Pregnancy and herbal medicines: An unnecessary risk for women's health—A narrative review

Bruno, Luciana Oliveira; Simões, Ricardo Santos; Simões, Manuel de Jesus; Girão, Manoel Joâo Batista Castello; Grundmann, Oliver

doi:10.1002/ptr.6020

Cited by 48 publications

(37 citation statements)

References 125 publications

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“…ADRs of herbal and traditional medicines are well known [80][81][82][83]. However, only 60.5% of HCPs considered it necessary to report events related to herbal drugs which is a concern (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Knowledge, attitudes and practices of health care professionals towards adverse drug reaction reporting in public sector primary health care facilities in a South African district

Haines

Meyer

et al. 2020

Eur J Clin Pharmacol

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Purpose Adverse drug reactions (ADRs) have an appreciable impact on patients' health. Little is known however about ADR reporting in ambulatory care environments especially in low-and middle-income countries. Consequently, our aim was to determine knowledge, attitudes and practices (KAP) among health care professionals (HCPs) towards ADR reporting in primary health care (PHC) facilities in South Africa. The findings will be used to direct future activities. Methods Descriptive, cross-sectional design using quantitative methodology among 8 public sector community health care centres and 40 PHC clinics in the Tshwane Health District, Gauteng Province. A self-administered questionnaire was distributed to 218 HCPs, including all key groups. Results A total of 200 responses were received (91.7%). Although an appropriate attitude towards ADR reporting existed, the actual frequency of ADR reporting was low (16.0%). Of the respondents, 60.5% did not know how to report, where to report or when to report an ADR and 51.5% said the level of their clinical knowledge made it difficult to decide whether or not an ADR had occurred. Over 97.5% stated they should be reporting ADRs with 89% feeling that ADR reporting is a professional obligation and over 70% that ADR reporting should be compulsory. When results were combined, the overall mean score in terms of positive or preferred practices for ADR reporting was 24.6% with pharmacists having the highest scores. Conclusion Under-reporting of ADRs with gaps in KAP was evident. There is a serious and urgent need for education and training of HCPs on ADR reporting in South Africa.

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Section: Discussionmentioning

confidence: 99%

Knowledge, attitudes and practices of health care professionals towards adverse drug reaction reporting in public sector primary health care facilities in a South African district

Haines

Meyer

et al. 2020

Eur J Clin Pharmacol

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“…Even though little is known about herbal medicines and risks of adverse effects, potential teratogenicity and interactions with medication, the pregnant women in our study considered herbal medicines less harmful compared with medication. These findings were most obvious in younger and lower educated women and it is a challenge for healthcare providers to give evidence‐based recommendations to these groups.…”

Section: Discussionmentioning

confidence: 99%

Women's perceptions of medication use during pregnancy and breastfeeding—A Swedish cross‐sectional questionnaire study

Wolgast

Lindh-Åstrand

Lilliecreutz

2019

Acta Obstet Gynecol Scand

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Introduction Use of medication for different kinds of symptoms and diseases during pregnancy is common. When counseling the pregnant woman, an understanding of her perceptions concerning the use of medication as well as possible associated anxiety and obstacles is important to ensure high adherence to the treatment regimen. Material and methods A questionnaire was developed regarding the use of medication, perceptions on use of medication, as well as perceptions about pregnancy outcomes in association with medication use during pregnancy. In total, 850 pregnant women in gestational weeks 25‐29 participated in the study. Results The response rate was 92.7% (n = 832/898). About 19.4% of the respondents (n = 160/824) were frequent users (medication use daily to several times a week) and 28.4% (n = 234/824) were non‐frequent users (medication use once a week to once a month). The majority perceived medication use during early pregnancy (61.4%, n = 501/816), late pregnancy (55.6%, n = 455/819) and breastfeeding (57.7%, n = 474/821) as probably harmful or harmful. These findings were more common in non‐users (medication used rarely or never) than frequent users (P‐value <0.001, <0.001 and 0.007). The pregnant women had great confidence in advice from a physician (83.8%, n = 666/795) or a midwife (77.0%, n = 620/805) concerning medication during pregnancy. Conclusions The majority of pregnant women in Sweden consider the use of medication during pregnancy either ‘probably harmful’ or ‘harmful’ and this perception is associated with non‐use of medication. The pregnant women in our study had high confidence in healthcare professionals when seeking advice; thus, actively asking about perceptions could lead to better counseling.

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“…Recently, some issues regarding herb-related genotoxicity have arisen. In particular, there are concerns about the frequent exposure of pregnant women and their foetuses to phytomedicines and herbal supplements without adequate knowledge of the safety during pregnancy [ 8 ]. An analysis of 14,551 births reported an increased risk of congenital malformations of the nervous system after exposure during the first trimester of pregnancy to Rhizoma Coptidis , a typical medicinal herb with the property of “clearing damp-heat” [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…The Swedish Medical Birth Register study reported that 787 of 860,215 women (0.9%) used herbal products during early pregnancy [ 6 ]. Accordingly, concerns about the potential risk for genotoxicity of herbal medicines and phytochemicals have arisen [ 7 , 8 ]. The Korean Ministry of Food and Drug Safety (MFDS) has developed a guideline (No.…”

Section: Introductionmentioning

confidence: 99%

Genotoxicity Evaluation of an Ethanol Extract Mixture of Astragali Radix and Salviae miltiorrhizae Radix

Lee

Cho

Lee

et al. 2018

Evidence-Based Complementary and Alternative Medicine

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Myelophil, a combination of Astragali Radix and Salviae Radix, is one of the most commonly used remedies for disorders of Qi and blood in traditional Chinese medicine. Based on the clinical applications of these plants, in particular to pregnant woman, this study aimed to evaluate the genotoxic potential of an ethanol extract mixture of the above two herbs, called Myelophil. Following the Organization for Economic Cooperation and Development (OECD) Guideline methods, a genotoxicity test was conducted using a bacterial reverse mutation test with Salmonella typhimurium (TA98, TA100, TA1535, and TA1537) and Escherichia coli (WP2μvrA), an in vitro mammalian chromosome aberration test using a Chinese hamster ovary cell line (CHO-K1), and an in vivo mammalian erythrocyte micronucleus test using ICR mouse bone marrow. In the Ames test, for both types of mutations (base substitution and frameshift) under conditions with/without an S9 mix up to 5,000 μg/plate, Myelophil did not increase the number of revertant colonies of all S. typhimurium strains as well as E. coli strain. For both short (6 h) and long tests with/without S9 mix, the chromosome aberration test did not show any significant increase in the number of structural or numerical chromosome aberrations by Myelophil. In addition, no significant change in the number of micronucleated polychromatic erythrocytes or polychromatic erythrocytes was observed in the bone marrow of an ICR mouse administered Myelophil orally at 2,000 mg/kg/day for 2 days, respectively. These results are the first to provide experimental evidence that Myelophil, an ethanol extract mixture of Astragali Radix and Salviae Radix, has no risk of genotoxicity.

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Pregnancy and herbal medicines: An unnecessary risk for women's health—A narrative review

Cited by 48 publications

References 125 publications

Knowledge, attitudes and practices of health care professionals towards adverse drug reaction reporting in public sector primary health care facilities in a South African district

Knowledge, attitudes and practices of health care professionals towards adverse drug reaction reporting in public sector primary health care facilities in a South African district

Women's perceptions of medication use during pregnancy and breastfeeding—A Swedish cross‐sectional questionnaire study

Genotoxicity Evaluation of an Ethanol Extract Mixture of Astragali Radix and Salviae miltiorrhizae Radix

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