Associations between the use of herbal medicines and adverse pregnancy outcomes in rural Malawi: a secondary analysis of randomised controlled trial data

Abstract

BackgroundThe use of herbal medicines during pregnancy is very high globally and previous studies have pointed out possible associations with adverse pregnancy outcomes. Nevertheless, the safety of herbal medicines in pregnancy is under-explored in low-income countries experiencing high maternal and neonatal complications. We investigated the associations between self-reported use of Mwanamphepo (a group of herbal medicines commonly used to induce or hasten labour) and adverse maternal and neonatal outcomes in rural Malawi.MethodsWe conducted a cross-sectional analysis of secondary household data relating to 8219 births that occurred between 2005 and 2010 in Mchinji district, Malawi. The data were collected as part of a cluster-randomised controlled trial (RCT) that evaluated community interventions designed to reduce maternal and neonatal mortality. Data were gathered on maternity history, demographic characteristics, pregnancy outcomes and exposure to Mwanamphepo. Associations between self-reported use of Mwanamphepo and maternal morbidity as well as neonatal death or morbidity were examined using mixed-effects models, adjusted for relevant covariates. All analyses were also adjusted for the clustered nature of the survey.ResultsOf the 8219 births, Mwanamphepo was used in 2113 pregnancies, representing an estimated prevalence of 25.7%. The self-reported use of Mwanamphepo was significantly associated with increased occurrence of maternal morbidity and neonatal death or morbidity. Specifically, the odds of maternal morbidity were 28% higher among self-reported users than non-users of Mwanamphepo (AOR = 1.28; 95% CI = 1.09–1.50) and the probabilities of neonatal death or morbidity were 22% higher (AOR =1.22; 95% CI = 1.06–1.40) among neonates whose mother reportedly used Mwanamphepo than those who did not.ConclusionThe use of Mwanamphepo was associated with adverse pregnancy outcomes in rural Malawi. Thus, herbal medicines may not be safe in pregnancy. Where possible, pregnant women should be discouraged from using herbal medicines of unconfirmed safety and those who report to have used should be closely monitored by health professionals. The study was limited by the self-report of exposure and unavailability of data relating to some possible confounders.

Herbal Medicinal Product Use During Pregnancy and the Postnatal Period

“…Fourteen interventional 56–69 and 11 observational studies 34,70–79 were graded as high quality; 10 interventional 80–89 and 13 observational studies 14,31,90–100 were graded average quality, and five interventional 101–105 and two observational studies 24,106 were graded poor quality. These poor-quality studies were still included in the review, only low-quality case reports were excluded (Fig.…”

“…Excluding case reports, specific safety concerns, such as adverse drug reactions, congenital malformations, fetal growth restriction and herb–drug interactions, were the primary study objective reported by 19 studies, 16 cohort studies, 31,34,70–75,77–79,92,95,96,98,100 one cross-sectional survey, 76 and two randomized controlled trials. 64,68…”

“…Sample size ranged from 27 to 500 women in interventional studies, 187 to 860,215 women in observational studies, and one to five women in case reports. Seven studies collected data during the first trimester of pregnancy; 71,82,85,88,96,105,107 10 during the second trimester; 41,58,67,81,83,84,87,89,101,108 12 during the third trimester; 38,62,64,80,91,92,100,102,103,106,109,110 five throughout pregnancy; 69,70,75,90,95 five around the time of labor (a few hours before or after delivery); 37,59–61,77 nine throughout pregnancy and the postnatal period; 14,31,39,72–74,78,79,111 three during the third trimester and the postnatal period; 40,112,113 20 during the postnatal period only; 24,34,56,63,65,66,68,76,86,94,97–99,104,114–119 and two did not specify the precise point during pregnancy of data collection. 57,93…”

Use of Herbal Medicine by Pregnant Women: What Physicians Need to Know

“…When used at a high dose, it may cause excessive uterine stimulation leading to adverse reactions. The adverse effects linked to "Isihlambezo" formulation include low neonatal birth-weights, fetal meconium staining, which was a sign of possible fetal distress and hypoxia, and fatal uterine rupture (Veale et al, 1998 (Zamawe et al, 2018). In Korea, the herbal formulation "Anjeonicheon-tang" containing Atractylodes macrocephala Koidzumi white rhizoma, Glycyrrhiza glabra L. rhizoma, Panax ginseng C.A.Mey.…”

Understanding forgotten exposures towards achieving Sustainable Development Goal 3: the case of herbal medicine use in Tanzania

“…In rural Malawi for instance, the odds of maternal morbidity were 28% higher among self-reported users than non-users of a popular herb, mwanamphepo. Furthermore, the probabilities of neonatal morbidity or death were 22% higher among neonates whose mothers reported use of the mwanamphepo than those who did not [28]. Signi cantly higher odds of having postnatal complications have also been observed among women in Tanzania who reported use of local herbs during pregnancy or delivery versus those who did not [18].…”