Shen Hsuan-Shu, Chang Wei-Chuan, Chen Yi-Lin, Wu Dai-Lun, Wen Shu-Hui, Wu Hsien-Chang
Department of Chinese Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Post-baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.
Front Pharmacol. 2022 Jun 6;13:831690. doi: 10.3389/fphar.2022.831690. eCollection 2022.
Tocolytic treatment is beneficial to pregnant women with a risk of premature labor or miscarriage. However, previous reports have shown that progestogen might not be effective and ritodrine may increase the risk of maternal vascular-related diseases. Chinese herbal products (CHP) are used as alternative therapies for pregnant women. The goal was to evaluate the efficacy of combined tocolytic therapy and CHP therapy in pregnancy outcomes for pregnant women in Taiwan. We conducted a retrospective cohort study based on the National Health Insurance Research Database. A total of 47,153 pregnant women treated with tocolytics aged 18-50 years from 2001 to 2015 were selected from two million random samples. According to the medical use of tocolytics and CHP, we divided the users into two groups: western medicine (WM) only (n = 40,961) and WM/CHP (n = 6,192) groups. A propensity score (PS)-matched cohort (6,192 pairs) was established based on baseline confounders. All participants were followed up to perinatal outcomes. Conditional logistic regression analysis was used to examine the effects of CHP use on the odds of miscarriage and preterm birth. The adjusted odds ratio (OR) for premature birth in the WM/CHP group (n = 411, 6.64%) was significantly lower than in the WM group (n = 471, 7,61%) (0,86, 95% confidence interval [CI], 0.74-0.99). Further subgroup analysis based on the usage of formulae that activate blood and remove stasis or purgative formulae, the adjusted OR of preterm birth of those using these formulae was significantly lower in the WM/CHP group (n = 215, 6.32%) than that in the WM group (n = 265, 7.77%) (OR: 0.79, 95% CI: 0.65-0.96). We found that the combination of CHP and tocolytics can be beneficial to pregnant women in the prevention of premature birth. Further research is required to investigate causal relationships.
宫缩抑制剂治疗对有早产或流产风险的孕妇有益。然而,既往报道显示孕激素可能无效,而利托君可能会增加孕产妇血管相关疾病的风险。中药产品被用作孕妇的替代疗法。目的是评估宫缩抑制剂联合中药产品治疗对台湾地区孕妇妊娠结局的疗效。我们基于国民健康保险研究数据库进行了一项回顾性队列研究。从两百万个随机样本中选取了2001年至2015年期间47153名年龄在18至50岁接受宫缩抑制剂治疗的孕妇。根据宫缩抑制剂和中药产品的使用情况,我们将使用者分为两组:仅使用西药(WM)组(n = 40961)和西药/中药产品(WM/CHP)组(n = 6192)。基于基线混杂因素建立了倾向评分(PS)匹配队列(6192对)。所有参与者均随访至围产期结局。采用条件逻辑回归分析来检验中药产品使用对流产和早产几率的影响。WM/CHP组(n = 411,6.64%)早产的校正比值比(OR)显著低于WM组(n = 471,7.61%)(0.86,95%置信区间[CI],0.74 - 0.99)。基于活血化瘀方剂或泻下方剂使用情况的进一步亚组分析显示,使用这些方剂的WM/CHP组(n = 215,6.32%)早产的校正OR显著低于WM组(n = 265,7.77%)(OR:0.79,95% CI:0.65 - 0.96)。我们发现中药产品与宫缩抑制剂联合使用对预防早产的孕妇有益。需要进一步研究来探讨因果关系。