University College London, Faculty of Population Health Sciences, Institute for Global Health, 30 Guildford Street, London, WC1N 1EH, UK.
BMC Complement Altern Med. 2018 May 25;18(1):166. doi: 10.1186/s12906-018-2203-z.
The use of herbal medicines during pregnancy is very high globally and previous studies have pointed out possible associations with adverse pregnancy outcomes. Nevertheless, the safety of herbal medicines in pregnancy is under-explored in low-income countries experiencing high maternal and neonatal complications. We investigated the associations between self-reported use of Mwanamphepo (a group of herbal medicines commonly used to induce or hasten labour) and adverse maternal and neonatal outcomes in rural Malawi.
We conducted a cross-sectional analysis of secondary household data relating to 8219 births that occurred between 2005 and 2010 in Mchinji district, Malawi. The data were collected as part of a cluster-randomised controlled trial (RCT) that evaluated community interventions designed to reduce maternal and neonatal mortality. Data were gathered on maternity history, demographic characteristics, pregnancy outcomes and exposure to Mwanamphepo. Associations between self-reported use of Mwanamphepo and maternal morbidity as well as neonatal death or morbidity were examined using mixed-effects models, adjusted for relevant covariates. All analyses were also adjusted for the clustered nature of the survey.
Of the 8219 births, Mwanamphepo was used in 2113 pregnancies, representing an estimated prevalence of 25.7%. The self-reported use of Mwanamphepo was significantly associated with increased occurrence of maternal morbidity and neonatal death or morbidity. Specifically, the odds of maternal morbidity were 28% higher among self-reported users than non-users of Mwanamphepo (AOR = 1.28; 95% CI = 1.09-1.50) and the probabilities of neonatal death or morbidity were 22% higher (AOR =1.22; 95% CI = 1.06-1.40) among neonates whose mother reportedly used Mwanamphepo than those who did not.
The use of Mwanamphepo was associated with adverse pregnancy outcomes in rural Malawi. Thus, herbal medicines may not be safe in pregnancy. Where possible, pregnant women should be discouraged from using herbal medicines of unconfirmed safety and those who report to have used should be closely monitored by health professionals. The study was limited by the self-report of exposure and unavailability of data relating to some possible confounders.
在全球范围内，孕妇使用草药的情况非常普遍，先前的研究指出，这可能与不良妊娠结局有关。然而，在孕产妇和新生儿并发症高发的低收入国家，草药在妊娠期间的安全性仍未得到充分探索。我们调查了马拉维农村地区自我报告使用 Mwanamphepo（一组常用于引产或加速分娩的草药）与不良母婴结局之间的关系。
我们对 2005 年至 2010 年在马拉维姆钦吉区发生的 8219 例分娩的二次家庭数据进行了横断面分析。这些数据是作为评估旨在降低孕产妇和新生儿死亡率的社区干预措施的一项集群随机对照试验（RCT）的一部分收集的。数据收集了产妇病史、人口统计学特征、妊娠结局和接触 Mwanamphepo 的情况。使用混合效应模型，调整了相关协变量，研究了自我报告使用 Mwanamphepo 与产妇发病率以及新生儿死亡或发病之间的关系。所有分析还针对调查的聚类性质进行了调整。
在 8219 例分娩中，有 2113 例（估计患病率为 25.7%）使用了 Mwanamphepo。自我报告使用 Mwanamphepo 与产妇发病率和新生儿死亡或发病的发生率显著相关。具体而言，与未使用 Mwanamphepo 的产妇相比，自我报告使用者的产妇发病率高 28%（调整后的优势比 [AOR] = 1.28；95%置信区间 [CI] = 1.09-1.50），报告使用 Mwanamphepo 的产妇的新生儿死亡或发病的概率高 22%（AOR = 1.22；95% CI = 1.06-1.40）。
在马拉维农村地区，使用 Mwanamphepo 与妊娠不良结局相关。因此，草药在妊娠期间可能不安全。在可能的情况下，应劝阻孕妇使用未经证实安全性的草药，而对于报告使用过草药的孕妇，应由卫生专业人员密切监测。该研究受到暴露的自我报告和缺乏一些可能混杂因素数据的限制。
