Beruflich Dokumente
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Original Research
Introduction: Little is known about herb use among underserved postpartum women and their patterns of communication about herb use with
prenatal providers.
Methods: We interviewed women from the postpartum unit at an urban hospital about herb use during pregnancy, socioeconomic factors, prenatal
vitamin use, and diet. We asked women if they discussed use of herbs and vitamins with their prenatal care providers and asked about their
satisfaction with these discussions. We reviewed inpatient chart medication lists for herb use.
Results: Of 160 women surveyed, 39% reported using herbs during pregnancy. Sixty-five percent of participants took a prenatal vitamin. Fifty-
seven percent of herb users (n = 40) reported taking prenatal vitamins. Herb users were significantly more likely to report making any dietary
change during their pregnancies than non-herb users (P = .03). Only 38% of herb users discussed it with their prenatal providers, and 82%
were satisfied with the conversation. Of all 160 participants, 125 had prenatal vitamin use documented, and no women had herbal medicine use
documented in the medical record during their birth hospitalization.
Discussion: We report a higher frequency of herb use during pregnancy than other studies. The fact that women of all backgrounds and economic
statuses report using herbs during pregnancy makes it even more important for all women to be asked about their use of herbs.
J Midwifery Womens Health 2013;58:150–157 c 2013 by the American College of Nurse-Midwives.
Keywords: complementary and alternative therapies, herbal medicine, nutrition, survey research
✦ Fewer than half of women who used herbs (38%) discussed their use with prenatal care providers, and herb use was not
documented in any woman’s hospital record.
✦ Herb use during pregnancy is common and should be asked about in the patient history.
Our goal was to determine the prevalence of herb use in a Survey Questions
population of underserved postpartum women, types of herbs
used, factors associated with herb use such as medical condi- We asked, the following questions: “During your pregnancy,
tions, dietary habits, and prenatal vitamin use. We also stud- did you use herbs, teas, or home remedies for your own health
ied patterns of communication and documentation on use of or treatment? What herbs or home remedies did you use?
these in the inpatient medical record. We hypothesized that (teas, rubs, pills, lotions, oils).” We also asked specifically
women would be more likely to discuss prenatal vitamin use about use of the following herbs: ginger, chamomile, ginseng,
than herb use with their prenatal providers and that herb use evening primrose, echinacea, castor oil, green tea, pepper-
would be associated with healthy dietary changes during preg- mint, raspberry leaf, cranberry, and others. These herbs were
nancy. selected based on previously published surveys as well as sur-
veys conducted at our hospital, which found that these were
popular among our patients.2,23 We also asked an open-ended
METHODS question about whether they took any herbs that were not
asked about.
All study procedures were approved by the institutional re- We asked women about their socioeconomic factors such
view board at Boston Medical Center and the Maternal and as age, race, education, number of previous pregnancies, place
Child Health Perinatal Committee before data collection was of birth, how long they have lived in the United States, primary
begun. language, and self-described health status. A chart review doc-
umented acute and chronic medical conditions.
All women were asked whether they made any changes
Patient Population to their diets during their pregnancies (yes or no). At Boston
Women were recruited for this study from a convenience sam- Medical Center there is a multicultural patient population in
ple on the inpatient postpartum unit of Boston Medical Cen- which eating certain plants or food may represent a cultural
ter. Boston Medical Center is the largest safety-net hospital in tradition or health practice. We were interested in assessing
New England. It has a long history of serving the health care changes in diet as well as any changes in herb use. A subset of
needs of immigrant and low-income populations, with 50% 100 women were asked more specific questions about whether
of its patients having an annual income below $17,000. Each they increased their intake of dairy products (yes/no), in-
year, approximately 2400 newborns are birthed at Boston creased their intake of fruit (yes/no), or made some other di-
Medical Center.22 etary change (yes/no). Additionally, women were asked about
their consumption of fish during the pregnancy. These addi-
tional questions were added after data collection started and
only asked to a subset of 100 women.
Survey Administration
We asked, “Did you discuss using herbs with your pre-
Surveys were administered from 2008 to 2010. Eligible par- natal provider?” and “How satisfied were you with the coun-
ticipants were women aged at least 18 years, with enough En- seling on herbs and home remedies?” Satisfaction was ranked
glish fluency to understand and respond to the interviewer- on a 4-point Likert scale, from “very satisfied” to “not satis-
administered survey. Eligibility for participation in the study fied.” Women also were asked whether or not they used pre-
was determined by the postnatal patient care team who iden- natal care vitamins during their pregnancies and whether they
tified medically stable patients. Interested and eligible partic- discussed prenatal care vitamin use with their providers. Sat-
ipants reviewed the informed consent form with a research isfaction with that discussion was ranked using the same 4-
assistant, and consent was obtained both for the interviewer- point Likert scale.
administered survey and the medical chart review. The re- An inpatient chart review documented any prescription
search assistant administered the survey during the inpatient medications, vitamins, minerals, and other supplements such
postpartum hospital stay. as herbals or fish oil. From the inpatient chart review data,
Continued
Women with an obstetric condition were more likely to related complaints such as nausea and low-back pain. Women
use herbs (P = .02); there was no difference in herb use with seeking treatment for infertility often use complementary and
other medical conditions. One possible explanation is that alternative medicine. One survey of 428 couples seeking treat-
prior obstetric problems might cause women to try herbs ment for infertility showed that 29% used some form of com-
during pregnancy. A recent review of the literature found plementary and alternative medicine to attempt to get preg-
that women reporting more physical symptoms during preg- nant, with 17% using herbal therapy.29
nancy were more likely to use complementary and alternative Women using herbs were more likely to report making a
medicine.28 They also reported that the most commonly iden- change to their diets during pregnancy (P = .03), although
tified reasons for complementary and alternative medicine there were no significant differences between the groups on
use during pregnancy was for relief of stress and pregnancy- specific dietary changes, such as change in dairy product,
Table 2. Dietary Changes Made During Pregnancy as Reported by Postpartum Women Who Used or Did Not Use Herbs (N = 160)
Overall Herb Users, n = 63 Non-Herb Users, n = 97
Any dietary change, n (%) P = .03
Yes 97 (61) 45 (71) 52 (54)
No 62 (39) 18 (29) 44 (46)
Increased dairy food intake, n (%) a
P = .95
Yes 33 (33) 16 (33) 17 (33)
No 67 (67) 32 (67) 35 (67)
Increased fruits intake,a n (%) P = .84
Yes 51 (51) 25 (52) 26 (50)
No 49 (49) 23 (48) 26 (50)
a
Other dietary change, n (%) P = .64
Yes 58 (58) 29 (60) 29 (56)
No 42 (42) 19 (40) 23 (44)
Ate fish during pregnancy, n (%) b
P = .08
Yes 105 (76) 50 (83) 55 (70)
No 33 (24) 10 (17) 23 (30)
Iron supplementation, n (%) P = .52
Yes 53 (33) 19 (30) 34 (35)
No 107 (67) 44 (70) 63 (65)
Vitamin D supplementation, n (%) P = .33
Yes 3 (2) 2 (3) 1 (1)
No 157 (98) 61 (97) 96 (99)
Calcium supplementation, n (%) P = .91
Yes 8 (5) 3 (5) 5 (5)
No 152 (95) 60 (95) 92 (95)
Other vitamin supplement, n (%) P = .07
Yes 21 (13) 12 (19) 9 (9)
No 139 (87) 51 (81) 88 (91)
a
Thesequestions were asked of a subset of 100 women, one person answering “not sure” excluded.
b
Fish question does not include first 21 women surveyed and does not include one woman answering “not sure.”
DISCLOSURE
Limitations
Research reported in this publication was supported by the
This study has a number of limitations, the first of which is
National Center For Complementary & Alternative Medicine
small sample size. Having only 160 women greatly limited
of the National Institutes of Health under Award Number
our power to detect smaller differences between women who
K07AT005463. The content is solely the responsibility of the
used herbs and those who did not. However, one major pur-
authors and does not necessarily represent the official views
pose of this study was to demonstrate the frequency of use of
of the National Institutes of Health.
herbal products, and the paucity of discussion about their use
with providers; this objective was not hindered by the smaller
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