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Herbal medicine use in pregnancy by Australian women: high rates of self-prescription and low rates of disclosure?

Welcome to the first edition of the Australian Journal of Herbal Medicine for 2014. This edition contains a commentary by Professor David Sibbritt on the decline of herbal medicine/naturopathic consultations by women despite the increase in use of herbal medicines and other complementary medicine products. (1) Women are high consumers of complementary and alternative medicine (CAM) and this use appears to extend to pregnancy. A recent, nationally representative study of pregnant women in Australia (n = 1,835) found that 52% of women were using some form of CAM during gestation (excluding vitamins and minerals which are commonly taken at this time). (2) This is very similar to the prevalence rates of CAM use during pregnancy from other countries around the world with most falling between 20 and 60%. (3) Of these therapies, herbal medicines have been found to be used commonly during gestation.

A study published last month in BMC Complementary and Alternative Medicine investigated the use of herbal medicine by pregnant women (n = 9,459) across 23 countries. (4) They found the use ranged from 4.3% in Sweden up to 69% in Russia. Additionally, Australia was found to have the third highest rate of herbal medicine use during pregnancy (43.8%). This is relatively consistent with prevalence rates reported from Australian studies which have revealed that between 11% and 36% of women are using herbal medicine during gestation. (2-5-7)

Women appear to use herbal medicine during pregnancy due to the perception that it may be safer than conventional medicine and due to a desire for a more holistic model of healthcare. (8,9) Women also report that they want a degree of choice and control in some of their healthcare decisions during pregnancy. (8) The self-prescribing of herbal medicines during pregnancy may be an extension of a woman's desire for some degree of autonomy during this time. A recent Australian study found that 34.4% of women were using herbal medicines during pregnancy and only 7.2% were consulting a naturopath or herbalist. (2,10) High rates of herbal medicine self-prescription appear to be common in Australia with another study reporting up to 71% of women who use herbal medicine during pregnancy self-prescribe them. (4) Whilst some herbal medicines may be innocuous, the safety of many during pregnancy is unknown. (11) Additionally, women may have an inadequate knowledge of herbal medicines that are considered harmful in pregnancy, may choose poorly or incorrectly, or may not be aware that these medicines can interact with other medications. In addition to concerns about teratogenicity and effects on uterine activity, there is the possibility that a chronic or pregnancy-related health condition may be undertreated leading to a worsening of the complaint or further complications. (9)

Research has also shown that pregnant women tend to seek information about the use of herbal medicine from unprofessional and informal information sources such as untrained friends and family. (3,4,9,12,13) Kennedy et al found that most women who used herbal medicine did so by their own initiative or sought advice from family and friends without consulting naturopaths, herbalists or maternity health care professionals; (3) a finding that has commonly been reported in other research. (3,9,12,13) If many women are using herbal medicines during pregnancy and the majority are seeking advice from family, friends and informal sources such as the internet and magazines, concern is warranted that women may receive poor quality advice that may compromise their health or the health of their baby.

It is not known how many Australian women disclose their use of herbal medicine to their maternity healthcare provider. Research from other countries has shown that the disclosure rate is generally poor (8,14) with one study reporting that 76% of pregnant women did not tell their midwife or doctor they were using herbal medicine. (15) Sometimes the lack of disclosure is simply because women are not being asked, (16) however it also appears to be due to concerns about receptivity and the possibility of feeling disparaged. (14) There has also been research presented previously in this journal (17) which identified a lack of communication between maternity health professionals and naturopaths or herbalists contributing further to this gap in public safety. Research conducted in other patient cohorts in Australia (18) has shown that many people do not disclose their use of herbal medicines and it is possible that this may also be the case during pregnancy. As Australian women are commonly utilising herbal medicines during pregnancy it is important to examine why women are largely self-prescribing and why consultations with herbalists and naturopaths are declining despite the growth in popularity of these medicines. (1) Research is required to examine women's attitudes towards the use of herbal medicine during pregnancy and the disclosure of this use to maternity health care professionals in order to ensure safe maternal and child outcomes.


(1.) Sibbritt D. 2014. The decline of herbal medicine/naturopathy consultations: how research can help further the profession. Aust J Herb Med 26(1): 8-9, 38.

(2.) Frawley J, Adams J, Sibbritt D, Steel A, Broom A, Gallois C. 2013. Prevalence and determinants of complementary and alternative medicine use during pregnancy: Results from a nationally representative sample of Australian pregnant women. Aust N Z J Obstet Gynaecol 53(4): 347-52.

(3.) Adams J, Lui CW, Sibbritt D, Broom A, Wardle J, Homer C, Beck, S. 2009. Women's use of complementary and alternative medicine during pregnancy: a critical review of the literature. Birth 36(3):237-45.

(4.) Kennedy DA, Lupattelli A, Koren G, Nordeng H. 2013. Herbal medicine use in pregnancy: results of a multinational study. BMC Complement Altern Med 13:355.

(5.) Forster DA, Denning A, Wills G, Bolger M, McCarthy E. 2006. Herbal medicine use during pregnancy in a group of Australian women. BMC Pregnancy Childbirth 6:21.

(6.) Skouteris H, Wertheim EH, Rallis S, Paxton SJ, Kelly L, Milgrom J. 2008. Use of complementary and alternative medicines by a sample of Australian women during pregnancy. Aust N Z J Obstet Gynaecol 48(4):384-90.

(7.) Gaffney L, Smith C. 2004. The views of pregnant women towards the use of complementary therapies and medicines. Birth Issues 13:43-50.

(8.) Warriner S, Bryan K, Brown AM. 2014. Women's attitude towards the use of complementary and alternative medicines (CAM) in pregnancy. Midwifery 30(1):138-43.

(9.) Nordeng H, Havnen GC. 2004. Use of herbal drugs in pregnancy: a survey among 400 Norwegian women. Pharmacoepidemiol Drug Saf 13(6):371-80.

(10.) Steel A, Adams J, Sibbritt D, Broom A, Gallois C, Frawley J. 2012. Utilisation of complementary and alternative medicine (CAM) practitioners within maternity care provision: results from a nationally representative cohort study of 1,835 pregnant women. BMC Pregnancy Childbirth 12:146.

(11.) Low Dog T. 2009. The use of botanicals during pregnancy and lactation. Altern Ther Health Med 15(1):54-8.

(12.) Hall HG, Griffiths DL, McKenna LG. 2011. The use of complementary and alternative medicine by pregnant women: a literature review. Midwifery 27(6):817-24.

(13.) Pettigrew AC, King MO, McGee K, Rudolph C. 2004. Complementary therapy use by women's health clinic clients. Altern Ther Health Med 10(6):50-5.

(14.) Harrigan JT. 2011. Patient disclosure of the use of complementary and alternative medicine to their obstetrician/gynaecologist. J Obstet Gynaecol 31(1):59-61.

(15.) Holst L, Wright D, Haavik S, Nordeng H. 2009. The use and the user of herbal remedies during pregnancy. J Altern Complement Med 15(7):787-92.

(16.) Furlow ML, Patel DA, Sen A, Liu JR. 2008. Physician and patient attitudes towards complementary and alternative medicine in obstetrics and gynecology. BMC Complement Altern Med 8:35.

(17.) Diezel, H, A Steel, J Wardle, and K Johnstone. 2013. Patterns and influences of interprofessional communication between midwives and CAM practitioners: a preliminary examination of the perceptions of midwives. Aust J Herbal Med 25(1): 4-10.

(18.) Shorofi SA, Arbon P. 2010. Complementary and alternative medicine (CAM) among hospitalised patients: an Australian study. Complement Ther Clin Pract 16(2):86-91.

Jane Frawley

Editor, Australian Journal of Herbal Medicine

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Author:Frawley, Jane
Publication:Australian Journal of Herbal Medicine
Article Type:Editorial
Geographic Code:8AUST
Date:Mar 1, 2014
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