Taiwan National Birth Registration Research Articles

Maternal psychologic problems increased the risk of childhood atopic dermatitis.

Little is known about the effect of postnatal maternal psychologic problems on the development of childhood atopic disorders. To assess the association between early life maternal psychologic problems and atopic dermatitis (AD) in children in a national birth cohort. We used multistage, stratified systematic sampling to recruit 24,200 mother-newborn pairs from the Taiwan national birth registration. Maternal psychologic problems and potential confounders were gathered by the standard questionnaire at 6 months old. At 3 years of age, information about the development of AD was assessed by International Study of Asthma and Allergies in Childhood via home interviews. Multiple logistic regression analysis was performed to estimate the association of postnatal maternal psychologic problems (postpartum depression (PPD) and maternal mental health index) and AD. The prevalence of physician-diagnosed AD was 10.5%. PPD increased the risk of subsequent physician-diagnosed AD in children after adjusting for potential confounders and other maternal mental health index (aOR = 1.42, 95% CI = 1.21-1.66). We observed that the risk of AD associated with PPD was not confounded by other social demographic factors such as maternal AD, maternal education, family income, breastfeeding, day care, and number of siblings. Postpartum depression increased the risk of childhood AD even when other maternal mental health index and social demographic factors are considered. Early intervention of PPD might be helpful for AD prevention.

Predicting risk for childhood asthma by prenatal, perinatal, and postnatal factors

Background: Symptoms of asthma start early in human life, important life and environmental factors cannot be studied in detail if the participants are preschool children or older. Aims: To investigate the early risk factors for childhood asthma and to develop a predictive model for the development of asthma by birth cohort study. Methods: A representative sample of mother-newborn pairs was obtained by multistage, stratified systematic sampling from the Taiwan national birth register in 2005. Home interviews at 6 months and 5 years of age were conducted to inquire potential risk factors and children's health status, respectively. Multivariate regression analysis was used to determine the risk factors for children asthma in predictive models. Area-under-curve (AUC) statistic from receiver-operating characteristic curve analysis was used to compare the ability of models to discriminate between children with and without asthma. Results: A total of 19,192 mother-newborn pairs completed the study satisfactorily. The prevalence of physician-diagnose asthma was 7.6% in boys and 5.5% in girls, respectively. Prenatal (parental atopy and socioeconomic status), perinatal (resident area and painting wall during pregnancy), and postnatal factors (mother with postpartum stress and children with atopic dermatitis (AD) before 6 months old) were chosen in predictive models by backward stepwise analysis. The highest predicted probability of asthma was 68.1% in boys and 76.1% in girls with above factors. The lowest probability was 7.7%, among boys and girls with none of above factors, respectively. Compared with AUCs of prenatal factor model and the model adding perinatal factors, model more adding postnatal factors provided significantly higher ability to discriminate between children with and without asthma. Conclusions: This investigation provides technique for predicting risk of childhood asthma by prenatal, perinatal, and postnatal factors that can be used for developing preventive strategy against asthma, especially among those children with AD and family history of atopy.

Maternal employment and atopic dermatitis in children: a prospective cohort study

Considering the early onset of atopic dermatitis (AD), which most often arises in the first year of life, risk factors occurring very early in life must be considered. Little is known about the effects of maternal occupational exposure on the development of atopic disorders in children. The aim of this study was to evaluate associations between maternal employment and childhood AD. We used multistage stratified systematic sampling to recruit 24,200 mother-newborn pairs from the Taiwan national birth register. Information on maternal occupation categories, work stress, working time, shift work and potential confounders during pregnancy was gathered by questionnaires after birth. At 3 years of age, information on the development of AD was assessed by home interviews. Multiple logistic regression analysis was performed to estimate the association of maternal employment and AD. Overall, 11,962 out of 19,381 mothers (61·7%) worked during pregnancy. The children of mothers who worked during pregnancy had an increased risk of AD compared with those whose mothers did not work [odds ratio (OR) 1·38, 95% confidence interval (CI) 1·25-1·53]. The children of mothers with a professional or technical occupation had a higher risk of AD (OR 1·64, 95% CI 1·44-1·87). The risk of AD was found to increase with maternal work stress during pregnancy in a dose-response manner (P(trend)<0·01). The mothers of children with AD had a longer working time than those without AD (P<0·0001). However, no significant association between AD and maternal shift work was found. Working in professional or technical occupations increased the risk of childhood AD in addition to work stress during pregnancy.

Haemophilus influenzae type b combination vaccines and atopic disorders: A prospective cohort study

Epidemiologic evidence for an association between vaccinations and atopy development is inconsistent. We evaluated the influence of Haemophilus influenzae type b (Hib) combination vaccines in 6-month-old infants on the prevalence of atopic disorders in 18-month-old children. We used multistage, stratified systematic sampling to recruit 24,200 mother-newborn pairs from the Taiwan national birth registration in 2005. Vaccination status was ascertained through official vaccine cards, while risk factors for atopic disorders were gathered by questionnaires at 6 months of age. Information about development of atopic dermatitis (AD) and recurrent wheezing was collected at 18 months of age. The relationship between atopic disorders and Hib combination vaccines, diphtheria-pertussis-tetanus-Hib and oral poliomyelitis vaccines (DPT-Hib&OPV) and DPT-Hib-inactivated poliomyelitis vaccines (DPT-Hib-IPV), were estimated by multiple logistic regression. A total of 19,968 children completed the follow-up and participated in the study. AD was noted in 1584 (7.9%) infants while recurrent wheezing was found in 1220 (6.1%) infants. The adjusted odds ratios (ORs) (95% CI) for the development of AD in the DPT-Hib&OPV and DPT-Hib-IPV vaccination groups were given as 1.38 (1.15-1.65) and 1.49 (1.29-1.72), compared to those without Hib vaccination (DTP&OPV vaccination). However, the association between DPT-Hib&OPV and DPT-Hib-IPV vaccinations and recurrent wheezing failed to reach statistical significance. There is a potential risk for AD after receiving Hib combination vaccines. Hib vaccination is important to the public health, and therefore the observation requires further investigations.

Infant feeding practices and physician diagnosed atopic dermatitis: a prospective cohort study in Taiwan

It is common to recommend breastfeeding and a delayed introduction of solids to prevent atopic dermatitis (AD). However, the scientific evidence for this is inconclusive. The aim of this study was to explore the effect of breastfeeding and solids on AD, when taking account of reverse causality. This on-going birth cohort study was designed to sample 24,200 representative post-partum women and their babies from the Taiwan National Birth Registration database. Using two home interviews at 6 and 18 months after birth, with structured questionnaires about diet and physician's diagnosis of AD by parental reports, a total of 20,172 pairs (83.4%) were reviewed completely. Considering reverse causality, we excluded 2399 children with AD in the first 6 months of life and 18,733 were finally recruited. All study participants provided informed consent as approved by the Ethics Review Board of the National Taiwan College of Public Health. After adjustment for potential confounders, the overall results showed that the increased duration of breastfeeding seemed to increase the risk of AD at 18 months in children. However, no significant effect was found for the delayed introduction of solids on the risk of AD. There is no evidence of a protective effect of prolonged breastfeeding and a delayed introduction of solids against AD among children at age 18 months, and may even be a risk factor of AD.

Women’s perceptions of their husband’s drinking behavior as a risk factor of their health-related quality of life in the postpartum period

The objective of this study is to investigate the association between women's perceptions of their husband's drinking behavior and their health-related quality of life (HRQOL) in the postpartum period. We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. A structured questionnaire to assess lifestyle risk behaviors and HRQOL was successfully administered to 87.8% of the sampled population. Subjects undertook a home interview 6 months after their deliveries between June 2005 and July 2006. The Medical Outcomes Study 36-item Short-Form (SF-36) was used to measure the HRQOL of the wives, and the scores were used to look for associations with their perceptions of husband's alcohol-drinking behavior. After controlling for the potential confounders, wives' scores on all SF-36 scales except the PF scale were inversely associated with the frequency of their husbands' alcohol drinking. Moreover, the MCS measure was also inversely associated with in the frequency of their husbands' alcohol drinking but the PCS did not show any association. Our study adds evidence supporting the negative association between of husbands' alcohol drinking and their wives' health as measured by the SF-36 HRQOL, especially for mental health.

Husbands‘ Drinking Behavior as a Risk Factor of Wives’ Health-Related Quality of Life during the Postpartum Period

ISEE-0605 Background and Objective: It is well known that husbands’ alcoholic drinking has adverse effects on women’s physical and mental health or even family violence. Evidence is limited in the association between husbands’ alcohol drinking and women’s health-related quality of life (HRQOL), especially for postpartum women. The objective of this study is to investigate the association between husbands’ alcohol drinking and wives’ HRQOL during the postpartum period. Methods: We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. A structured questionnaire was successfully administered to 87.8% of the sampled population. Subjects undertook a home interview 6 months after their deliveries between June 2005 and July 2006. The Medical Outcomes Study 36-item Short-Form (SF-36) was used to measure the quality of life of the women with their husbands’ alcohol drinking behavior. Results: After controlling for the potential confounders, there were significantly gradual decreases in wives’ scores on the SF-36 scales other than physical functioning along with the increase in frequency of husbands’ alcohol drinking. There were significantly gradual decreases in wives’ scores of SF-36 scales other than physical functioning and role-physical along with the increase in frequency of husbands’ alcohol drinking either in primiparous or multiparous women. Conclusions: Our study adds evidence supporting the adverse effect of husbands’ alcohol drinking on women’s health as measured by the SF-36 HRQOL. However, the limitation that this study was cross-sectional in design should be considered. Further longitudinal follow-ups are needed to better understand this complex relationship between husbands’ alcohol drinking and wives’ quality of life.

Maternal return to work and breastfeeding: A population-based cohort study

Background In recent decades there has been a marked rise in the participation of women with infants in the labour market, while there has been a decline in the prevalence rate of breastfeeding. Objective To explore the relationship between maternal return to work and breastfeeding. Design An on-going prospective longitudinal study. Setting and participants Multistage stratified systematic sampling was designed to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. Participating women underwent two home interviews at 6 and 18 months after giving birth, following structured questionnaires. A total of 21,248 and 20,172 women were interviewed, and the completed interview rate was thus 87.8% and 83.4% at 6 and 18 months, respectively. All study participants provided informed consent as approved by the Ethics Review Board of the National Taiwan College of Public Health. Results The overall prevalence of initial breastfeeding was 83.7%. Postpartum women returning to work less than or equal to 1 month had the lowest initiation of breastfeeding rate (77.5%), but had a higher prevalence of breastfeeding duration less than or equal to 1 month (34.9%) than the overall population (26.8%). Overall 67.9%, 39.4%, 25.4%, and 12.7% mothers who started breastfeeding still breastfed their infants at the age of 1, 3, 6 and 12 months, respectively. Women with maternal leave of less than or equal to 6 months ceased breastfeeding earlier than those with maternal leave beyond 6 months and those who did not return to work up to 18 months after birth. After adjustment for potential confounders, odds ratios of initial breastfeeding seemed no different, except those for postpartum women who returned to work less than or equal to 1 month and those who did not return to work. Mothers returning to work within 1 year after giving birth were significantly earlier in weaning than those without return to work. Conclusion In our study, an early maternal return to work, especial within 6 months after giving birth, was a barrier to the initiation and continuation of breastfeeding. Thus, a comprehensive strategy is required to encourage the practice of breastfeeding in working women from pregnancy to the return to work, and nurses should work to promote breastfeeding in the different occasion.

Working hours and risk of gestational hypertension and pre-eclampsia

The potential impact of employment on maternal health, particularly in relation to gestational hypertension and pre-eclampsia, has been subject to research. However, there is limited evidence on associations between shift work and long working hours on the incidence of these conditions. To evaluate potential associations between maternal shift work and long working hours during pregnancy and gestational hypertension or pre-eclampsia. Multistage stratified systematic sampling was used to recruit 24 200 post-partum women from the Taiwan national birth registration database in 2005. Subjects underwent home interview 6 months after their deliveries by structured questionnaire to obtain characteristics of maternal employment and potential confounders. Diagnosis of gestational hypertension and pre-eclampsia was obtained from the birth registration. There was no association between employment status and gestational hypertension or pre-eclampsia. Also, no significant association between gestational hypertension or pre-eclampsia and maternal shift work or long working hours during pregnancy was found in all or primiparous women. There was no convincing evidence that maternal shift work or long working hours had a higher risk of gestational hypertension or pre-eclampsia. However, further research is warranted to confirm these negative findings.

Predicting risk for early infantile atopic dermatitis by hereditary and environmental factors

Hereditary and environmental factors contribute to the occurrence of atopic dermatitis (AD). However, the interaction of these two factors is not totally understood. To evaluate the early risk factors for infantile AD at the age of 6 months and to develop a predictive model for the development of AD. In 2005, a representative sample of mother and newborn pairs was obtained by multistage, stratified systematic sampling from the Taiwan national birth register. Information on hereditary and environmental risk factors was collected by home interview when babies were 6 months old. Multivariate regression analysis was applied to determine the risk factors for AD in the infants. A total of 20 687 pairs completed the study satisfactorily. AD was diagnosed in 7.0% of 6-month-old infants by physicians. Parental asthma, atopic dermatitis and allergic rhinitis, and maternal education levels were risk factors for AD in infants. Among environmental factors, fungus on walls at home and renovation/painting in the house during pregnancy were significantly associated with early infantile AD. Using these factors, the probability of having infantile AD was estimated and grouped into low, high and very high. With five runs of tests in mutually exclusive subsets of this population, the likelihood of AD for 6-month-old infants was consistent in all the groups with the predictive model. The highest predicted probability of AD was 70.1%, among boys with maternal education levels > 12 years, both parents with AD, renovation and painting of the house during pregnancy and fungus on walls at home. The lowest probability was 3.1%, among girls with none of the above factors. This investigation provides a technique for predicting the risk of infantile AD based on hereditary and environmental factors, which could be used for developing a preventive strategy against AD, especially among those children with a family history of atopy.

Use of Sheng-Hua-Tang and health-related quality of life in postpartum women: A population-based cohort study in Taiwan

Although Sheng-Hua-Tang (comprising Radix Angelicae Sinensis, Ligustici Rhizoma, Semen Persicae, Zingiberis Rhizoma and Glycyrrhizae Radix) use during the postpartum has been popular in Chinese communities over a long period, its benefits have not been evaluated in terms of its effects on the health-related quality of life of postpartum women. This study aims to explore the relation between different patterns of Sheng-Hua-Tang use and the health-related quality of life in postpartum women. A longitudinal birth cohort follow-up study. We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. A structured questionnaire was successfully administered to 87.8% of the sampled population. Subjects underwent a home interview 6 months after their deliveries between June 2005 and July 2006. The Medical Outcomes Study 36-item Short-Form (SF-36) was used to measure the quality of life of the women with different patterns of Sheng-Hua-Tang use. Compared with those who never used after delivery, the scores of role limitations due to physical health and emotional problems significantly increased in women who used Sheng-Hua-Tang within 1 month only but decreased in those who continuously used within 1 month and later. In addition, the scores of role limitations due to physical health and emotional problems significantly increased in women who used Sheng-Hua-Tang regardless of the frequency. Sheng-Hua-Tang use during the first month of the postpartum period may have a positive effect on women's health-related quality of life especially in terms of role limitations due to physical health and emotional problems. However, continuous use after the first month of the postpartum period might have a negative effect on women's quality of life. Further studies are needed to replicate the results and elucidate the causal relations.

Chinese herbal medicine use in Taiwan during pregnancy and the postpartum period: A population-based cohort study

Background Using Chinese herbal medicines during pregnancy and postpartum is common in the Chinese community. Objective The purpose of this current study is to explore the use of Chinese herbal medicines by women during pregnancy and postpartum in Taiwan. Design It is an on-going prospective longitudinal study design. Setting and participants We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. Subjects underwent a home interview 6 months after their deliveries between June 2005 and July 2006. A structured questionnaire was successfully administered to 87.8% of the sampled population. Results At least one Chinese herbal medicine was used by 33.6% and 87.7% of the interviewed subjects during pregnancy and the postpartum period, respectively. An-Tai-Yin, Pearl powder, and Huanglian were the most commonly used during pregnancy, while Shen-Hua-Tang and Suz-Wu-Tang were the most commonly used by postpartum women. Pregnant women aged 20–34, with high education, threatened abortion, chronic disease, and primipara appeared to use more Chinese herbal medicines than others in the sample. Postpartum women with high education, primipara, normal spontaneous delivery, and breastfeeding were found to use more Chinese herbal medicines; but women with pregnancy-related illness used less. Conclusions Chinese herbal medicines are frequently used by women during pregnancy and the postpartum period in Taiwan and those with high education and primipara used more such herbs. Due to limited safety information on these herbs, we would advise caution regarding their use either during pregnancy or postpartum breastfeeding period. Moreover, it is important for nurses/midwifes enquiring about such habits, and providing the adequate education to women during prenatal and postpartum care to prevent potential side effects.

The association between infant feeding pattern and mother’s quality of life in Taiwan

This study compared the health-related quality of life (HRQOL) of mothers using different infant feeding methods. We used the Medical Outcomes Study 36-item Short-Form (SF-36) to measure the HRQOL of 1,747 mothers and used the scores to look for associations with infant feeding methods (not breastfeeding, breastfeeding for <1 month, breastfeeding 1-5 months, and still breastfeeding at the 6th month). The mothers were chosen via a stratified sampling from the Taiwan national birth registration data between November and December 2003. HRQOL and breastfeeding duration were positively associated. Of the eight unadjusted domain scores of the SF-36, general health perception and mental health were significantly different among these four different infant feeding groups (P < 0.05). After controlling for potential confounding factors, mothers who breastfed for 6 months or longer had a higher HRQOL score than the other mothers. In addition, their physical functioning, general health perception and mental health scores were higher than those of mothers who did not breastfeed (P < 0.05). Mother's family income and parity and child's health status were also associated with mother's quality of life. Compared to the other mothers, mothers who breastfed for six moths or longer had better HRQOL. However, the limitation that this study was cross-sectional in design should be considered and further studies are needed.

Environmental risk factors for early infantile atopic dermatitis

Previous studies of predictors of atopic dermatitis (AD) in Asia have had limited sample size and small numbers of variables focused primarily on family history or dietary exposures. The purpose of this study was to evaluate the influence of various environmental risk factors for early infantile AD. We used multistage, stratified systematic sampling to recruit 2048 mother-child pairs from the Taiwan national birth registration in 2003. Information on environmental risk factors for infant AD gathered by questionnaire were available from 1760 infants at 6 months of age. Multiple logistic regression was used to estimate adjusted odds ratios (aORs) and their 95% confidence intervals (CIs) for risk factors for AD after adjusting for potential confounders. AD was noted in 118 of 1760 (6.7%) of the infants. After adjusting for maternal age and education, family history of atopy, infant gender, and gestational age, fungi on walls of the house [aOR 2.14 (95% CI 1.41-3.22)] and frequent use of microwave oven at home [aOR 1.71 (95% CI 1.13-2.58)] increased the risk of early infantile AD. This study suggests that environmental factors do play a role in early infantile AD. Fungi, a kind of aeroallergen, are especially important in humid climate as in Taiwan and their impacts might be felt at the early infant stage. The hazards of microwave use should be paid more attention.

The combined effect of employment status and transcultural marriage on breast feeding: a population‐based survey in Taiwan

In recent decades there has been a marked rise in both the labour market participation of women with infants and transcultural marriage in Taiwan. The objectives of this study were to explore the combined effect of employment status and transcultural marriage on the prevalence and factors relating to initiation and continuation of breast feeding in Taiwan. We used multistage stratified systematic sampling to recruit 2048 postpartum women from the Taiwan National Birth Registration database for the period November to December 2003. They were interviewed at home within 6 months of delivery using a structured questionnaire; 87% of the sampled population completed the interview. We used logistic regression analysis to estimate the odds ratio (OR) of breast-feeding initiation and Cox regression (survival) analysis to predict continued breast feeding. The prevalences of initial breast feeding for employed Taiwanese mothers, unemployed Taiwanese mothers, employed foreign-born mothers and unemployed foreign-born mothers were 84.4%, 83.7%, 79.1% and 79.7%, respectively. Among the four groups of mothers who initiated breast feeding, 12.9%, 27.2%, 14.7% and 39.7% of their infants, respectively, were still breast feeding at the age of 6 months. Factors associated with initiation of breast feeding were high maternal education (OR 3.80; 95% confidence interval [CI] 1.81, 7.98) and normal spontaneous delivery (OR 1.36; 95% CI 1.04, 1.78). The main reason for not breast feeding in 52% of the mothers was insufficient or no milk. There existed a combined effect of employment status and transcultural marriage on the continuation of breast feeding. Employed Taiwanese mothers were earlier than others at weaning. Unemployed foreign-born mothers breast fed the longest [hazard ratio (HR) 0.54; 95% CI 0.42, 0.70]. Other factors related to late weaning were high maternal education (HR 0.67; 95% CI 0.47, 0.96), older maternal age (HR 0.76; 95% CI 0.61, 0.94), mother sleeping with baby at night (HR 0.68; 95% CI 0.59, 0.78), and no supplemental baby food before the age of 6 months (HR 0.78; 95% CI 0.68, 0.90). The initiation of breast feeding was high but it decreased dramatically after the postpartum period in Taiwan. There was a significant combined effect of employment status and transcultural marriage on the continuation of breast feeding. Employment is a persistent barrier to continued breast feeding.

Herbal Medicines Used During the First Trimester and Major Congenital Malformations–an Analysis of Data From a Pregnancy Cohort Study

P-364 Introduction: Major congenital malformations place a considerable burden on the affected child, the family and society. Use of herbal medicine during pregnancy is gaining popularity worldwide. Any kind of medicine used during pregnancy might have a harmful impact, so such practice has raised concerns. Aim: To explore the relationship between use of herbal medicines by pregnant women during the first trimester of pregnancy and risk of major congenital malformation in live born infants. Methods: This was a cross-sectional analysis of data from a prospective pregnancy cohort which was established in 1984–1987. To assemble the cohort, each pregnant woman of 26 or more weeks of gestation who came to the Taipei Municipal Maternal and Child Hospital in Taiwan for prenatal care was enrolled and interviewed using structured questionnaires. Detailed information, including herbal medicines used during different periods of pregnancy, was obtained. Past medical history, current obstetric data, and medicines used during pregnancy were abstracted from medical records. Data on birth weight, gestational duration, and characteristics of live born infants were gathered from the Taiwan national birth registration. Congenital malformation information was obtained from multiple sources: from the newborn examination record during 1984–1987; from the national death registration for the period during 1984–2003; and from the National Health Insurance for critical illness and injury registration data during 1996–2000 in Taiwan. Multiple logistic regression was used to estimate the odds ratio of major congenital malformation by herbal medicines used during the first trimester. Results: A total of 14,551 live births were analyzed. After adjustment for confounding factors, taking Huanglian during the first trimester of pregnancy was found to be associated with increased risk of congenital malformations of the nervous system (adj. odds ratio 8.62, 95% CI 2.54 to 29.24). An-Tai-Yin was associated with increased risk of congenital malformations of musculoskeletal and connective tissues (adj. odds ratio 1.61, 95% CI 1.10 to 2.36) and eye (adj. odds ratio 7.30, 95% CI 1.47 to 36.18). Conclusion: We found evidence for a link between the use of specific herbal medicines during the first trimester of pregnancy and increased risks of specific groups of congenital malformations. We could not investigate whether the adverse effects related to direct toxicity of herbal medicines, from misuse or contamination, or from uncontrolled confounding. Nonetheless, we would advise caution regarding use of herbal medicine during pregnancy, and suggest further investigation of these findings.

Chinese herbal medicines used in pregnancy: a population‐based survey in Taiwan

To explore the use (prevalence and related factors) of Chinese herbal medicines used by pregnant women. We used multistage stratified systematic sampling to recruit 2048 postpartum women from the Taiwan national birth register between November and December 2003. Subjects underwent a home interview 6 months after their deliveries. A structured questionnaire was successfully applied to 87% of the sampled population. At least one Chinese herbal medicine was used during pregnancy by 24.1% of the interviewed subjects. Pregnant women with threatened abortion appeared to use more Chinese herbal medicines than other pregnant women. Chinese herbal medicines are frequently used by pregnant women in Taiwan and are very frequently used by those with a threatened abortion.

Herbal Medicines Used During the First Trimester and Major Congenital Malformations

Major congenital malformations place a considerable burden on the affected child, the family and society. Any kind of medicine used during pregnancy might have a harmful impact; therefore, such practice has raised concerns. The objective of the current study was to explore the relationship between the use of herbal medicines by pregnant women during the first trimester of pregnancy and the risk of major congenital malformation in their live born infants. This was a cross-sectional analysis of data from a prospective pregnancy cohort, which was established between 1984 and 1987. To assemble the cohort, pregnant women of >or=26 weeks of gestation who came to the Taipei Municipal Maternal and Child Hospital in Taiwan for prenatal care were enrolled in the study and interviewed using a structured questionnaire. Detailed information, including herbal medicine use during different periods of pregnancy, was obtained during the interview. Past medical history, current obstetric data and details on conventional medicines used during pregnancy were abstracted from medical records. Data on birth weight, gestational duration and characteristics of live born infants were gathered from the Taiwan national birth register. Congenital malformation information was obtained from multiple sources: the newborn examination record (1984-7); the national death register (1984-2003); and Taiwan National Health Insurance data (1996-2000). Multiple logistic regression was used to estimate the odds ratio [OR] of major congenital malformation by herbal medicines used during the first trimester. A total of 14,551 live births were analysed. After adjustment for confounding factors, taking huanglian during the first trimester of pregnancy was found to be associated with increased risk of congenital malformations of the nervous system (adjusted OR 8.62, 95% CI 2.54, 29.24). An-Tai-Yin was associated with an increased risk of congenital malformations of the musculoskeletal and connective tissues (adjusted OR 1.61, 95% CI 1.10, 2.36) and the eye (adjusted OR 7.30, 95% CI 1.47, 36.18). We found evidence for a possible link between the use of specific herbal medicines during the first trimester of pregnancy and increased risks of specific groups of congenital malformations. We could not investigate whether the adverse effects were related to direct toxicity from the herbal medicines, or were from misuse, contamination or uncontrolled confounding. Nonetheless, we would advise caution regarding use of herbal medicines during pregnancy, and we suggest that further investigation of these findings is warranted.

Use of Coptidis Rhizoma and foetal growth: a follow‐up study of 9895 pregnancies

To explore the effect of Coptidis Rhizoma on foetal growth in pregnancy. During 1985-1987, each pregnant woman with 26 or more weeks of gestation who came to the Taipei Municipal Maternal and Child Hospital for prenatal care was enrolled and interviewed by three trained interviewers using structured questionnaires to obtain detailed information including the herbal medicines used during pregnancy. Medical histories of diabetes, hypertension, antepartum haemorrhage and medicines used during pregnancy were abstracted from medical records of mothers'. Data of birth weight, gestational duration and characteristics of infants were gathered from the Taiwan national birth registration. A total of 9,895 singleton livebirths were analysed. The variables related to foetal growth included two dichotomous measures: low birth weight (LBW) and small for gestational age (SGA); and one continuous measure: birth weight. Potential risk factors associated with these outcomes were investigated using multiple logistic and linear regression models. After adjustment, pregnant women taking Coptidis Rhizoma during pregnancy had no significantly adverse effect on foetal growth. There was a non-significantly slightly decreased mean of birth weight and increased risk of LBW and SGA babies if the frequency of using Coptidis Rhizoma was more than 56 times. The usual usage of Coptidis Rhizoma during pregnancy seemed not to increase the adverse risk on foetal growth. Future observations for use of longer than 56 times or a higher cumulated dose were needed to clarify the safety.