Use of traditional Chinese herbal medicine during pregnancy: a prospective survey

Abstract

There are traditional beliefs that certain kinds of traditional Chinese medicines (TCMs) are beneficial to pregnancy (1). However, the efficacy of most TCMs is largely unproven and its safety has yet to be established. In the literature, few data exist regarding the epidemiology and pattern of usage of TCMs during pregnancy. We therefore conducted a prospective survey to evaluate the usage of TCMs in pregnant women. Each participant was given a questionnaire in the postnatal ward to inquire the incidence, pattern, and reasons for TCMs consumption during pregnancy. The study was approved by the Research Ethics Committee of the local institute. The response rate was 40·5% (593 of 1465). More than half (331, 55·8%) of the women had consumed TCMs during pregnancy (Table I). These women were more likely to be born in mainland China, less educated, and belonged to a lower socioeconomic class. Of these 331 women, 272 responded to the question concerning the timing of their use of TCM during pregnancy. Two-thirds of the women (174 subjects, 64·0%) reported continued consumption of TCMs during pregnancy. A total of 278 women responded to the question about the types of TCMs they consumed. More than 40 types of TCM were recorded. The three most common types of TCMs used during pregnancy were ginseng (88, 31·7%), Chinese Angelica (69, 24·8%), and Jin Yin Hua (62, 22·3%). Almost half of the women consumed more than one type of TCM (118 women, 42·4%). The women were then asked about the reasons for taking TCM during pregnancy. A total of 280 women gave 304 responses. The three most common reasons were ‘good for pregnancy and fetus’ (126 subjects, 45·0%), ‘good for general health (85 subjects, 30·4%), and common cold (74 subjects, 26·4%). In our cohort of Hong Kong Chinese parturient, more than half of the pregnant women had consumed TCMs during their pregnancy. This incidence is much higher than the reported figures of 9·1–15% in western countries (2, 3). We also found that women who used TCMs during pregnancy were more likely to be born in mainland China and belonged to a lower socioeconomic group. This is in sharp contrast with findings from western countries that higher social classes use herbal medicine products more frequently than women from lower classes. This difference could be due to two reasons. First, TCMs may be more popular in mainland China and women born there might be more likely to seek treatment from TCMs practitioners as their first line medical care. Secondly, the usual consultation fee is much cheaper for TCMs practitioners (about half) compared with western medicine practitioners in Hong Kong. Those at a lower socioeconomic class may find TCMs more affordable. We found that many women continue to use TCMs despite knowing that they were pregnant. It is important for obstetricians to point out that the safety profile of many TCMs in pregnancy has not yet been established. Apart from the active ingredients, TCMs may contain other pharmacological active substances or heavy metals such as lead and mercury (4), which may have harmful effects on human pregnancy. Moreover, TCMs are usually complex mixtures, the additive or synergistic effect of these on human pregnancy is largely unknown. This is further complicated by the fact that almost half of the women consumed more than one types of TCMs. Furthermore, herbal drugs may interact with western medicines (including anesthetic agents) which cause serious consequences. Therefore, the use of TCMs during pregnancy should warrant medical attention. Routine antenatal information should include use of TCMs in part of the history taking so to alert health care professionals. Further research on the risks and benefits of specific TCMs in pregnancy would be of great clinical relevance.