Use of herbal medicines among pregnant women attending family health centers in Alexandria

ObjectiveThe aim of the study is to elucidate the use of herbal medicines in pregnant women and to explore patterns of herbal medication use including dietary supplements in pregnant women in Alexandria, Egypt.MethodologyA cross sectional study of pregnant females was conducted in a family health center in Alexandria between March and June 2011 utilizing a sample of 300 pregnant women (100 pregnant women in each trimester). A specially designed self administered questionnaire was used to collect the data.ResultsThe mean age of studied pregnant women was 26.9 ± 4.9 years. Only 27.3% of the studied pregnant women reported the use of herbal medicines during pregnancy while 89% reported the use of dietary supplements.The majority of pregnant women resorted to (family/friends) as primary source of information of herbal medicines (42.7% and 28%, respectively), while the majority of women using dietary supplements resorted to (physicians) as primary source of information (76%).52.4% of the studied pregnant women reported that they use ginger during the 1st trimester of pregnancy while 51.6% reported that they use fenugreek during the 3rd trimester of pregnancy.More than half of the studied pregnant women (64.6%) reported the efficacy of herbal medicines in relieving their complaints during pregnancy.ConclusionThe use of herbal medicines during pregnancy in Alexandria was uncommon while the use of dietary supplements was very common.About three quarters of studied sample reported that the physician was the person to recommend dietary supplement usage while the physician was rarely cited as the person recommending herbal usage.The most common herbs used by pregnant women were aniseed, fenugreek, ginger, while the least used was peppermint.Ginger was found to be used by a significantly higher percentage of pregnant women in the first trimester; on the other hand, fenugreek was used by a significantly higher percentage of pregnant women in the third trimester.RecommendationsResults of the following study suggest the following recommendations:General recommendationsGeneral health education for pregnant women about benefits and harms of herbal use during pregnancy in ante-natal care especially for herbs commonly used in Egypt.Specific recommendations

• ACare providers:

Training of family physicians in the family health centers on the use of herbal medicines in pregnancy and possible effects on the fetus.

• BPregnant women:

Health education program directed toward pregnant women to increase their awareness about the effects of herbal medicines.     

Use of anti-emetic herbs in pregnancy: women's choices, and the question of safety and efficacy

The majority of North American pregnant women experience some degree of nausea and vomiting, usually in the first few months of pregnancy. Women utilize many coping strategies, including self-treatment with herbal medicine and other alternative therapies. In a qualitative study of self-care in pregnancy, birth and lactation within a non-random sample of 27 women in British Columbia, Canada, 20 women (74%) experienced pregnancy-induced nausea. Ten of these women used anti-emetic herbal remedies, which included ginger, peppermint, and Cannabis. The safety and efficacy of each of these herbal remedies is discussed here. Only ginger has been subjected to clinical trials among pregnant women, though all three herbs were clinically effective against nausea and vomiting in other contexts, such as chemotherapy-induced nausea and post-operative nausea. While safety concerns exist in the literature for all three herbs with regards to their use by pregnant women, clinical evidence of harm is lacking.     

Herb remedies during pregnancy: a systematic review of controlled clinical trials

Objective: The use of herbal remedies has been documented both among various patient groups and in the general population to promote health. The aim of this systematic review is to analyze the benefits of herb use during pregnancy. Methods: A systematic literature search covering the period from January 1990 to September 2010 was performed using various electronic databases. Randomized controlled clinical trials (RCTs) were included. Paper quality was evaluated using the Jadad scale. Results: Of the 511 articles identified, 14 RCTs were eligible. Ginger was the most investigated remedy and was consistently reported to ameliorate nausea and vomiting during pregnancy better than placebo; its efficacy in doing so was noted to be equal to that of vitamin B6 and dimenhydrinate. A single trial also supported the use of Hypericum perforatum for wound healing. Cranberry, however, was not efficacious in the treatment of urinary tract infections; finally, raspberry leaf did not shorten the first stage of labor, and garlic did not prevent pre-eclampsia. Conclusions: Despite the widespread, popular use of herbal remedies during pregnancy, too few studies have been devoted to specific clinical investigations. With the exception of ginger, there is no data to support the use of any other herbal supplement during pregnancy.     

Relationship between complementary and alternative medicine use and incidence of adverse birth outcomes: An examination of a nationally representative sample of 1835 Australian women

Objectivethere is evidence of high use of complementary and alternative medicine (CAM) by pregnant women. Despite debate and controversy regarding CAM use in pregnancy there has been little research focus upon the impacts of CAM use on birth outcomes. This paper reports findings outlining the incidence of adverse birth outcomes among women accessing CAM during pregnancy.Designa survey-based cohort sub-study from the nationally-representative Australian Longitudinal Study on Women׳s Health (ALSWH) was undertaken in 2010.Participantswomen (aged 31–36 years) who identified in 2009 as pregnant or recently given birth (n=2445) from the younger cohort (n=8012) of ALSWH were recruited for the study.Measurements and findingsparticipants׳ responses were analysed to examine the relationship between use of CAM and adverse birth outcomes from their most recent pregnancy. Of the respondents (n=1835; 79.2%), there were variations in birth outcomes for the women who used different CAM. Notably, the outcome which was most commonly associated with CAM use was emotional distress. This was found to occur more commonly in women who practised meditation/yoga at home, used flower essences, or consulted with a chiropractor. In contrast, women who consulted with a chiropractor or consumed herbal teas were less likely to report a premature birth, whilst participation in yoga classes was associated with an increased incidence of post partum/intrapartum haemorrhage.Key conclusionsthe results emphasise the necessity for further research evaluating the safety and effectiveness of CAM for pregnant women, with a particular focus on birth outcomes.Implications for practicehealth professionals providing care need to be aware of the potential birth outcomes associated with CAM use during pregnancy to enable the provision of accurate information to women in their care, and to assist in safely supporting women accessing CAM to assist with pregnancy, labour and birth.     

Traditional practices during pregnancy and birth,and perceptions of perinatal losses in women of rural Pakistan

ObjectiveUnderstanding the sociocultural context and local practices during pregnancy and birth is imperative to identify factors related to perinatal mortality in countries where its burden is high. This study aims to explore the pregnancy and birth related cultural practices and the perceptions of women with a recent perinatal death in Sindh province, Pakistan.DesignThis qualitative exploratory study consisted of in-depth interviews with women who had experienced a perinatal death in the year preceding the study. Women were identified and recruited with the help of lady health workers. After consent, women were interviewed in their homes and in their own language (Sindhi) by a local female interviewer.Setting and ParticipantsInterviews were conducted with women from predominantly rural district of the southern province of Sindh in Pakistan between May and August 2018. The data were coded both inductively and deductively and then analysed using themes.FindingsTwenty-five women were interviewed. Traditional home remedies were commonly used to alleviate pregnancy symptoms such as general aches and pains. The health providers often delayed the information about the perinatal deaths in health facilities, which saddened the women. Most women had fatalistic opinions about what caused their losses, and explained the cause based on their own interpretation, which were not necessarily consistent with known causes of perinatal death. The women also desired to use contraception and believed that it would prevent future pregnancy loss; however, many women were unable to make that decision themselves.Conclusions and implicationsThe high use of traditional home-based remedies may be a proxy measure for poor access to formal healthcare services. Many women described poor acknowledgement of their grief which may be harmful. Women’s knowledge about the causes of perinatal mortality in general was very low, improving this knowledge may help women to seek appropriate healthcare services during pregnancy.     

Herbal remedies for menopausal symptoms: Are we cautious enough?

Objectives To evaluate adverse effects of herbal remedies consumed by menopausal women for control of the climacteric syndrome.

Methods We examined the long term safety and herb-drug interactions of commonly used herbal therapy such as soy, black cohosh, dong quai, ginseng and vitamin E.

Results Even carefully designed studies on herbal treatments for vasomotor menopausal symptoms never addressed specifically safety issues. Sporadic reports show dangerous adverse effects of these herbal preparations as well as hazardous interactions between botanic compounds and conventional medications.

Conclusions The unrestricted sale of plant products constitutes a new situation for physicians with little training in phytotherapy. The qualitative and quantitative diversity of the commercially available preparations, the absence of precise prescribing guidelines, and the risk of self-prescribed medication justify the introduction of ‘phyto-vigilance’. Physicians should warn their patients about the lack of evidence regarding safety and possible interactions of herbal remedies with concurrent medications.     

Safety and efficacy of herbal remedies in obstetrics—review and clinical implications

Objective

to review the literature on safety and efficacy of the most commonly used herbs to enable midwives to give evidence-based information to pregnant women.

Design

survey and review of the scientific literature.

Setting

the survey was performed at the antenatal clinic at Norfolk and Norwich University Hospital between 26 November 2007 and 15 February 2008.

Participants

a total of 578 expectant mothers at least 20-weeks pregnant.

Measurements and findings

57.8% of the participants used one or more herbal remedies. The most commonly used herbal preparations during pregnancy were ginger, cranberry, raspberry leaf, chamomile, peppermint and echinacea. Altogether, 14 studies focusing on the safety and/or efficacy of these herbals in human pregnancy were identified. Ten studies of ginger, one of cranberry, two of raspberry leaf and one of echinacea were located.

Key conclusions

there is limited documentation on the safety and efficacy of many herbs commonly used during pregnancy.

Implications for practice

midwives are important caregivers for pregnant women and should strive to give evidence-based advice on herbal use in pregnancy. If ‘traditional use’ is the only available information, the pregnant woman should be made aware of this to enable her to make an informed decision about the eventual use.     

Unauthorised pregnancies and use of maternity care in rural China

ABSTRACT

Objectives To describe the use of maternity care in rural China by the legal status of the pregnancy.

Methods Cross-sectional survey wherein information was obtained about 2576 women who gave birth in 2006. Logistic regression was used to compare women having an unauthorised pregnancy with those having an authorised second birth, adjusting for confounding factors.

Results Almost all respondents had antenatal care and most deliveries occurred in hospitals. Women with unauthorised pregnancies were significantly less likely to have had maternity care, particularly prenatal care, postnatal care, to have been hospitalised during pregnancy, and to have been reimbursed for hospital delivery costs than women with an authorised second birth. They were also more likely to have been hospitalised for seven or more days after delivery. Primiparous women used maternity care services and received financial support more often than women with an authorised second birth. Among the women with an unauthorised pregnancy an important reason for not using hospital care during pregnancy or delivery was financial constraint.

Conclusions Women with unauthorised pregnancies use less maternity care, although pregnancy in such circumstances may adversely impact their health. Primiparous women benefit from more financial support than multiparous women.     

Opioid and Cannabis Use During Pregnancy and Breastfeeding in Relation to Sociodemographics and Mental Health Status: A Descriptive Study

ObjectiveThis study of Canadian women estimates the prevalence of opioid and cannabis use during pregnancy and cannabis use during the breastfeeding period and explores the sociodemographic and mental health characteristics associated with use.MethodsA total of 13 000 women who gave birth between January and June 2018 were invited to participate in the Survey on Maternal Health by Statistics Canada; 7111 women participated for a response rate of 54.7%. Participants were asked about their mental health, supports during pregnancy, and substance use. Multivariable logistic regression was used to describe the relationship between sociodemographic and mental health characteristics and substance use during pregnancy and while breastfeeding.ResultsThe prevalence of self-reported opioid use during pregnancy was 1.4% (95% confidence interval [CI] 1.1%–1.8%). A higher proportion of women reported using cannabis during pregnancy and while breastfeeding, at 3.1% (95% CI 2.5%–3.6%) and 2.6% (95% CI 2.1%–3.1%), respectively. Younger age, not being in a relationship, lower level of education, and thoughts of self-harm were significantly associated with cannabis use during pregnancy. Lower level of education and thoughts of self-harm were also significantly associated with cannabis use while breastfeeding, as were symptoms of postpartum depression and/or generalized anxiety. Lower level of education and symptoms of postpartum depression and/or generalized anxiety were also significantly associated with opioid use during pregnancy.ConclusionThe results of this survey show relatively low levels of opioid and cannabis use during pregnancy and cannabis use while breastfeeding in Canada. Different sociodemographic and mental health characteristics are associated with the use of these substances, and public health interventions and policies should take into account these factors.     

Perception and attitude of Jordanian physicians towards complementary and alternative medicine (CAM) use in oncology

PurposeTo determine general perception and attitudes to CAM among Jordanian physicians at King Hussein Cancer Center (KHCC), and challenges facing formal integration of CAM into conventional practice.MethodA cross-sectional survey of KHCC physicians using a semi-structured questionnaire.ResultsResponse rate was 71%(71/100). 84%(41/49) defined CAM as “not evidence-based” treatments and/or “Herbs”. More than 80% reported interest to learn about CAM. 70% believed that herbal remedies were harmful, though only 17%(12/71) reported some knowledge about their composition. Physicians' concern of harmful interactions was the most significant reason for asking their patients about use (p < 0.0001). >90%(32/35) of physicians who estimated a low rate (<10%) of CAM usage by patients had minimal knowledge of herbal remedies (p = 0.06).ConclusionKHCC physicians have very little knowledge but high interest to learn about CAM use in oncology. An educational component will be crucial for the implementation of a formal CAM program at KHCC.     

Women’s views on anxiety in pregnancy and the use of anxiety instruments: a qualitative study

Objective: To explore women’s experience of anxiety in pregnancy and views on the use of anxiety instruments in antenatal care.

Background: Anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed.

Methods: A qualitative study using two focus group discussions was undertaken. Focus group one included women in a community setting and focus group two included women in a hospital clinic setting who had received additional support for anxiety in pregnancy. Participants were women who had given birth within the past nine months and considered themselves to have been anxious during their pregnancy.

Results: Three main themes were identified using template analysis: sources of support, administration of anxiety instruments and the use of instruments to prompt discussion. Women stated that anxiety instruments could help them to identify their anxious feelings and prompt a discussion around those feelings. However, they expressed concerns surrounding the administration of anxiety instruments and questioned how useful they would be in helping women access help and support.

Conclusions: The introduction of anxiety instruments in antenatal care may present an opportunity to discuss women’s emotional health and anxieties. Providing women with sufficient time to discuss their anxious feelings, identified by such instruments, could facilitate access to additional support.     

Pregnant Women’s Knowledge of Influenza and the Use and Safety of the Influenza Vaccine During Pregnancy

IntroductionWe wished to assess pregnant women’s knowledge of influenza, vaccine safety during pregnancy and breast feeding, and the recommendations for use of the influenza vaccine in pregnancy.MethodsWe performed a cross-sectional survey of postpartum women during influenza season in 2006.ResultsPregnant women’s overall knowledge of these subjects was poor. Most women (95%) knew that influenza is highly contagious, but almost 90% incorrectly believed that pregnant women have the same risk of complications as non-pregnant women. Only one half of the women were aware of national recommendations for vaccination during pregnancy and that the vaccine is safe during pregnancy and breast feeding, and 80% incorrectly believed that the vaccine can cause birth defects. Only 20% of women had been offered the vaccine during the current pregnancy or a prior pregnancy.ConclusionsPregnant women’s knowledge about influenza vaccine recommendations and safety during pregnancy is poor. There is substantial room for improvement among prenatal care providers in both patient education and offering the vaccine.     

Use of herbal drugs during pregnancy among 600 Norwegian women in relation to concurrent use of conventional drugs and pregnancy outcome

Purpose

The purpose of this study was to investigate the use of herbal drugs by pregnant women in relation to concurrent use of conventional drugs, delivery, and pregnancy outcome.

Method

600 women at Stavanger University Hospital Norway were interviewed using a structured questionnaire within five days after delivery. Medical birth charts were reviewed with respect to pregnancy outcome.

Results

In all, 39.7% of the women reported having used herbal drugs during pregnancy, most commonly ginger, iron-rich herbs, echinacea and cranberry. Although 86.3% of the women reported having used conventional drugs during pregnancy there were few potential interactions between herbal drugs and conventional drugs. There was a significant association between the use of iron-rich herbs during pregnancy and high birthweight, and use of raspberry leaves and caesarean delivery.

Conclusion

Use of herbal drugs is common during pregnancy and indicates a need for documentation about their safety in pregnancy.     

Reproductive Outcomes following Use of Barbed Suture during Laparoscopic Myomectomy

Study ObjectiveTo review pregnancy outcomes after laparoscopic myomectomy with the use of barbed suture.DesignRetrospective cohort study and follow-up survey.SettingSingle, large academic medical center.PatientsPatients who underwent laparoscopic myomectomy with the use of barbed suture for myometrial closure between 2008 and 2016.InterventionLaparoscopic myomectomy and a follow-up survey regarding pregnancy outcome.Measurements and Main ResultsA total of 486 patients met inclusion criteria and underwent a laparoscopic myomectomy between 2008 and 2016. Of the 428 with viable contact information, 240 agreed to participate (56%). Of those who responded to the survey, 101 (42%) attempted to get pregnant, and there were 4 unplanned pregnancies. There were 110 pregnancies among 76 survey respondents. In total, of the women attempting a postoperative pregnancy, 71% had at least 1 pregnancy. Comparing the women who did and did not conceive postoperatively, the group who got pregnant was on average younger, 33.8 ± 4.5 years vs 37.5 ± 6.5 years (p = .001); had fewer myomas removed, median = 2 (range 1-9) vs median = 2 (range 1-16) myomas (p = .038); and had a longer follow-up period, 30 months ( vs 30 (11-93 months) ± 20 (p <.001). The mean time to first postoperative pregnancy was 18.0 months (range 2–72 months). Of the 110 reported postoperative pregnancies, there were 60 live births (55%), 90% by means of cesarean section. The mean gestational age at birth was 37.8 weeks. In the cohort, there were 8 preterm births, 3 cases of abnormal placentation, 2 cases of fetal growth restriction, 3 cases of hypertensive disorders of pregnancy, and 2 cases of myoma degeneration requiring hospitalization for pain control. There were no uterine ruptures reported.ConclusionAccording to our findings, pregnancy outcomes after laparoscopic myomectomy with barbed suture are comparable with available literature on pregnancy outcomes with conventional smooth suture.     

Assessing depression,anxiety and couple psychological well-being in pregnancy: a preliminary study

Objective: The aim of the study was to evaluate symptoms of depression and anxiety and psychological well-being in men and women in their third trimester of pregnancy, and to compare them with two control groups of men and non-pregnant women, both with children and without children. Background: Perinatal research has largely focused on maternal depression, anxiety and the state of the marital relationship, but few studies exist including partners and comparisons with control groups of men and women both with and without children. Methods: The study was a cross-sectional survey. The total sample was 156 participants. Approximately equal numbers of participants in each group were recruited through a local community health centre in Zaragoza (Spain) and completed questionnaires in the presence of a psychologist. Anxiety, depression and the couple’s self-ratings of their well-being were assessed with the Beck Depression Inventory, the State-Trait Anxiety Inventory, and Psychological Well-being in the couple Scale, respectively. Results: The results show higher levels of depression symptoms in the ‘pregnancy group’; specifically, pregnant women reported higher levels of depression than their male partners. Also, the ‘pregnancy group’ (men and women) show lower scores on psychological well-being in the couple compared with the control groups. No significant differences in anxiety-state between the groups and sex were obtained. Conclusion: These findings are important for both researchers and clinicians in practice, in order to improve the identification of women with antenatal depressive symptoms and offer more psychological support for women and their partners during and after pregnancy.