed to study the effect of date fruit consumption on breast milk quantity and nutritional status of infants. Materials and Methods: This was a parallel randomized controlled trial. Forty-eight pairs of breastfeeding mothers and infants aged 1-3 months were included. The intervention group (n = 25) was asked to consume their normal dietary intake with 10 date fruits/day for 4 weeks. The control group (n = 23) was asked to consume their normal dietary intake without date fruit. Breast milk quantity was measured by using an electric breast pump and recorded for 2 days at baseline, week 2 and 4. The nutritional status of infants was assessed by calculating infant weight-for-age at baseline and week 4. Dietary data were collected at baseline, week 2, and 4, using a 2-day food record. Data were analyzed using Chi-square, t-test Mann-Whitney U test, and Wilcoxon matched-pairs signed-ranks test by SPSS version 18.0. Results: Breastfeeding mothers who received 10 date fruits/day had an 11% increase in breast milk quantity from baseline to week 2, and a 23% increase from baseline to week 4, (both p < 0.05). The breast milk quantity of the breastfeeding mothers who received date fruits was significantly higher than that of the control group (p < 0.05). However, there were no differences in infant nutritional status. Conclusions: Date fruit consumption appears to be useful for promoting and increasing breast milk quantity in breastfeeding mothers. Date fruits may be an alternative galactagogue.

Therapeutic Potential of Date Palm against Human Infertility: A Review

Male and female infertility is a global major health problem. Approximately 15% of couples of a reproductive age are unable to achieve the desired pregnancy within 12 months, despite daily unprotected sexual intercourse, and about 10% of infertilities have no specific reason worldwide. Currently, many researchers are interested to investigate the use of natural remedies for preventive and curative purposes of infertility. This review brings together some of the data on the nutritional characteristics of the date palm and its different parts on fertility outcomes and critically evaluates the past and recent literature relevant to the consumption of date fruit against infertility-related problems. Due to its antioxidant potential, dates are considered a functional treatment for reducing the risks of infertility. In males, the date palm has a potent effect on the reproductive parameters including hormonal levels and seminal vesicle parameters as well as sperm motility, count, and viability; whereas, in females, it shows a convincing effect on reproductive parameters including oogenesis process, strengthening of oocytes, regulation of hormones, strengthening of pregnancy, reduction of the need for labor augmentation, and postpartum hemorrhage prevention.

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.

Clinical effects of date palm (Phoenix dactylifera L.): A systematic review on clinical trials

PURPOSE

The aim of present study was to review and categorize the clinical trials investigating the clinical effects of different botanical parts of dates compared with any controls.

METHODS

All clinical trials (randomized, pilot, quasi-experimental, cross-over. and non-randomized clinical trials) evaluating the clinical effects of date palm from 2000 until August 2019 in English and Persian languages were included in this systematic review. The methodological quality of the included studies was evaluated according to the risk of bias assessment of Cochrane handbook of systematic reviews, and then reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

RESULTS

Twenty-six studies met the inclusion criteria. Studies were performed in 8 categories based on different botanical parts of date palm. These categories were obstetrics, gynecology, oncology, dermatology, hematology, gastroenterology, endocrinology, metabolism, and infertility. A total of 38 % of included studies were randomized controlled trials. Further, 80 % of the included studies had performance and detection bias. Finally, about 50 % of them had selection bias and about 20 % had attrition and reporting bias.

CONCLUSION

The widespread consumption of date palm as medicinal and botanical plant suggests the importance of this plant in human healthcare. The clinical trials conducted so far have explained a number of clinical effects of date palm. However, there is not enough clinical evidence to support the clinical effects in other review articles and traditional medical systems, and further randomized controlled trials with robust designs and methods are required.

Effect of Ajwa Dates Consumption to Inhibit the Progression of Preeclampsia Threats on Mean Arterial Pressure and Roll-Over Test

Background

Preeclampsia is the major problem and the main leading cause of fetal and maternal mortality worldwide. The early prediction of preeclampsia in pregnant women is required to prevent the occurrence of preeclampsia. The mean arterial pressure (MAP) and roll-over test (ROT) are the combination of measurement which can be used to predict preeclampsia. On the contrary, Ajwa dates were reported to have an enormous activity which contributes to its role in improving health conditions. In this study, we aimed to evaluate the effect of daily consumption of seven Ajwa dates on prevention of preeclampsia, through MAP and ROT changes.

Methods

Forty pregnant women (n = 40) were randomly assigned into the control group (n = 10) and the intervention group which received a daily intake of Ajwa dates (n = 30). The MAP and ROT were assessed before and after the 8-week intervention period.

Results

The intervention group showed the significant reduction in MAP and ROT following the 8-week intervention period (p < 0.05).

Conclusion

Daily consumption of seven Ajwa dates has a remarkable potential to decrease the MAP and ROT in pregnant women at risk of developing preeclampsia, and thus, it can contribute to prevent the development of preeclampsia.

Effects of consuming date fruits (Phoenix dactylifera Linn) on gestation, labor, and delivery: An updated systematic review and meta-analysis of clinical trials

BACKGROUND

Recent studies have shown that consumption of date fruits during pregnancy and also postpartum period might affect some pregnancy outcomes. We performed an updated systematic review and meta-analysis about the effects of consuming date fruits on gestation, labor, and delivery.

METHODS

Two researchers independently searched the online databases of PubMed, Scopus, Web of Science, Embase, Google Scholar, and EBSCO up to January 2019 for clinical trials examining the effects of date fruits consumption on any types of gestation, labor, and delivery outcomes. A fixed-effects model or random-effects models were applied to pool data, where appropriate. Quality assessment was done by Jadad scale.

RESULTS

In total, 11 and 8 studies were included in the systematic review and meta-analysis. Meta-analysis revealed that date fruit consumption significantly reduced gestation duration (pooled effect size: -0.30, 95% CI: -0.45, -0.15; P < 0.001), increased cervical dilation on admission (pooled effect size: 0.94, 95% CI: 0.88, 1.00; P < 0.001), and shorten duration of first stage of labor (pooled effect size: -50.09, 95% CI: -72.25, -27.93; P < 0.001). Also, it was revealed that date fruit consumption significantly reduced duration of second stage of labor in fixed-effects model (pooled effect size: -9.85, 95% CI: -14.00, -5.70; P < 0.001); however, this effect was not significant in random-effects analysis (pooled effect size: -11.27, 95% CI: -28.23, -5.68; P = 0.193).

CONCLUSIONS

Date fruits intake seems to reduce gestation duration and duration of the first stage of labor, and also increase cervical dilation on admission.

Effects of date fruit consumption on labour and vaginal delivery in Tabuk, KSA

Objectives

The date fruit has been shown to possess several health benefits. This study aims to determine the effects of date fruit consumption on the onset and progression of labour.

Methods

A randomised controlled clinical study was conducted on 89 participants to assess the effects of date fruit consumption on the onset and progression of labour. Twenty-six participants consumed date fruits alone, and 32 consumed date fruits followed by drinking of water. Thirty-one served as controls.

Results

There was a significant positive impact of consuming (rutab) date fruits on maternal outcomes in both the first and third stages of labour (p < 0.05 and p < 0.001, respectively). In addition, there was a significant relationship with the foetal well-being factors, such as healthy liquor, foetal heart rate, presence of caput, and Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score at 5 min (p < 0.05). The other maternal and foetal well-being factors showed no significant relationship with consumption of date fruits during labour.

Conclusion

The present study showed a promising effect of (rutab) date fruit consumption on the duration of the stages of labour. No significant differences were observed between the date fruit consumers and their counterparts regarding cervical dilatation; rupture of membranes; strength, frequency, and regularity of uterine contractions; tocometric reports; and maternal progression factors. Additionally, the APGAR score at 5 min was better among the infants whose mothers consumed date fruits.

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.

Date fruit consumption at term: Effect on length of gestation, labour and delivery

Labour induction and augmentation with Prostaglandin and Oxytocin are well established as standard practice worldwide. They are safe when used judiciously, but may be associated with maternal and neonatal morbidities. Other safer alternatives have been studied including dates consumption during late pregnancy with various outcomes. The aim of this randomised controlled trial was to investigate the effect of date fruit consumption during late pregnancy on the onset of labour and need for induction or augmentation of labour. A total of 154 nulliparous women with an uncomplicated singleton pregnancy were randomly allocated to either dates-consumer (77) or control group (77). The women in the dates-consumer group had significantly less need for augmentation of labour and longer intervention to delivery interval. There was no significant difference in the onset of spontaneous labour. Dates consumption reduces the need for labour augmentation but does not expedite the onset of labour. Impact statement • Dates fruit consumption during late pregnancy has been shown to positively affect the outcome of labour and delivery. In this study, date consumption reduced the need for labour augmentation with oxytocin but did not expedite the onset of labour. Therefore, dates consumption in late pregnancy is a safe supplement to be considered as it reduced the need for labour intervention without any adverse effect on the mother and child. This further supports the finding of earlier studies.

Use of herbal medicines during pregnancy in a group of Palestinian women

ETHNOPHARMACOLOGICAL RELEVANCE

The use of herbal medicines during pregnancy is common worldwide due to physiological changes that lead to pregnancy related problems.

OBJECTIVES

The aims of this study were to measure the prevalence and predictors of herb use among a group of Palestinian pregnant women and the possible influence of herbal consumption on pregnancy outcomes.

METHODS

This study was a questionnaire-based cross sectional descriptive study. It was conducted in the maternity ward of a governmental hospital between March and May 2012, a random sample of women who gave birth during the study period were met and asked to answer a face to face questionnaire.

RESULTS

Out of 300 women, 120 women (40.0%) used herbs during pregnancy; most women preferred to use herbs because they thought herbs are safer than medications (82.5%), women based in their choices mainly on advice from family or doctors (36.7%, 33.0%, respectively), 65.8% of them told their doctors that they used herbs, 91.7% considered these therapies beneficial, and 99.2% reported no side effects. The most commonly used herbs were anise (Pimpinella anisum) (61.7%), chamomile (Matricaria recutita) (53.3%), sage (Salvia officinalis) (55%), mixture of herbs (33.3%), and thyme (Thymus vulgaris) (29.2%). Most women were using herbs on as needed bases. There were no statistically significant differences between users and non-users of herbs in all socio-demographic variables and pregnancy outcomes.

CONCLUSIONS

This study found that the use of herbs during pregnancy is very common among Palestinian women. Infrequent use of herbs during pregnancy seems to be safe and beneficial. To provide the best care to pregnant women who use herbal products, clinicians and pharmacist are recommended to stay up to date with herb use and their safety in pregnancy. Not all women tell their doctors about herbal products use, so the physicians are recommended to ask pregnant women about this to avoid any possible negative outcomes on the mother or the fetus.