From Medscape Medical News
Laurie Barclay, MD
January 20, 2010 — Exposure to secondhand smoke (SHS) is associated with increased sleep problems among children with asthma, according to the results of a study reported online January 18 and to be published in the February print issue of Pediatrics.
"Adult and adolescent smokers report difficulties with sleep," write Kimberly Yolton, PhD, from Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio, and colleagues. "Young children who are exposed to tobacco smoke have poorer sleep quality. Children with asthma report more sleep problems and are more sensitive to the respiratory effects of tobacco smoke."
The goal of this study was to analyze the association between exposure to SHS and child sleep patterns among a group of 219 children with asthma who were enrolled in an asthma intervention trial and who had regular exposure to tobacco smoke at home. SHS exposure was measured with serum cotinine levels, and the Children's Sleep Habits Questionnaire was used to evaluate sleep patterns based on parental reports.
Statistical analyses allowed adjustment for covariates of age, sex, race, maternal marital status, education, income, prenatal tobacco exposure, maternal depression, Home Observation for Measurement of the Environment total score, household density, asthma severity, and use of asthma medications.
SHS exposure was associated with longer sleep-onset delay (P = .004), sleep-disordered breathing (P = .02), parasomnias (P = .002), daytime sleepiness (P = .022), and overall sleep disturbance (P = .0002).
"We conclude that exposure to SHS is associated with increased sleep problems among children with asthma," the study authors write. "As SHS exposure increased, parents reported that their children had longer delays in sleep onset, more-frequent parasomnias and sleep-disordered breathing, increased daytime sleepiness, and greater overall sleep disturbance."
Limitations of this study include lack of generalizability to children without asthma; wide variance of the degree of SHS exposure; sleep data based only on parental reports; and lack of information on prematurity, which could be an important contributor to sleep problems.
"We report significant associations between SHS exposure, as measured with a biological marker (serum cotinine levels), and sleep problems in children with asthma," the study authors conclude. "Reduction in SHS exposure is an area with the potential for significant impact in the pediatric population."
The National Institutes of Health supported this study. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online January 18, 2010. Abstract
Sunday, January 24, 2010
Friday, January 22, 2010
Lower Birth Weights for Full-Term Babies
From WebMD Health News
Bill Hendrick
January 21, 2010 — Birth weights of full-term babies in the United States decreased from 1990 to 2005, a new study says.
Researchers at the Harvard Pilgrim Health Care Institute’s Department of Population Medicine, an affiliate of Harvard Medical School, and Boston University published their findings in the February 2010 issue of Obstetrics & Gynecology.
The researchers say their findings are surprising because previous studies have indicated that birth weights have been increasing over the past half century.
But that’s not what’s been happening in the past 15 years, at least, says co-author Emily Oken, MD, MPH, an assistant professor of medicine at Harvard Medical School.
She says her research team expected to find that birth weights were still increasing, partly because of increasing age of mothers giving birth and decreased rates of smoking.
Instead, the researchers say they found that birth weights of full-term babies decreased by an average of 1.83 ounces between 1990 and 2005, and that decreases were especially notable after 1995.
The researchers analyzed data on birth weight, maternal and neonatal characteristics, obstetric care, and other trends from the National Center for Health Statistics, looking at records of 36.8 million single-birth babies born full term in the United States in the 15-year period ending in 2005.
The authors say they teased out factors such as age of mothers, race and ethnicity, education level, marital status, tobacco use, and the amount of weight the women had gained during pregnancy.
The researchers also took into account the risk of hypertension and use of procedures such as induction of labor and cesarean delivery.
Birth weights were even lower for babies born to women considered to be at low risk of having small babies, the researchers say.
Mothers who were white, well educated, married, didn’t smoke, and received early prenatal care had babies weighing an average of 2.78 ounces less at birth in 2005 compared to 1990, the authors note.
Average pregnancy time among full-term births also dropped by more than two days, the researchers say. The researchers note that factors such as the decreased pregnancy time and increased use of C-sections for delivery do not account for the declines in newborn weight.
The decline in birth weights may represent a reversal of previous increases and needs further investigation, the researchers say.
The researchers say additional studies may identify other factors that might contribute to lower birth weight, such as trends in diets of mothers, stress, physical activity, and exposure to environmental toxins.
“There’s still a lot we don’t know about the causes of low birth weight,” Oken says in the news release.
SOURCES:
News release, Harvard Medical School.
Donahue, S. Obstetrics & Gynecology, February 2010: vol 115, no 2, Part 1.
Bill Hendrick
January 21, 2010 — Birth weights of full-term babies in the United States decreased from 1990 to 2005, a new study says.
Researchers at the Harvard Pilgrim Health Care Institute’s Department of Population Medicine, an affiliate of Harvard Medical School, and Boston University published their findings in the February 2010 issue of Obstetrics & Gynecology.
The researchers say their findings are surprising because previous studies have indicated that birth weights have been increasing over the past half century.
But that’s not what’s been happening in the past 15 years, at least, says co-author Emily Oken, MD, MPH, an assistant professor of medicine at Harvard Medical School.
She says her research team expected to find that birth weights were still increasing, partly because of increasing age of mothers giving birth and decreased rates of smoking.
Instead, the researchers say they found that birth weights of full-term babies decreased by an average of 1.83 ounces between 1990 and 2005, and that decreases were especially notable after 1995.
The researchers analyzed data on birth weight, maternal and neonatal characteristics, obstetric care, and other trends from the National Center for Health Statistics, looking at records of 36.8 million single-birth babies born full term in the United States in the 15-year period ending in 2005.
The authors say they teased out factors such as age of mothers, race and ethnicity, education level, marital status, tobacco use, and the amount of weight the women had gained during pregnancy.
The researchers also took into account the risk of hypertension and use of procedures such as induction of labor and cesarean delivery.
Birth weights were even lower for babies born to women considered to be at low risk of having small babies, the researchers say.
Mothers who were white, well educated, married, didn’t smoke, and received early prenatal care had babies weighing an average of 2.78 ounces less at birth in 2005 compared to 1990, the authors note.
Average pregnancy time among full-term births also dropped by more than two days, the researchers say. The researchers note that factors such as the decreased pregnancy time and increased use of C-sections for delivery do not account for the declines in newborn weight.
The decline in birth weights may represent a reversal of previous increases and needs further investigation, the researchers say.
The researchers say additional studies may identify other factors that might contribute to lower birth weight, such as trends in diets of mothers, stress, physical activity, and exposure to environmental toxins.
“There’s still a lot we don’t know about the causes of low birth weight,” Oken says in the news release.
SOURCES:
News release, Harvard Medical School.
Donahue, S. Obstetrics & Gynecology, February 2010: vol 115, no 2, Part 1.
NSAIDs May Be More Effective Than Paracetamol for Menstrual Pain
From Medscape Medical News
Laurie Barclay, MD
January 20, 2010 — Nonsteroidal anti-inflammatory drugs (NSAIDs) may be more effective than paracetamol for menstrual pain, according to the results of a systematic review reported online January 20 in the Cochrane Database of Systematic Reviews.
"Dysmenorrhoea is a common gynaecological problem consisting of painful cramps accompanying menstruation, which in the absence of any underlying abnormality is known as primary dysmenorrhoea," write Dr. Jane Marjoribanks, Cochrane Menstrual Disorders and Subfertility Group in Auckland, New Zealand, and colleagues. "Research has shown that women with dysmenorrhoea have high levels of prostaglandins, hormones known to cause cramping abdominal pain. ...NSAIDs are drugs which act by blocking prostaglandin production."
The goal of this review was to compare the effectiveness and safety of NSAIDs used in the treatment of primary dysmenorrhea vs placebo, paracetamol, and each other. The reviewers searched the Cochrane Menstrual Disorders and Subfertility Group trials register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Web of Science to May 2009. They also searched the National Research Register, the Clinical Trials Register, abstracts of major scientific meetings, and bibliographies of identified articles.
Inclusion criteria were all randomized controlled comparisons of NSAIDs vs placebo, other NSAIDs, or paracetamol for treatment of primary dysmenorrhea. Two reviewers independently evaluated trials for methodologic quality, extracted data, and calculated odds ratios (ORs) for dichotomous outcomes and mean differences for continuous outcomes. The reviewers then combined the data using inverse variance methods.
Based on 73 randomized controlled trials meeting selection criteria, NSAIDs were significantly more effective for pain relief than placebo among women with primary dysmenorrhea (OR, 4.50; 95% confidence interval [CI], 3.85 - 5.27), but there was marked heterogeneity for this finding (I2 statistic = 53%).
Excluding 2 outlying studies with no or negligible placebo effect decreased heterogeneity (OR, 4.14; 95% CI, 3.52 - 4.86; I2 = 40%).
Compared with paracetamol, NSAIDs were also significantly more effective for pain relief (OR, 1.90; 95% CI, 1.05 - 3.44), but NSAIDs were associated with significantly more overall adverse effects than placebo (OR, 1.37; 95% CI, 1.12 - 1.66).
"Women using these drugs need to be aware of the side effects," Dr. Marjoribanks said in a news release. "It would be interesting to see whether these could be reduced, without loss of effectiveness, by combining lower doses with other drugs such as paracetamol, or with other therapies such as transcutaneous electrical nerve stimulation."
Comparison of various NSAIDs vs other NSAIDs showed limited evidence that any individual NSAID was superior for either pain relief or safety.
Limitations of this review include limited power to detect differences among NSAIDs because most individual comparisons were based on very few trials with small sample size.
"NSAIDs are an effective treatment for dysmenorrhoea, though women using them need to be aware of the significant risk of adverse effects," the review authors conclude. "There is insufficient evidence to determine which (if any) individual NSAID is the safest and most effective for the treatment of dysmenorrhoea."
The University of Auckland School of Medicine and Princess of Wales Memorial Trust Fund administered by the Mercia Barnes Fund, New Zealand, supported this study. The study authors have disclosed no relevant financial relationships.
Cochrane Database Syst Rev. Published online January 20, 2010.
Laurie Barclay, MD
January 20, 2010 — Nonsteroidal anti-inflammatory drugs (NSAIDs) may be more effective than paracetamol for menstrual pain, according to the results of a systematic review reported online January 20 in the Cochrane Database of Systematic Reviews.
"Dysmenorrhoea is a common gynaecological problem consisting of painful cramps accompanying menstruation, which in the absence of any underlying abnormality is known as primary dysmenorrhoea," write Dr. Jane Marjoribanks, Cochrane Menstrual Disorders and Subfertility Group in Auckland, New Zealand, and colleagues. "Research has shown that women with dysmenorrhoea have high levels of prostaglandins, hormones known to cause cramping abdominal pain. ...NSAIDs are drugs which act by blocking prostaglandin production."
The goal of this review was to compare the effectiveness and safety of NSAIDs used in the treatment of primary dysmenorrhea vs placebo, paracetamol, and each other. The reviewers searched the Cochrane Menstrual Disorders and Subfertility Group trials register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Web of Science to May 2009. They also searched the National Research Register, the Clinical Trials Register, abstracts of major scientific meetings, and bibliographies of identified articles.
Inclusion criteria were all randomized controlled comparisons of NSAIDs vs placebo, other NSAIDs, or paracetamol for treatment of primary dysmenorrhea. Two reviewers independently evaluated trials for methodologic quality, extracted data, and calculated odds ratios (ORs) for dichotomous outcomes and mean differences for continuous outcomes. The reviewers then combined the data using inverse variance methods.
Based on 73 randomized controlled trials meeting selection criteria, NSAIDs were significantly more effective for pain relief than placebo among women with primary dysmenorrhea (OR, 4.50; 95% confidence interval [CI], 3.85 - 5.27), but there was marked heterogeneity for this finding (I2 statistic = 53%).
Excluding 2 outlying studies with no or negligible placebo effect decreased heterogeneity (OR, 4.14; 95% CI, 3.52 - 4.86; I2 = 40%).
Compared with paracetamol, NSAIDs were also significantly more effective for pain relief (OR, 1.90; 95% CI, 1.05 - 3.44), but NSAIDs were associated with significantly more overall adverse effects than placebo (OR, 1.37; 95% CI, 1.12 - 1.66).
"Women using these drugs need to be aware of the side effects," Dr. Marjoribanks said in a news release. "It would be interesting to see whether these could be reduced, without loss of effectiveness, by combining lower doses with other drugs such as paracetamol, or with other therapies such as transcutaneous electrical nerve stimulation."
Comparison of various NSAIDs vs other NSAIDs showed limited evidence that any individual NSAID was superior for either pain relief or safety.
Limitations of this review include limited power to detect differences among NSAIDs because most individual comparisons were based on very few trials with small sample size.
"NSAIDs are an effective treatment for dysmenorrhoea, though women using them need to be aware of the significant risk of adverse effects," the review authors conclude. "There is insufficient evidence to determine which (if any) individual NSAID is the safest and most effective for the treatment of dysmenorrhoea."
The University of Auckland School of Medicine and Princess of Wales Memorial Trust Fund administered by the Mercia Barnes Fund, New Zealand, supported this study. The study authors have disclosed no relevant financial relationships.
Cochrane Database Syst Rev. Published online January 20, 2010.
Thursday, January 14, 2010
Maternal Benefits of Breast-Feeding: Less Risk of Vascular Disease
From Heartwire
Lisa Nainggolan
January 5, 2010 (Pittsburgh, Pennsylvania) — More evidence that breast-feeding likely has long-term health benefits for the mother as well as the child has emerged from a new US study [1].
Women who had never breast-fed were more likely to have vascular changes associated with an increased risk of cardiovascular disease than those who had consistently breast-fed their children, Dr Eleanor Bimla Schwartz (University of Pittsburgh Center for Research on Health Care, PA) and colleagues discovered. They report their findings in the January 2010 issue of Obstetrics & Gynecology.
Prior studies have indicated longer-term beneficial effects of lactation for the mother, including a reduced risk of midlife metabolic syndrome and cardiovascular disease, say Schwartz et al. "These findings build on previous work that has shown that women who do not breast-feed are at greater risk of clinical cardiovascular disease, by providing insight into the early effects of lactation on a mother's body," they observe.
This adds to the evidence that breast-feeding is good for mothers and good for babies.
Ob/gyn Dr Alison Stuebe (University of North Carolina School of Medicine, Chapel Hill), who has conducted research on lactation and coronary heart disease but was not involved in this study, told heartwire : "This adds to the evidence that breast-feeding is good for mothers and good for babies [and] underscores why we need to ensure that mothers who want to breast-feed have access to the support they need to successfully nurse their babies and meet their breast-feeding intentions."
Women Who Never Breast-Fed: Almost Four Times the Risk of Aortic Calcification
Schwartz and colleagues performed a cross-sectional analysis of almost 300 women aged 42 to 52 years who had reported at least one previous live birth and were enrolled in the Study of Women Across the Nation (SWAN)-Heart. Lactation history was assessed at baseline and was self-reported. Women were classified as never having breast-fed; inconsistently breast-fed--nursed any of their children for less than three months; or consistently breast-fed--breast-feeding each child for three months or more.
Subclinical cardiovascular disease was measured at the baseline visit. Calcification of the aorta and coronary arteries was assessed by electron-beam computed tomography (EBCT). B-mode ultrasonography was employed to measure carotid adventitial diameter, intima-media thickness (IMT), and carotid plaque.
After adjustment for measures of socioeconomic status and lifestyle and family-history variables, those who had not breast-fed were almost four times more likely to have aortic calcification (odds ratio 3.85, 95% CI 1.47–10.00) and nearly three times more likely to have coronary artery calcification (OR 2.78, 95% CI 1.05-7.14) than mothers who had consistently breast-fed.
There were no differences between the groups for carotid measures after adjustments for potential confounders.
Comparing women who had consistently breast-fed with those who had inconsistently lactated showed the latter were twice as likely to have coronary artery calcification (OR 2.02) in unadjusted analyses, but there was no significant difference between the two groups following multivariate adjustment.
Comprehensive Changes Needed to Help Support Breast-Feeding
The researchers note that their study is observational and as such may be subject to residual confounding. Nevertheless, they say, "These findings support recommendations that women breast-feed their infants in the interest of both maternal and child health."
Stuebe said that in a recent large US survey, 77% of mothers who weaned by three months wanted to breast-feed longer but were unable to do so. "In US maternity hospitals, most mothers receive poor-quality breast-feeding care, and 'booby traps' in the community undermine women, whether they are thrown out of a department store for breast-feeding an infant, denied paid maternity leave, or prohibited from pumping during breaks at work," she commented.
"This is a women’s health problem. We need comprehensive changes in medical training, hospital policies, maternity leave, and workplace support to ensure that all mothers can meet their breast-feeding goals," she concludes.
Lisa Nainggolan
January 5, 2010 (Pittsburgh, Pennsylvania) — More evidence that breast-feeding likely has long-term health benefits for the mother as well as the child has emerged from a new US study [1].
Women who had never breast-fed were more likely to have vascular changes associated with an increased risk of cardiovascular disease than those who had consistently breast-fed their children, Dr Eleanor Bimla Schwartz (University of Pittsburgh Center for Research on Health Care, PA) and colleagues discovered. They report their findings in the January 2010 issue of Obstetrics & Gynecology.
Prior studies have indicated longer-term beneficial effects of lactation for the mother, including a reduced risk of midlife metabolic syndrome and cardiovascular disease, say Schwartz et al. "These findings build on previous work that has shown that women who do not breast-feed are at greater risk of clinical cardiovascular disease, by providing insight into the early effects of lactation on a mother's body," they observe.
This adds to the evidence that breast-feeding is good for mothers and good for babies.
Ob/gyn Dr Alison Stuebe (University of North Carolina School of Medicine, Chapel Hill), who has conducted research on lactation and coronary heart disease but was not involved in this study, told heartwire : "This adds to the evidence that breast-feeding is good for mothers and good for babies [and] underscores why we need to ensure that mothers who want to breast-feed have access to the support they need to successfully nurse their babies and meet their breast-feeding intentions."
Women Who Never Breast-Fed: Almost Four Times the Risk of Aortic Calcification
Schwartz and colleagues performed a cross-sectional analysis of almost 300 women aged 42 to 52 years who had reported at least one previous live birth and were enrolled in the Study of Women Across the Nation (SWAN)-Heart. Lactation history was assessed at baseline and was self-reported. Women were classified as never having breast-fed; inconsistently breast-fed--nursed any of their children for less than three months; or consistently breast-fed--breast-feeding each child for three months or more.
Subclinical cardiovascular disease was measured at the baseline visit. Calcification of the aorta and coronary arteries was assessed by electron-beam computed tomography (EBCT). B-mode ultrasonography was employed to measure carotid adventitial diameter, intima-media thickness (IMT), and carotid plaque.
After adjustment for measures of socioeconomic status and lifestyle and family-history variables, those who had not breast-fed were almost four times more likely to have aortic calcification (odds ratio 3.85, 95% CI 1.47–10.00) and nearly three times more likely to have coronary artery calcification (OR 2.78, 95% CI 1.05-7.14) than mothers who had consistently breast-fed.
There were no differences between the groups for carotid measures after adjustments for potential confounders.
Comparing women who had consistently breast-fed with those who had inconsistently lactated showed the latter were twice as likely to have coronary artery calcification (OR 2.02) in unadjusted analyses, but there was no significant difference between the two groups following multivariate adjustment.
Comprehensive Changes Needed to Help Support Breast-Feeding
The researchers note that their study is observational and as such may be subject to residual confounding. Nevertheless, they say, "These findings support recommendations that women breast-feed their infants in the interest of both maternal and child health."
Stuebe said that in a recent large US survey, 77% of mothers who weaned by three months wanted to breast-feed longer but were unable to do so. "In US maternity hospitals, most mothers receive poor-quality breast-feeding care, and 'booby traps' in the community undermine women, whether they are thrown out of a department store for breast-feeding an infant, denied paid maternity leave, or prohibited from pumping during breaks at work," she commented.
"This is a women’s health problem. We need comprehensive changes in medical training, hospital policies, maternity leave, and workplace support to ensure that all mothers can meet their breast-feeding goals," she concludes.
Friday, January 1, 2010
Herbal Product Use Common in Pregnancy, May Pose Risks to Fetus
From Medscape Medical News
Fran Lowry
December 30, 2009 — Use of herbal products during the period just before and during pregnancy is common among US women. Because so little is known about the effects of herbals on the developing fetus, however, healthcare providers should counsel their patients to err on the side of caution and avoid their use, according to an analysis published online December 28 in the American Journal of Obstetrics and Gynecology.
"Herbal use surrounding pregnancy raises particular concerns, because many herbals are marketed specifically for symptoms that occur commonly during pregnancy, such as nausea and vomiting," write Cheryl S. Broussard, PhD, from the Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues. "More importantly, our ignorance of the potential harm to the pregnant woman is complicated by our even greater ignorance of the potential effects on fetal safety."
In this study, the researchers sought to estimate the prevalence and patterns of herbal use among US women immediately before and during pregnancy.
They used data from the National Birth Defects Prevention Study, an ongoing, population-based, case-control study involving case infants with major structural birth defects and control infants without such defects, conducted in 10 centers across the United States.
Their analysis included 4239 women who delivered infants without major birth defects between 1998 and 2004.
A computer-assisted telephone interview was used to collect data from mothers about exposures in the 3 months before pregnancy and throughout pregnancy to delivery. The women were asked: "Did you use any herbs or folk medicines to treat any medical conditions, to lose weight, or just to keep you healthy?"
The researchers found that 462 mothers (10.9%) reported use of an herbal product 3 months before or during pregnancy. During pregnancy, the overall prevalence was 9.4% and was highest during the first trimester (6.9%). A substantial proportion of women took herbal products during the second (5.1%) and third (5.2%) trimesters.
The use of herbal products increased with age, with a higher prevalence associated with age older than 30 years, and herbal use was also highest among women with more than a high school education and those with a household income of $20,000 or more per year.
The most commonly used herbals early in pregnancy were ginger, probably because it is believed to prevent nausea and vomiting, and ephedra, the authors report. Later in pregnancy, herbal teas and chamomile were most commonly used.
Other commonly used herbals were cranberry extract, raspberry leaf, mint or peppermint, and primrose oil.
Herbal Product Use in First Trimester Raises Safety Concerns
The fact that use of herbal products was greatest during the first trimester of pregnancy raises concerns about fetal safety because this is a critical period of fetal organ development, the authors write.
They note that the US Food and Drug Administration withdrew ephedra from the market in April 2004 because of concerns about cardiovascular effects including increased blood pressure and irregular heart rhythm in adults — effects that could have implications for the fetus.
A limitation of this analysis is that the mothers self-reported their exposure. Another is the variable time to interview, as one fifth of the mothers were interviewed 12 to 24 months after their estimated date of delivery. These might have led to exposure misclassification or lack of specificity in defining the mother's exposure because the interviews relied on women's recall of exposures up to 3 years in the past, the authors note.
Knowledge of the effects of herbals on the developing fetus is "remarkably limited," the authors write. In addition, it is difficult to ascertain the ingredients in herbal products with any degree of reliability because of the nature of the herbal product industry, which may label ingredients inaccurately or change the blend of their ingredients. Finally, despite their widespread use, many pregnant women who use herbals do not tell their physicians.
It is therefore critical that risks and relative safety of herbal products in pregnancy be studied and that more data on the fetal risks associated with these products be accumulated, the authors say.
In the meantime, healthcare providers should ask their patients about their use of herbals "in a routine and nonjudgmental fashion," and they should also counsel their patients that the fact that a substance is natural does not necessarily mean that it is safe for the fetus.
"Providers also should inform patients that it would be prudent to err on the side of caution regarding use of these products during and surrounding pregnancy, because little is known about their potential risks," the authors conclude.
Dr. Broussard has disclosed no relevant financial relationships.
Am J Obstet Gynecol. Published online December 28, 2009.
Fran Lowry
December 30, 2009 — Use of herbal products during the period just before and during pregnancy is common among US women. Because so little is known about the effects of herbals on the developing fetus, however, healthcare providers should counsel their patients to err on the side of caution and avoid their use, according to an analysis published online December 28 in the American Journal of Obstetrics and Gynecology.
"Herbal use surrounding pregnancy raises particular concerns, because many herbals are marketed specifically for symptoms that occur commonly during pregnancy, such as nausea and vomiting," write Cheryl S. Broussard, PhD, from the Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues. "More importantly, our ignorance of the potential harm to the pregnant woman is complicated by our even greater ignorance of the potential effects on fetal safety."
In this study, the researchers sought to estimate the prevalence and patterns of herbal use among US women immediately before and during pregnancy.
They used data from the National Birth Defects Prevention Study, an ongoing, population-based, case-control study involving case infants with major structural birth defects and control infants without such defects, conducted in 10 centers across the United States.
Their analysis included 4239 women who delivered infants without major birth defects between 1998 and 2004.
A computer-assisted telephone interview was used to collect data from mothers about exposures in the 3 months before pregnancy and throughout pregnancy to delivery. The women were asked: "Did you use any herbs or folk medicines to treat any medical conditions, to lose weight, or just to keep you healthy?"
The researchers found that 462 mothers (10.9%) reported use of an herbal product 3 months before or during pregnancy. During pregnancy, the overall prevalence was 9.4% and was highest during the first trimester (6.9%). A substantial proportion of women took herbal products during the second (5.1%) and third (5.2%) trimesters.
The use of herbal products increased with age, with a higher prevalence associated with age older than 30 years, and herbal use was also highest among women with more than a high school education and those with a household income of $20,000 or more per year.
The most commonly used herbals early in pregnancy were ginger, probably because it is believed to prevent nausea and vomiting, and ephedra, the authors report. Later in pregnancy, herbal teas and chamomile were most commonly used.
Other commonly used herbals were cranberry extract, raspberry leaf, mint or peppermint, and primrose oil.
Herbal Product Use in First Trimester Raises Safety Concerns
The fact that use of herbal products was greatest during the first trimester of pregnancy raises concerns about fetal safety because this is a critical period of fetal organ development, the authors write.
They note that the US Food and Drug Administration withdrew ephedra from the market in April 2004 because of concerns about cardiovascular effects including increased blood pressure and irregular heart rhythm in adults — effects that could have implications for the fetus.
A limitation of this analysis is that the mothers self-reported their exposure. Another is the variable time to interview, as one fifth of the mothers were interviewed 12 to 24 months after their estimated date of delivery. These might have led to exposure misclassification or lack of specificity in defining the mother's exposure because the interviews relied on women's recall of exposures up to 3 years in the past, the authors note.
Knowledge of the effects of herbals on the developing fetus is "remarkably limited," the authors write. In addition, it is difficult to ascertain the ingredients in herbal products with any degree of reliability because of the nature of the herbal product industry, which may label ingredients inaccurately or change the blend of their ingredients. Finally, despite their widespread use, many pregnant women who use herbals do not tell their physicians.
It is therefore critical that risks and relative safety of herbal products in pregnancy be studied and that more data on the fetal risks associated with these products be accumulated, the authors say.
In the meantime, healthcare providers should ask their patients about their use of herbals "in a routine and nonjudgmental fashion," and they should also counsel their patients that the fact that a substance is natural does not necessarily mean that it is safe for the fetus.
"Providers also should inform patients that it would be prudent to err on the side of caution regarding use of these products during and surrounding pregnancy, because little is known about their potential risks," the authors conclude.
Dr. Broussard has disclosed no relevant financial relationships.
Am J Obstet Gynecol. Published online December 28, 2009.
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