Skip to main content
Top
Published in: BMC Complementary Medicine and Therapies 1/2016

Open Access 01-12-2016 | Research article

Safety classification of herbal medicines used in pregnancy in a multinational study

Authors: D. A. Kennedy, A. Lupattelli, G. Koren, H. Nordeng

Published in: BMC Complementary Medicine and Therapies | Issue 1/2016

Login to get access

Abstract

Background

The use of herbal medicines for health prevention and ailments is an increasing trend worldwide. Women in pregnancy are no exception; the reported prevalence of herbal medicine use in pregnancy ranges from 1 to 60 %. Despite a common perception of safety, herbal medicines may have potent pharmacological actions, and historically, have been used for this reason.

Methods

A multinational, cross-sectional study on how women treat disease and pregnancy-related health ailments was conducted between October 2011 and February 2012 in Europe, North America, and Australia. This study’s primary aim was to evaluate and classify the herbal medicines used according to their safety in pregnancy and, secondly, to investigate risk factors associated with the use of contraindicated herbal medicines during pregnancy.

Results

In total, 29.3 % of the women (n = 2673) reported the use of herbal medicines in pregnancy; of which we were able to identify 126 specific herbal medicines used by 2379 women (89.0 %). Twenty seven out of 126 herbal medicines were classified as contraindicated in pregnancy, and were used by 476 women (20.0 %). Twenty-eight were classified as safe for use in pregnancy and used by the largest number of women (n = 1128, 47.4 %). The greatest number was classified as requiring caution in pregnancy; these sixty herbal medicines were used by 751 women (31.6 %). Maternal factors associated with the use of contraindicated herbal medicines in pregnancy were found to be working in the home, having a university education, not using folic acid, and consuming alcohol. Interestingly, the recommendation to take a contraindicated herbal medicine was three times more likely to be from a healthcare practitioner (HCP) than an informal source.

Conclusion

Based on the current literature the majority of women in this study used an herbal medicine that was classified as safe for use in pregnancy. Women who reported taking a contraindicated herb were more likely to have been recommended it use by an HCP rather than informal source(s), indicating an urgent need for more education among HCPs. The paucity of human studies on herbal medicines safety in pregnancy stands in stark contrast to the widespread use of these products among pregnant women.
Appendix
Available only for authorised users
Literature
2.
go back to reference Hall HG, Griffiths DL, McKenna LG. The use of complementary and alternative medicine by pregnant women: a literature review. Midwifery. 2011;27(6):817–24.CrossRefPubMed Hall HG, Griffiths DL, McKenna LG. The use of complementary and alternative medicine by pregnant women: a literature review. Midwifery. 2011;27(6):817–24.CrossRefPubMed
3.
go back to reference Frawley J, Adams J, Sibbritt D, Steel A, Broom A, Gallois C. Prevalence and determinants of complementary and alternative medicine use during pregnancy: results from a nationally representative sample of australian pregnant women. Aust N Z J Obstet Gynaecol. 2013;53(4):347–52.CrossRefPubMed Frawley J, Adams J, Sibbritt D, Steel A, Broom A, Gallois C. Prevalence and determinants of complementary and alternative medicine use during pregnancy: results from a nationally representative sample of australian pregnant women. Aust N Z J Obstet Gynaecol. 2013;53(4):347–52.CrossRefPubMed
4.
go back to reference Holst L, Wright D, Haavik S, Nordeng H. Safety and efficacy of herbal remedies in obstetrics-review and clinical implications. Midwifery. 2011;27(1):80–6.CrossRefPubMed Holst L, Wright D, Haavik S, Nordeng H. Safety and efficacy of herbal remedies in obstetrics-review and clinical implications. Midwifery. 2011;27(1):80–6.CrossRefPubMed
5.
go back to reference Nordeng H, Bayne K, Havnen GC, Paulsen BS. Use of herbal drugs during pregnancy among 600 Norwegian women in relation to concurrent use of conventional drugs and pregnancy outcome. Complement Ther Clin Pract. 2011;17(3):147–51.CrossRefPubMed Nordeng H, Bayne K, Havnen GC, Paulsen BS. Use of herbal drugs during pregnancy among 600 Norwegian women in relation to concurrent use of conventional drugs and pregnancy outcome. Complement Ther Clin Pract. 2011;17(3):147–51.CrossRefPubMed
6.
go back to reference Lapi F, Vannacci A, Moschini M, Cipollini F, Morsuillo M, Gallo E, Banchelli G, Cecchi E, Di Pirro M, Giovannini MG, Cariglia MT, Gori L, Firenzuoli F, Mugelli A. Use, attitudes and knowledge of complementary and alternative drugs (cads) among pregnant women: a preliminary survey in Tuscany. Evid Based Complement Alternat Med. 2010;7(4):477–86. Lapi F, Vannacci A, Moschini M, Cipollini F, Morsuillo M, Gallo E, Banchelli G, Cecchi E, Di Pirro M, Giovannini MG, Cariglia MT, Gori L, Firenzuoli F, Mugelli A. Use, attitudes and knowledge of complementary and alternative drugs (cads) among pregnant women: a preliminary survey in Tuscany. Evid Based Complement Alternat Med. 2010;7(4):477–86.
7.
go back to reference Moussally K, Oraichi D, Berard A. Herbal products use during pregnancy: prevalence and predictors. Pharmacoepidemiol Drug Saf. 2009;18(6):454–61.CrossRefPubMed Moussally K, Oraichi D, Berard A. Herbal products use during pregnancy: prevalence and predictors. Pharmacoepidemiol Drug Saf. 2009;18(6):454–61.CrossRefPubMed
8.
go back to reference Louik C, Gardiner P, Kelley K, Mitchell AA. Use of herbal treatments in pregnancy. Am J Obstet Gynecol. 2010;202(5):439.e431-439.e410. Louik C, Gardiner P, Kelley K, Mitchell AA. Use of herbal treatments in pregnancy. Am J Obstet Gynecol. 2010;202(5):439.e431-439.e410.
9.
go back to reference Holst L, Wright D, Nordeng H, Haavik S. Use of herbal preparations during pregnancy: focus group discussion among expectant mothers attending a hospital antenatal clinic in Norwich, UK. Complement Ther Clin Pract. 2009;15(4):225–9.CrossRefPubMed Holst L, Wright D, Nordeng H, Haavik S. Use of herbal preparations during pregnancy: focus group discussion among expectant mothers attending a hospital antenatal clinic in Norwich, UK. Complement Ther Clin Pract. 2009;15(4):225–9.CrossRefPubMed
10.
go back to reference Nordeng H, Havnen GC. Impact of socio-demographic factors, knowledge and attitude on the use of herbal drugs in pregnancy. Acta Obstet Gynecol Scand. 2005;84(1):26–33.CrossRefPubMed Nordeng H, Havnen GC. Impact of socio-demographic factors, knowledge and attitude on the use of herbal drugs in pregnancy. Acta Obstet Gynecol Scand. 2005;84(1):26–33.CrossRefPubMed
11.
go back to reference Pallivalappila AR, Stewart D, Shetty A, Pande B, McLay JS. Complementary and alternative medicines use during pregnancy: a systematic review of pregnant women and healthcare professional views and experiences. Evid Based Complement Alternat Med. 2013;2013:10.CrossRef Pallivalappila AR, Stewart D, Shetty A, Pande B, McLay JS. Complementary and alternative medicines use during pregnancy: a systematic review of pregnant women and healthcare professional views and experiences. Evid Based Complement Alternat Med. 2013;2013:10.CrossRef
12.
go back to reference Warriner S, Bryan K, Brown AM. Women’s attitude towards the use of complementary and alternative medicines (cam) in pregnancy. Midwifery. 2014;30(1):138–43.CrossRefPubMed Warriner S, Bryan K, Brown AM. Women’s attitude towards the use of complementary and alternative medicines (cam) in pregnancy. Midwifery. 2014;30(1):138–43.CrossRefPubMed
13.
go back to reference Kennedy D, Lupattelli A, Koren G, Nordeng H. Herbal medicine use in pregnancy: results of a multinational study. BMC Complement Altern Med. 2013;13(1):355.CrossRefPubMedPubMedCentral Kennedy D, Lupattelli A, Koren G, Nordeng H. Herbal medicine use in pregnancy: results of a multinational study. BMC Complement Altern Med. 2013;13(1):355.CrossRefPubMedPubMedCentral
14.
go back to reference Dante G, Bellei G, Neri I, Facchinetti F. Herbal therapies in pregnancy: What works? Curr Opin Obstet Gynecol. 2014;26(2):83–91.CrossRefPubMed Dante G, Bellei G, Neri I, Facchinetti F. Herbal therapies in pregnancy: What works? Curr Opin Obstet Gynecol. 2014;26(2):83–91.CrossRefPubMed
15.
go back to reference Mills E, Duguoa J-J, Perri D, Koren G. Herbal medicines in pregnancy and lactation: An evidence-based approach. London ; New York: Taylor & Francis; 2006.CrossRef Mills E, Duguoa J-J, Perri D, Koren G. Herbal medicines in pregnancy and lactation: An evidence-based approach. London ; New York: Taylor & Francis; 2006.CrossRef
16.
go back to reference Nordeng H, Havnen GC. Use of herbal drugs in pregnancy: a survey among 400 Norwegian women. Pharmacoepidemiol Drug Saf. 2004;13(6):371–80.CrossRefPubMed Nordeng H, Havnen GC. Use of herbal drugs in pregnancy: a survey among 400 Norwegian women. Pharmacoepidemiol Drug Saf. 2004;13(6):371–80.CrossRefPubMed
18.
go back to reference Mills SY, Bone K. The essential guide to herbal safety. St. Louis, Mo: Elsevier Churchill Livingstone; 2005. Mills SY, Bone K. The essential guide to herbal safety. St. Louis, Mo: Elsevier Churchill Livingstone; 2005.
20.
go back to reference Gardner ZE, McGuffin M, American Herbal Products Association. American herbal products association’s botanical safety handbook. 2nd ed. Boca Raton: American Herbal Products Association, CRC Press; 2013. Gardner ZE, McGuffin M, American Herbal Products Association. American herbal products association’s botanical safety handbook. 2nd ed. Boca Raton: American Herbal Products Association, CRC Press; 2013.
21.
go back to reference Romm AJ. Botanical medicine for women’s health, vol. xix. St. Louis, Mo: Churchill Livingstone/Elsevier; 2010. p. 694. Romm AJ. Botanical medicine for women’s health, vol. xix. St. Louis, Mo: Churchill Livingstone/Elsevier; 2010. p. 694.
23.
go back to reference Duke JA, Duke JA. Handbook of medicinal herbs. 2nd ed. Boca Raton, FL: CRC Press; 2002.CrossRef Duke JA, Duke JA. Handbook of medicinal herbs. 2nd ed. Boca Raton, FL: CRC Press; 2002.CrossRef
24.
go back to reference Gruenwald J, Brendler T, Jaenicke C. Pdr for herbal medicines. 4th ed. Montvale, NJ: Medical Economic Company; 2000. Gruenwald J, Brendler T, Jaenicke C. Pdr for herbal medicines. 4th ed. Montvale, NJ: Medical Economic Company; 2000.
25.
go back to reference Hardin JW, Hilbe J. Generalized estimating equations. Boca Raton: CRC Press; 2013. Hardin JW, Hilbe J. Generalized estimating equations. Boca Raton: CRC Press; 2013.
26.
go back to reference Dante G, Pedrielli G, Annessi E, Facchinetti F. Herb remedies during pregnancy: a systematic review of controlled clinical trials. J Matern Fetal Neonatal Med. 2013;26(3):306–12.CrossRefPubMed Dante G, Pedrielli G, Annessi E, Facchinetti F. Herb remedies during pregnancy: a systematic review of controlled clinical trials. J Matern Fetal Neonatal Med. 2013;26(3):306–12.CrossRefPubMed
27.
go back to reference Brinker F. Managing and interpreting the complexities of botanical research. HerbalGram. 2009;82:42–9. Brinker F. Managing and interpreting the complexities of botanical research. HerbalGram. 2009;82:42–9.
28.
go back to reference Venkataramanan R, Komoroski B, Strom S. In vitro and in vivo assessment of herb drug interactions. Life Sci. 2006;78(18):2105–15.CrossRefPubMed Venkataramanan R, Komoroski B, Strom S. In vitro and in vivo assessment of herb drug interactions. Life Sci. 2006;78(18):2105–15.CrossRefPubMed
29.
go back to reference Committee on Herbal Medicinal Products. Community herbal monograph on plantago ovata forssk., semen. London: European Medicines Agency; 2013. Committee on Herbal Medicinal Products. Community herbal monograph on plantago ovata forssk., semen. London: European Medicines Agency; 2013.
30.
go back to reference Committee on Herbal Medicinal Products. Community herbal monograph on salix, cortex. London: European Medicines Agency; 2009. Committee on Herbal Medicinal Products. Community herbal monograph on salix, cortex. London: European Medicines Agency; 2009.
31.
go back to reference Holst L, Haavik S, Nordeng H. Raspberry leaf--should it be recommended to pregnant women? Complement Ther Clin Pract. 2009;15(4):204–8.CrossRefPubMed Holst L, Haavik S, Nordeng H. Raspberry leaf--should it be recommended to pregnant women? Complement Ther Clin Pract. 2009;15(4):204–8.CrossRefPubMed
32.
go back to reference Jepson RG, Williams G, Johnathan C. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008;(1):CD001321. Jepson RG, Williams G, Johnathan C. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008;(1):CD001321.
33.
go back to reference Perez-Lopez FR, Haya J, Chedraui P. Vaccinium macrocarpon: an interesting option for women with recurrent urinary tract infections and other health benefits. J Obstet Gynaecol Res. 2009;35(4):630–9.CrossRefPubMed Perez-Lopez FR, Haya J, Chedraui P. Vaccinium macrocarpon: an interesting option for women with recurrent urinary tract infections and other health benefits. J Obstet Gynaecol Res. 2009;35(4):630–9.CrossRefPubMed
34.
go back to reference Wing DA, Rumney PJ, Preslicka CW, Chung JH. Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study. J Urol. 2008;180(4):1367–72.CrossRefPubMedPubMedCentral Wing DA, Rumney PJ, Preslicka CW, Chung JH. Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study. J Urol. 2008;180(4):1367–72.CrossRefPubMedPubMedCentral
35.
go back to reference Heitmann K, Nordeng H, Holst L. Pregnancy outcome after use of cranberry in pregnancy--the Norwegian mother and child cohort study. BMC Complement Altern Med. 2013;13:345.CrossRefPubMedPubMedCentral Heitmann K, Nordeng H, Holst L. Pregnancy outcome after use of cranberry in pregnancy--the Norwegian mother and child cohort study. BMC Complement Altern Med. 2013;13:345.CrossRefPubMedPubMedCentral
36.
37.
go back to reference Mills S, Bone K. Principles and practice of phytotherapy: Modern herbal medicine. Edinburgh, New York: Churchill Livingstone; 2000. Mills S, Bone K. Principles and practice of phytotherapy: Modern herbal medicine. Edinburgh, New York: Churchill Livingstone; 2000.
38.
go back to reference Hoffmann D. Medical herbalism : The science and practice of herbal medicine. Rochester, Vt: Healing Arts Press; 2003. Hoffmann D. Medical herbalism : The science and practice of herbal medicine. Rochester, Vt: Healing Arts Press; 2003.
40.
go back to reference O’Higgins A, Murphy OC, Egan A, Mullaney L, Sheehan S, Turner MJ. The use of digital media by women using the maternity services in a developed country. Ir Med J. 2014;107(10):313–5.PubMed O’Higgins A, Murphy OC, Egan A, Mullaney L, Sheehan S, Turner MJ. The use of digital media by women using the maternity services in a developed country. Ir Med J. 2014;107(10):313–5.PubMed
41.
go back to reference Bert F, Gualano MR, Brusaferro S, De Vito E, de Waure C, La Torre G, Manzoli L, Messina G, Todros T, Torregrossa MV, Siliquini R. Pregnancy e-health: a multicenter Italian cross-sectional study on internet use and decision-making among pregnant women. J Epidemiol Community Health. 2013;67(12):1013–8. Bert F, Gualano MR, Brusaferro S, De Vito E, de Waure C, La Torre G, Manzoli L, Messina G, Todros T, Torregrossa MV, Siliquini R. Pregnancy e-health: a multicenter Italian cross-sectional study on internet use and decision-making among pregnant women. J Epidemiol Community Health. 2013;67(12):1013–8.
42.
go back to reference van Gelder MM, Bretveld RW, Roeleveld N. Web-based questionnaires: the future in epidemiology? Am J Epidemiol. 2010;172(11):1292–8.CrossRefPubMed van Gelder MM, Bretveld RW, Roeleveld N. Web-based questionnaires: the future in epidemiology? Am J Epidemiol. 2010;172(11):1292–8.CrossRefPubMed
43.
go back to reference Ekman A, Dickman PW, Klint A, Weiderpass E, Litton JE. Feasibility of using web-based questionnaires in large population-based epidemiological studies. Eur J Epidemiol. 2006;21(2):103–11.CrossRefPubMed Ekman A, Dickman PW, Klint A, Weiderpass E, Litton JE. Feasibility of using web-based questionnaires in large population-based epidemiological studies. Eur J Epidemiol. 2006;21(2):103–11.CrossRefPubMed
44.
go back to reference Lupattelli A, Spigset O, Twigg MJ, Zagorodnikova K, Mardby AC, Moretti ME, Drozd M, Panchaud A, Hameen-Anttila K, Rieutord A, Gjergja Juraski R, Odalovic M, Kennedy D, Rudolf G, Juch H, Passier A, Bjornsdottir I, Nordeng H. Medication use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open. 2014;4(2):e004365. Lupattelli A, Spigset O, Twigg MJ, Zagorodnikova K, Mardby AC, Moretti ME, Drozd M, Panchaud A, Hameen-Anttila K, Rieutord A, Gjergja Juraski R, Odalovic M, Kennedy D, Rudolf G, Juch H, Passier A, Bjornsdottir I, Nordeng H. Medication use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open. 2014;4(2):e004365.
Metadata
Title
Safety classification of herbal medicines used in pregnancy in a multinational study
Authors
D. A. Kennedy
A. Lupattelli
G. Koren
H. Nordeng
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2016
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-016-1079-z

Other articles of this Issue 1/2016

BMC Complementary Medicine and Therapies 1/2016 Go to the issue