Patterns of herbal medicines use and its effects on pregnancy outcome in Bangladesh, Nepal, and Yemen

Background: The use of herbal medicines (HM) during pregnancy is widely reported, and its prevalence in Asian countries is reported between 22.3% and 67%. Because herbs contain pharmacologically active substances and can influence biological reactions, some studies from western countries have evaluated possible adverse effects of using HM during pregnancy. However, little is known about the effects of HM use in pregnancy on its outcome from Asian region. The aim of this research is to determine the spontaneous side effects of HM use in pregnancy and its possible adverse effects on pregnancy outcome in selected countries from Asia. Methodology: Cross-sectional surveys were conducted from July 4, 2017 to August 12, 2017 at maternity wards of public hospitals in three developing countries from Asian region: Bangladesh, Nepal, and Yemen. Postpartum women before discharge from the hospitals were invited to take part in the survey using structured questionnaire. Data of 943 postpartum women from Bangladesh (N = 243), Nepal (N = 400), Yemen (N = 300) were included in the final analysis. Results: Herbal medicines were used by 589 (67.6%) participants in their previous pregnancy. Significantly higher proportion of HM use was reported from Bangladesh (N = 170, 70%), followed by Nepal (N = 241, 60.3%) and Yemen (N = 178, 59.3%). Ginger was the most commonly used modality of HM in Bangladesh (N = 102, 60%) and Nepal (N = 111, 46.1%). Whereas in Yemen, cinnamon (N = 70, 39.3%) was the most popular modality. Urban residence, education of under elementary school, travel time to health facility, use of HM prior to previous pregnancy, and morbidities in pregnancy were significantly associated with HM use in pregnancy. In Yemen, HM use predicted caesarian deliveries and complications around childbirth such as abnormal presentation. Whereas in the Bangladesh sample, newborns of HM users had higher incidence of symptoms such as neonatal jaundice and breathing problems than those of non-users. Overall, there were 80 instances of side effects. The most frequently reported side effects were dry mouth (N = 17), nausea/vomiting (N = 13), diarrhea (N = 11), abdominal pain (N = 9), and drowsiness (N = 9). The most frequent sources to recommend use of HM in pregnancy were family and friends in Bangladesh (N = 121, 71.1%), Nepal (N = 236, 98.3%), and Yemen (N = 154, 87%). The disclosure rate of HM use with healthcare providers was lowest in Bangladesh (N = 43, 25.3%), followed by Yemen (N = 62, 34.8%) and Nepal (N = 132, 54.8%). Conclusions: High prevalence of herbal medicines use in pregnancy, with inappropriate use in some cases, the reports of spontaneous side effects and possible adverse effects on outcome of pregnancy necessitate conducting further studies on national level, especially case-control and cohort studies. Spontaneous Adverse Drug Reaction reporting may help in safety signal detection. It is recommended that a robust pharmacovigilance of HM should be established. The data acquired via pharmacovigilance will help in evidence-based decision-making to promote safe use of HM in pregnancy. The conceptual framework adopted by this study can be used in other countries to measure potential adverse effects of HM on pregnancy outcome.Docto