Pregnancy advice


Pharmacy is the go to source of complementary medicines information for maternity care providers, but advice varies greatly, posing safety questions 

Pharmacists are the prime source of advice for maternity care providers seeking information and recommendations on complementary medicine use in pregnancy a study has revealed.

An Australian survey of 54 healthcare professionals working with pregnant women found 74% turned to a pharmacist first for advice, with 22% going to a GP and 3.7% to a naturopath or herbalist.

However, the study also revealed “a paucity of safety information for complementary and alternative medicines in the pregnant patient cohort,” said the authors, who called for more to be done to prevent “future patients from taking contraindicated supplements”.     

The authors, from the Royal Women’s Hospital Pharmacy Department, Melbourne, said the supplements most commonly recommended were ginger (40.7%), probiotics (29.6%) and raspberry leaf (22.2%).

Existing safety data on these medicines can be considered “neither alarming nor having the robustness to suggest an absolute recommendation as safe to use in pregnancy,” they said. 

While multiple studies observing oral ginger use in pregnancy had reported no increased risks of harm to the mother or fetus, some concerns persisted regarding ginger’s potential to increase risk of bleeding and
postpartum haemorrhage, they said.

Current published studies suggested that probiotics generally appear safe and well-tolerated in healthy pregnant individuals, possibly due in part to limited systemic absorption. However, safety data may depend on the strains within the proprietary product, and this data could not be located for some strains.

Raspberry leaf has been a CAM supplement favoured in the past by some healthcare providers
for use in labour augmentation, the authors said, adding that while it was “possibly safe in late pregnancy under healthcare professional supervision”, the lack of efficacy evidence may not justify even the
low perceived risk of use.

Participants specifically requested further safety information for raspberry leaf, evening primrose oil, fish oil, probiotics, ginger, vitamin C, valerian, turmeric, blue cohosh and colloidal silver.

The research highlighted the widely differing advice patients were given, the authors said, with integration of herbal or alternative medicines into conventional medical care remains controversial.

“Some maternity healthcare professionals often recommend herbal medicine products for pregnancy-related conditions and others consider them entirely contraindicated during pregnancy,” they said.

Given this variety of advice and “this current climate of high herbal medicine usage and sub-optimal quantity of safety data, it is essential that maternity healthcare professionals can easily locate appropriate information where available”, the study authors concluded.

“Further education and access to unbiased safety information, including regarding drug-interaction potential, is required to empower maternity healthcare professionals to provide informed recommendations to their pregnant patients”.

The research was published in the International Journal of Clinical Pharmacology

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