This is the first study to investigate use of HM among Bangladeshi women and its possible effects on the outcome of pregnancy. The study followed cross-sectional design and data were collected via survey on postpartum women in two maternity hospitals in Dhaka, Bangladesh. The results show that the use of HM in pregnancy is common in Bangladesh.
It was found that 70% of the women used at least one herbal product during their last pregnancy. This prevalence rate is significantly quite high considering the fact that more than 88% of the sample resided in urban areas, and majority of the participants lived near to a health facility. These results suggest higher prevalence than previously reported from Asian and non-Asian countries [8, 20, 28,29,30,31]. The difference in the prevalence of HM use could be explained by several factors such as culture, socio-demographic factors, and use of health care services.
Likely predictors of using HM among Bangladeshi women in pregnancy were unemployment and use of HM prior to last pregnancy, which is consistent with previous studies [5, 32]. The most common reasons to use HM were that these were cheap, accessible, and safe. A study from Ethiopia also reported that most of the women used HM in pregnancy because they considered these cheap and accessible [33]. Elsewhere, it has been reported that HM are consumed during pregnancy because these are considered natural and safe [34]. Moreover, the findings suggest that most of the women used HM occasionally or daily throughout their previous pregnancy, consistent with previous studies [3, 5]. These findings imply that women used HM occasionally when they needed to manage their symptoms or used on daily basis to stay healthy.
In this study, family, friends, and neighbors were the main source of recommendation for use of herbal medicines in pregnancy. Similar findings were reported by studies conducted in the United Kingdom and Iraq [5, 35]. These results are conceivable as family and friends are easily accessible, and usually the most trusted members of a society. Furthermore, a majority of study participants did not inform healthcare providers about their use of HM in pregnancy. When asked for the reason of this non-disclosure, most of them responded that they forgot and the healthcare providers did not ask them, consistent with a previous report [5]. It shows respondents’ lack of awareness about safety issues regarding use of HM in pregnancy. The findings also reflect poor communication between healthcare providers and their patients.
Ginger was the most frequently used modality of HM, and it was primarily used for relief of nausea/vomiting and cold/flu. Ginger has been widely used to treat pregnancy related morning sickness. However, there is a need for more data because its clinical value and safety profile in treating nausea and vomiting in early pregnancy is still unknown [36]. Black seed was frequently used for nausea/vomiting and as a galactagogue. It is suggested that this herb’s potential to increase the milk flow could be due to its constituents: lipid portion and hormonal structures [37]. Lemon tea was primarily used to soothe cough during pregnancy. Lemon may be suitable for treating mild cough during pregnancy [38]. However, it should be ensured that there is no underlying cause such as asthma or bacterial infection. Apart from garlic, a few women consumed prunes to treat their hypertension. A placebo controlled clinical study from Pakistan reported significant reduction in blood pressure following use of prunes [39].
Although modalities of HM reported in this study may have some benefit, certain herbs could be potentially harmful to use in pregnancy or the information about their safety may be lacking. For instance, information on safe use of black seed, prunes, and mustard oil during pregnancy is lacking and maternal use of betel nuts, terminalia, and turmeric is not recommended at higher doses. Indeed, a recent study reported that betel nuts chewing during pregnancy was associated with increased chances of anemia. [40]. Turmeric and terminalia, if ingested in doses higher than commonly found in food, can stimulate uterus and may trigger its emmenagogic and abortifacient effects during pregnancy [41,42,43].
Participants of this study were asked to report any side effect following their use of HM in pregnancy. The findings show that among 170 users, side effects were reported in 15 instances (8.8%). In previous studies, the reported side effects ranged between 3.7 and 18% among HM users [20, 44]. Few participants of this study reported dry mouth and nausea/vomiting following their consumption of garlic in pregnancy. Similar adverse effects have been reported in the literature [45]. Moreover, two cases of diarrhea were reported following consumption of myrobalan or Terminalia chebula which is used to alleviate constipation [46]. In this study, five respondents used it for this symptom. It is possible that high doses of terminalia were taken to relieve severe constipation, resulting in diarrhea.
This study did not find any significant difference between users and non-users of HM in terms of morbidities during pregnancy, complications around childbirth, and neonatal symptoms. To evaluate the data even further, deep analyses of each herbal medicine were conducted to see their relationship with maternal and neonatal characteristics. No significant adverse effect of using individual modality of HM was found on the outcome of pregnancy. The number of cases with complications during childbirth was too small to make reliable inference based on statistical analysis. Further research will need to clarify if there is a relationship, using a larger sample size. Furthermore, there were six cases of blocked nasolacrimal duct which is a common neonatal condition.
This study showed that women during pregnancy used HM a lot. Information given by physician and midwives could help the pregnant women to use the herbs that have less risk [18]. Therefore, healthcare practitioners should maintain proper communication with their patients to ensure their health and safety [47]. Moreover, physician and midwives should not forget to ask pregnant women on HM use, and write it in the medical records, as it is written for drugs. Reports of side effects and recommendations by unqualified people suggest that there is need to establish an integrative pharmacovigilance of HM within communities and health facilities, especially in the maternity clinics. So that data regarding use of HM and herbs, their indications, and potential effects can be gathered. Such data would contribute to evidence based policymaking and health awareness campaigns in maternal and child health programs.
This study has several limitations. The data was collected from two maternity hospitals of Dhaka city. Therefore, it does not represent the entire population of Bangladesh and the findings cannot be extrapolated to whole country. Moreover, the study could not estimate the dose and frequency of ingestion of individual HM. There could be a recall bias in the questionnaire as it was retrospective data. However, asking before discharge could decrease this risk, as it was very close to the pregnancy. Another limitation is that the whole data is self-reported, even if there was the help of medical staff. A separate questionnaire should have been distributed to physicians and midwifes in order to be sure that it is not only self-reported. The major strength of this study is that this is the first attempt to see the relationship between maternal use of HM and outcome of pregnancy in South Asian region.