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

Background

the use of complementary and alternative medicine (CAM) has become increasingly prevalent in industrialised countries, with women being the most prolific users. Some women continue to consume these therapies when they become pregnant.

Aim

to review the literature exploring prevalence and motivation for use of complementary and alternative medicine by pregnant women.

Method

a search for relevant literature published from 2001 was undertaken using a range of databases and by examining relevant bibliographies.

Results

although the estimates vary widely from 1% to 87%, the general trend indicates that a significant number of pregnant women use complementary and alternative medicine. Common modalities used include massage, vitamin and mineral supplements, herbal medicine, relaxation therapies and aromatherapy. Reasons for use are varied and include the belief that these therapies offer safe alternatives to pharmaceuticals, they allow greater choice and control over the childbearing experiences, and they are congruent with their holistic health beliefs. The influence of traditional cultural practices on the use of these therapies is unclear. Most expectant women rely on advice from family and friends, and many do not disclose their use to their pregnancy care providers.

Conclusions

many women use complementary and alternative medicine when they are pregnant. Further research is needed to gain a greater understanding of the true prevalence and expectant women’s motivation for the use of complementary and alternative medicine. Health-care professionals are encouraged to ask women about their use of these treatments and seek out relevant information.     

The use of complementary and alternative medicine (CAM) therapies by Turkish women with gynecological cancer

PURPOSE: To evaluate the prevalence and patterns of complementary and alternative medicine (CAM) utilization among Turkish women with gynecological cancer METHODS: In this cross-sectional study, a total of 156 patients treated between December 2002 and March 2005 at the Ministry of Health Aegean Obstetrics and Gynecology Teaching Hospital, Department of Gynecologic Oncology were evaluated. Data regarding CAM use were obtained from patients by means of face-to-face interviews. RESULTS: Sixty women (38.5%) had used CAM having been diagnosed with cancer; herbal medicine was the most common. The age, income, educational level, cancer site, FIGO stage, previous CAM usage, and time since patients were diagnosed with cancer were associated with CAM usage. The most (40%) commonly cited reason for CAM use was to boost the immune system. Although only 8.3% of CAM users received CAM information from health care professionals or CAM practitioners, this group of patients was more likely to discuss their CAM use with physicians. CONCLUSION: Our data suggest that physicians should increase their knowledge of CAM therapies and ask cancer patients about previous CAM history.     

Use of complementary and alternative medicine among women with gynecologic cancers

OBJECTIVE: The aim of this study was to determine the prevalence and types of complementary and alternative medicine (CAM) usage by women with gynecologic cancer in an outpatient midwestern university practice. METHODS: Any patient with a gynecologic cancer seen in the outpatient clinic of the gynecologic oncology division at Washington University over a 3-month period was eligible, excluding those patients with a new cancer diagnosis. Subjects completed a questionnaire anonymously. Two by two comparisons were made using the Fisher exact test and P was considered significant at P < 0.05. RESULTS: Nearly half (49.6%) of 113 respondents had used CAM since being diagnosed with cancer. Characteristics significantly associated with CAM use include annual income greater than $30,000, cancer site of origin other than the cervix, and use of CAM prior to cancer diagnosis. Users with annual incomes greater than $30,000 were significantly more likely to use CAM in the "other" category that included acupuncture, reflexology, and electromagnetic therapy. Fewer than 25% of CAM users received information regarding CAM from a physician, nurse, or practitioner of CAM. Women used CAM in hopes of achieving a wide range of potential benefits including both improved well-being and anti-cancer effects. The most common actual benefit these women perceived was an improvement in psychosocial well-being, including increased hope or optimism. CONCLUSIONS: American patients with gynecologic cancer frequently use CAM in addition to standard medical therapy. Oncologists caring for women with gynecologic cancer should initiate a dialogue about usage of CAM, discussing the potential adverse effects of CAM and the patient's therapeutic goals.     

Exploring traditional and complementary medicine use by Indigenous Australian women undergoing gynaecological cancer investigations

BackgroundIndigenous Australian women experience worse gynaecological cancer outcomes than non-Indigenous women. While traditional and complementary medicine (T&CM) is increasingly used by cancer patients alongside conventional treatments, little is known about T&CM use by Indigenous women. This study aimed to explore the beliefs, attitudes and experiences related to T&CM use and disclosure among Indigenous women undergoing gynaecological cancer investigations.MethodsA mixed-methods design explored T&CM use among Indigenous women who presented for gynaecological cancer investigation at an urban Queensland hospital (September 2016 and January 2018).ResultsFourteen women participated. The reported use (86%) and perceived value of T&CM was high among the participants, however, women reported major challenges in communicating with healthcare providers about T&CM, commonly associated with trust and rapport.ConclusionsThese findings highlight the need for strategies to facilitate culturally-appropriate doctor-patient communication around T&CM to foster trust and transparency in gynaecological cancer care for Indigenous women.     

Use of complementary,non-pharmacological pain reduction methods during childbirth among foreign-born and Swedish-born women

Objective

to investigate the association between country of origin of women and their use of complementary pain reduction methods (i.e. non-pharmacological) during childbirth in Sweden.

Design

cross-sectional design.

Setting

a national register-based study.

Participants

215,497 singleton deliveries (including the first birth of each woman during the period) of women aged 18–47 years in Sweden between 1996 and 1998, divided into 12 subgroups of countries or regions.

Measurements

the use of complementary pain reduction methods during childbirth was analysed by logistic regression, adjusting for parity, level of education, number of antenatal care visits, complications in pregnancy, complications during childbirth, use of any pharmacological methods and use of epidural/spinal analgesia during childbirth.

Findings

all subgroups of foreign-born women, except those from Finland, had lower odds of complementary pain reduction methods during childbirth than Swedish-born women. Women from Bosnia, Arab countries, Sub-Saharan Africa, Turkey, Iran and Asia had about 40% lower odds for use of complementary pain reduction methods during childbirth than Swedish-born women. Women who used epidural analgesia had higher odds for use of complementary pain reduction methods during childbirth than women who did not use any pharmacological methods.

Key conclusion

most subgroups of foreign-born women showed lower odds for and a different pattern in the use of complementary pain reduction methods during childbirth than Swedish-born women. These findings raise questions of whether the Swedish health-care system and care providers have sufficient awareness of and insight into the socio-cultural context of giving birth.     

Factors associated with worsening and improving urinary incontinence across the menopausal transition

OBJECTIVE: To evaluate whether the menopausal transition is associated with worsening of urinary incontinence symptoms over 6 years in midlife women. METHODS: We analyzed data from 2,415 women who reported monthly or more incontinence in self-administered questionnaires at baseline and during the first six annual follow-up visits (1995-2002) of the prospective cohort Study of Women's Health Across the Nation. We defined worsening as a reported increase and improving as a reported decrease in frequency of incontinence between annual visits. We classified the menopausal status of women not taking hormone therapy annually from reported menstrual bleeding patterns and hormone therapy use by interviewer questionnaire. We used generalized estimating equations methodology to evaluate factors associated with improving and worsening incontinence from year to year. RESULTS: Over 6 years, 14.7% of incontinent women reported worsening, 32.4% reported improvement, and 52.9% reported no change in the frequency of incontinence symptoms. Compared with premenopause, perimenopause and postmenopause were not associated with worsening incontinence; for example, early perimenopause was associated with improvement (odds ratio [OR] 1.19; 95% confidence interval [CI] 1.06-1.35) and postmenopause reduced odds of worsening (OR 0.80; 95% CI 0.66-0.95). Meanwhile, each pound of weight gain increased odds of worsening (OR 1.04; 95% CI 1.03-1.05) and reduced odds of improving (OR 0.97; 95% CI 0.96-0.98) incontinence. CONCLUSION: In midlife incontinent women, worsening of incontinence symptoms was not attributable to the menopausal transition. Modifiable factors such as weight gain account for worsening of incontinence during this life stage.     

Prevalence and associated factors with integrative and complementary practices use in Brazil

The aim of the current study was to investigate the prevalence of the use the integrative and complementary practices (ICP) and its associated factors in Brazil. Data was obtained from the cross-sectional National Health Survey 2013 (NHS), which had 145,580 adults aged 18 or over were interviewed. The outcome was the use of any ICP over the last 12 months and independent variables were macro-region, sex, age, educational attainment, skin color/race, and chronic disease. The results show that the prevalence of ICPs use in Brazil was 4.1%, while the most used types were medicinal plants and phytotherapy (2.5%), acupuncture (0.9%) and homeopathy (0.6%). The prevalence of ICPs use was higher in the North Region, among older people, women, participants with higher educational attainment, and with a higher number of chronic diseases. The findings from the current study provide valuable evidence that can inform future evidence-based public policies in Brazil.     

Factors associated with contraceptive use in Tehran, Iran.

OBJECTIVES: In spite of the government's efforts, the prevalence of contraceptive use in Iran is only 55.4%. Health concerns, side effects, failure of the methods and some demographic issues, among which education, age, and number of daughters, have a great influence on the enforcement of contraceptive measures. The aim of the present study was to identify factors affecting contraceptive use in Iran. METHODS: Data from the project 'The study of contraceptive practice in Tehran, 1999-2000' were analyzed with regard to the factors associated with contraceptive use by Iranian couples. A total of 4042 women at reproductive ages who had delivered in one of the 12 teaching hospitals of Tehran and had at least one child that lived for at least 24 hours after birth, were interviewed using a questionnaire that gathered information about their socio-demographic status, fertility history, and other characteristics. RESULTS: Using a multinomial logistic regression, it was found that the woman's age, her own or her husband's level of education, previous awareness about contraceptive methods, number of abortions, and number of sons and daughters were factors that were significantly associated with contraceptive use. CONCLUSIONS: A number of factors affect the application of contraceptive measures. It is essential that health policy makers be aware of these to promote contraception and population control.     

Herbal and other complementary medicine use by Texas midwives

This cross-sectional survey sought to document complementary and alternative medicine (CAM) use by Texas midwives, as well as to determine whether licensed direct-entry midwives (LMs) and certified nurse-midwives (CNMs) differed significantly in their patterns of use. All respondents (n = 69) indicated that they used, recommended, or referred their clients for at least one CAM therapy during the preceding year. Ninety percent (90%) of respondents used, recommended, or referred their clients for an herbal remedy (not including homeopathic tinctures). Herbal therapies were among the top three modalities recommended for 7 of 12 (58%) clinical indications. Herbs were the most salient CAM therapy used for cervical ripening (83%), followed closely by use for nausea, vomiting, and hyperemesis (80%), and labor induction (77%). Herbal therapies also constituted 50% or more of the CAM therapies used for the following indications: anemia/iron supplementation (70%), perineal healing (66%), and anxiety/stress/fatigue (50%). LM respondents used, recommended, or referred their clients for a greater number of herbal therapies compared to CNMs. While several of the CAM modalities used or recommended by Texas midwives show potential for clinical benefit, few have been studied sufficiently to determine their efficacy or safety during pregnancy.     

The use of complementary and alternative medicine by patients with cancer: in Turkey

This research sought to assess the use of complementary and alternative therapies (CAM) amongst Turkish patients with cancer. The research sample included 94 adult patients with cancer who underwent chemotherapy at an outpatient clinic at the Adult Oncology Department of the University of Izmir between November 2006 and January 2007. Data was collected by questionnaire. Results suggest that the majority of Turkish oncology patients in the study had used herbal essences or herbal therapies. Socio-demographic factors associated with CAM use considered gender, age, education and economic status, health insurance, and whether CAM use had been recommended by friends, health care professionals or others. There appeared to be a link between CAM use, the diagnosis of cancer and where patients lived (p?相似文献   

Factors associated with contraceptive use in Angola

After emerging from decades of civil war, Angola's economy has rapidly grown, yet its reproductive health outcomes have not improved at a commensurate level. At the time of this study, Angola had one of the highest rates of maternal mortality and fertility in the world. Only 6 percent of women aged 15-49 used contraception, with substantial differences in use and access across the different provinces of the country. This study uses a mixed-methods approach, combining analyses of a nationwide cross-sectional survey to assess which factors are associated with contraceptive use, with data from qualitative, semi-structured interviews of health care providers and internally displaced women to better understand and illuminate the survey data. High educational level and living in the capital region were strongly associated with contraceptive use, while age below 20 years was negatively associated with use. During qualitative interviews, health professionals commonly mentioned rural living, young age, cultural beliefs, and power imbalances as reasons for not using contraception. Internally displaced women often described difficulty paying for services, lack of nearby services, and limited knowledge of methods as barriers to use.     

Factors associated with pregnancy termination in Ukrainian women

OBJECTIVES: To study differences in social and demographic characteristics between women undergoing an induced abortion and antenatal care attendants in the Ukraine. DESIGN: Hospital-based unmatched case control study. METHODS: From a survey including 1,694 women of fertile age, who attended five women's clinics in the Donetsk region, Ukraine, we studied those who came for termination of pregnancy (n = 919) and for antenatal care (n = 478). The data were obtained through an anonymous self-questionnaire. From the 192-item questionnaire questions dealing with social and demographic characteristics, previous pregnancy experience, and attitude towards abortion were analyzed. Multiple logistic regression was used to analyze the risk of pregnancy termination. RESULTS: Termination of pregnancy was associated with being single (OR = 11.8). Both previous childbirth and previous induced abortion were other determinants as well as being younger than 19 years old (OR = 3.8), having a positive attitude towards abortion (OR = 2.7), and sharing apartment with parents (OR = 1.9). A higher risk for an induced abortion was found among women with a history of previous induced abortion(s). Neither income nor educational level was identified as a risk factor for pregnancy termination. CONCLUSION: This study demonstrated major social and demographic differences between women attending for abortion and antenatal care patients, and highlights some of the factors influencing the decision to terminate a pregnancy.     

Silent voices: women, complementary medicine, and the co-optation of change

Despite the prominence of complementary and alternative medicine (CAM) in public and policy debates, our knowledge of the relationship between CAM and gender remains undeveloped. By tracing two dominant strands of research involving the women's health movement and the implications of CAM's increasing popularity among women, this article draws attention to the need for research addressing the roles of women as practitioners and students of CAM. It is argued that the medicalization and co-optation of CAM has serious implications for women's health by constraining CAM's potential to challenge, resist, and transform the hegemony and inequalities of biomedicine.     

Factors associated with quality of life in a cohort of postmenopausal women.

OBJECTIVE: To evaluate quality of life (QOL) and identify its associated factors in a cohort of postmenopausal women who had not received hormone therapy. METHODS: A cross-sectional study was conducted among 81 postmenopausal women who had not used hormone therapy in the last six months. Sociodemographic and clinical characteristics, in addition to the prevalence of menopausal symptoms, were evaluated. QOL was assessed by the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) questionnaire, which may be condensed into two summaries: Physical Component Summary and Mental Component Summary. Generalized linear models were used to analyze the data, allowing the identification of factors affecting QOL, adjusting for confounding variables. RESULTS: The mean (+/-standard deviation) age of the participants was 58.1 +/- 4.7 years. The most prevalent symptoms were nervousness (67%) and hot flushes and sweating (51%). Factors associated with poorer QOL were sweating, palpitations, nervousness (physical component), and dizziness, nervousness, depression, insomnia and dyspareunia (mental component). CONCLUSION: We observed that menopausal symptoms negatively affected the physical and mental components of QOL in postmenopausal women.     

Improvement of the lipid profile in post menopausal women who use estradiol and testosterone implants

The authors aimed to investigate the effect of sildenafil citrate (Sc) on expressions of β₃ integrin and vascular endothelial growth factor (VEGF), which is taking part in endometrium receptivity in implantation window period in controlled ovarian hyperstimulation (COH) performed rats. In this study, Wistar albino female rats were used and were divided into four groups as control, COH, Sc, and COH + Sc groups. They were sacrificed on the third, fourth, and fifth day of pregnancy, uteruses were resected, and uteri sections were stained with immunohistochemical method and evaluated. β₃ integrin immunoreactivity was most intensely observed in the endometrial glandular epithelium (GE) and stromal cells in the Sc group on the third day, whereas immunoreactivity was most intensely detected in the luminal epithelium (LE), GE, and stromal cells in the Sc group on the fourth day. VEGF immunoreactivity was most intensely observed in the endometrial LE in the Sc group on the third day, in the Sc and COH + Sc groups on the fourth day, and in the COH + Sc group on the fifth day. Our results indicated that Sc plays a role in both implantation and decidualization by affecting β₃ integrin and VEGF expressions in implantation window period in rats.     

妊娠期妇女子宫颈细胞学检查结果异常的相关因素分析

目的 探讨妊娠期妇女宫颈细胞学检查结果异常的相关因素.方法 选择2007年9月至2008年9月在首都医科大学附属北京妇产医院产科定期产前检查的妊娠12～36周的妇女,除外先兆流产、胎膜早破、前置胎盘等并发症共12 112例,于初次产前检查时常规行宫颈液基细胞学检查(TCT),同时记录妊娠期妇女的职业、受教育程度、户口地址、家庭收入、民族、初次性生活年龄、性伴侣个数、避孕方法、孕产史、妇科伴随症状、相关肿瘤家族史、既往妇科病史、吸烟史,并记录当天妇科检查情况,分析TCT结果异常的相关危险因素.结果 资料完整的妊娠期妇女共11 906例,资料满意率为98.30%(11 906/12 112).其中,TCT结果正常10 354例,占86.96%(10 354/11 906)、未明确诊断意义的不典型鳞状上皮细胞(ASCUS)1134例,占9.52%(1134/11 906)、未明确诊断意义的不典型腺上皮细胞(ACUS)112例,占0.94%(112/11 906)、低度鳞状上皮内病变(LSIL)229例,占1.92%(229/11 906)、高度鳞状上皮内病变(HSIL)74例,占0.62%(74/11 906),宫颈鳞癌3例,占0.02%(3/11 906).多因素非条件logistic回归分析结果显示,与ASCUS及AGUS相关的危险因素包括初次性生活年龄(OR_(ASCUS)=2.90、OR_(AGUS)=7.32)、性伴侣个数(OR_(ASCUS)=1.49、OR_(AGUS)=2.02)、流产次数(OR_(ASCUS)=1.68、OR_(AGUS)=3.50);与LSIL、HSIL相关的危险因素包括初次性生活年龄(OR_(LSIL)=6.34、OR_(HSIL)=9.26)、性伴侣个数(OR_(LSIL)=1.69、OR_(HSIL)=1.65)、流产次数(OR_(LSIL)=1.53、OR_(HSIL)=5.33)、吸烟(OR_(LSIL)=1.84、OR_(HSIL)=1.77);与TCT结果异常(包括ASCUS、AGUS、LSIL、HSIL)相关的感染因素包括滴虫性阴道炎(P<0.01)、人乳头状瘤病毒(HPV)感染(P<0.01);柱状上皮异位与TCT结果异常密切相关(χ~2=43.269,P=0.000),但与柱状上皮异位的程度无关.结论 妊娠期妇女宫颈细胞学检查结果异常发生的相关因素与非妊娠期相同.