Herbal Medicine: Catch Potential Problems in Pregnant Women Early

Pharmacists are realizing that they need to increase vigilance for complementary and alternative products. The United States market for herbal and natural products (HNP) is more than $72 billion. Patients can buy herbal products at many locations, and often, they purchase them at pharmacies.

Pregnant women take HNPs because manufacturers market them as effective, safe alternatives to prescription medications. But, HNPs have active ingredients and drug interactions that can potentially cause harm to both the mother and her baby.

Researchers have published the results of a survey published in BMC Complementary and Alternative Medicine, and it explores herb-drug interactions (HDIs) and their clinical significances in pregnant women. These researchers conducted a cross-sectional, self-reported survey of women during early pregnancy or immediately postpartum.

Of the 889 respondents, 445 reported using at least 1 prescription medicine. Using the Natural Medicines Comprehensive Database, they compared 91 prescriptions and 36 HNPs for herb-drug interactions. They identified 34 interactions in 23 women having the potential to increase postpartum hemorrhage risk, alter maternal hemodynamics, or enhance maternal/fetal CNS depression.

Women took ginger, chamomile, cranberry, raspberry, and fish oil most often, while the most common prescribed drugs were antibiotics, opiate analgesics, anti-emetics, and thyroid replacement therapy. The researchers did not collect over the counter medication data, and suggest this omission underestimates the number of potential herb-drug interactions.

HNPs have potential adverse effects due to direct chemical toxicity, herb-drug and herb-herb interactions, incorrect dosing, toxic constituents, and product adulteration. Pregnant women taking herbal medicine underreport their use and are unaware of the potential harms.

Healthcare professionals should be aware that concurrent use of HNPs and prescriptions during pregnancy is common—this study shows a rate of about 50%—and carries potential risks. Pharmacists who provide patient education and review prescribed and herbal medicines with pregnant patients can avoid interactions and catastrophic drug events.

Reference

McLay JS, Izzati N, Pallivalapila AR, et al. Pregnancy, prescription medicines and the potential risk of herb-drug interactions: a cross-sectional survey. BMC Complementary and Alternative Medicine. 2017;17(1).