Abstract
BackgroundPregnant women are routinely prescribed medicines while self-medicating with herbal natural products to treat predominantly pregnancy related conditions. The aim of this study was to assess the potential for herb-drug interactions (HDIs) in pregnant women and to explore possible herb-drug interactions and their potential clinical significance.MethodsA cross-sectional survey of women during early pregnancy or immediately postpartum in North-East Scotland. Outcome measures included; Prescription medicines use excluding vitamins and potential HDIs assessed using Natural Medicines Comprehensive Database.ResultsThe survey was completed by 889 respondents (73% response rate). 45.3% (403) reported the use of at least one prescription medicine, excluding vitamins. Of those taking prescription medicines, 44.9% (181) also reported concurrent use of at least one HNP (Range 1–12). A total of 91 different prescription medicines were reported by respondents using HNPs. Of those taking prescription medicines, 44.9% (181) also reported concurrent use of at least one HNP (Range 1–12). Thirty-four herb-drug interactions were identified in 23 (12.7%) women with the potential to increase the risk of postpartum haemorrhage, alter maternal haemodynamics, and enhance maternal/fetal CNS depression.Almost all were rated as moderate (93.9%), one as a potentially major (ginger and nifedipine) and only one minor (ondansetron and chamomile).ConclusionAlmost half of pregnant women in this study were prescribed medicines excluding vitamins and minerals and almost half of these used HNPs. Potential moderate to severe HDIs were identified in an eighth of the study cohort. Healthcare professionals should be aware that the concurrent use of HNPs and prescription medicines during pregnancy is common and carries potential risks.
Highlights
Pregnant women are routinely prescribed medicines while self-medicating with herbal natural products to treat predominantly pregnancy related conditions
Women are recognised to be the major users of herbal and natural products (HNP) for treatment of disease and maintenance of health [3,4,5, 19, 20], and this widespread use extends into pregnancy, where reportedly between 10 and 74% of pregnant women in Australia, Europe, United Kingdom (UK) and the United States (USA) use these products [21,22,23,24,25,26,27,28,29,30]
The potential risks associated with the use of prescription medicines during pregnancy are well recognised, data from Australia, Europe and North and South America, suggest that 12–81% of pregnant women are prescribed medicines by their healthcare professional who may be unaware of possible HNP use by their patient [31,32,33,34,35]
Summary
Pregnant women are routinely prescribed medicines while self-medicating with herbal natural products to treat predominantly pregnancy related conditions. The potential risks associated with the use of prescription medicines during pregnancy are well recognised, data from Australia, Europe and North and South America, suggest that 12–81% of pregnant women are prescribed medicines by their healthcare professional who may be unaware of possible HNP use by their patient [31,32,33,34,35]. The current level of concomitant HNP and prescription medicine use in the UK is unclear, studies from North America, Europe, Asia and Africa suggest that between 2.5%–13% of pregnant women use herbal and natural products together with prescribed medicines [38,39,40,41]. There are limited published data from the UK reporting the levels of HNP use together with prescription medicines during pregnancy and the possible resultant herb-drug interactions
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