Complementary and alternative medicines (CAMs) are taken by many women, and the practice often continues during pregnancy. A common misconception is that, since they are non-prescription, they cannot be harmful. Sadly, that is not true. A new study assessed their use during pregnancy, focusing on the third trimester (last three months of pregnancy). The findings were published in the January 2015 edition of the journal Obstetrics & Gynecology.
The authors note that CAM has been defined by the World Health Organization and the National Center for Complementary and Alternative Medicine in the United States. The National Center for Complementary and Alternative Medicine defines CAM as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.” The authors note that, despite, a lack of data regarding safety and effectiveness, 50–90% of women irrespective of age and health status use CAM.
The authors explain that evidence is increasing regarding CAM-related maternal and fetal harm both during the first and third trimesters. This concern was reinforced in a recommendation from the UK National Institute for Clinical Excellence, which stated; “pregnant women should be informed that few complementary therapies have been established as being safe and effective during pregnancy. Women should not assume that such therapies are safe and they should be used as little as possible during pregnancy.” The authors recently released a study that two thirds of women in the UK use complementary and alternative medicine during early pregnancy; however, there is a lack of hard data describing complementary and alternative medicine use during late pregnancy.
In view of the foregoing, the aim of the new study was to estimate the prevalence of CAM use and reasons for use together with independent associated factors for use in pregnant women during the third trimester of pregnancy. A questionnaire survey was conducted among 700 women who delivered a live infant at the Royal Aberdeen Maternity Hospital, northeast Scotland. The use of CAM, vitamins, and minerals were assessed. In addition, the investigators looked at: reasons for CAM use; independent associated factors for use; views; and experiences. The data was subjected to statistical analysis.
A response rate was 79.6% among eligible women was attained. The majority of the women (61.4%) reported using CAM, excluding vitamins and minerals, during the third trimester. The women reported using a 30 different CAM products; the most commonly used were oral herbal products (38% of the women; 40 different products). The independent associated factors for CAM use identified were: CAM use before pregnancy (4.36-fold higher use); a university education (2.41-fold higher use), and CAM use by family or friends (2.36-fold higher use). The investigators did not find any association with healthcare professional recommendations. Users were significantly more likely than nonusers to agree that CAMs were safer than prescribed medicines, less likely to be associated with side effects, and could interfere with conventional medicines.
The authors concluded that, despite the majority of women, and notably users, being uncertain about their safety and effectiveness, CAM products were widely used during the third trimester of pregnancy in this group of women. Prior use was the most significant independent associated factor; however, the role of family and friends, rather than healthcare professionals, in the decision to use complementary and alternative medicine may be an area of concern.
The authors are affiliated with: Institute of Medical Sciences, The University of Aberdeen, Pharmacy Practice, School of Pharmacy and Life Sciences, Robert Gordon University, and Royal Aberdeen Maternity Hospital, Aberdeen, and Ninewells Hospital and Medical School, Dundee, United Kingdom; and Biostatistics, Medical Research Center, Hamad Medical Corporation, Doha, Qatar.
Take home message:
As the study authors noted, CAM can be harmful to the pregnant woman and her fetus. Many prescription products are derived from plants, including herbs. Two examples are the heart medication quinine and digitalis. Many Internet sources are not reliable for ascertaining safety because they are written by individuals who are selling and/or promoting the products. A reliable source of CAM information published by the American Congress of Obstetricians and Gynecologists can be found at this link.