January 26th, 2010 
Roughly 1 in 10 pregnant women in the U.S. expose their unborn baby to herbal products, according to a new study.
This finding is potentially concerning, researchers say, given that data on the safety of herbal use during pregnancy is lacking. Furthermore, the prevalence of exposure was highest in the first 3 months of pregnancy, a critical period of development.
“If we assume that our study sample was representative of the 4.2 million births each year in the United States, our findings project that 9.4 percent, or potentially 395,000 U.S. births annually, will involve exposure to at least one herbal product during pregnancy,” lead author Dr. Cheryl S. Broussard, from the Centers for Disease Control and Prevention in Atlanta, told Reuters Health by email.
The findings, reported in the American Journal of Obstetrics and Gynecology, are based on data from 4,239 mothers in the National Birth Defects Prevention Study who delivered infants with no major birth defects from 1998 to 2004. The 10 study centers were located across the U.S.
Overall, 462 (10.9 percent) of the 4,239 mothers reported using herbal products in the 3 months before or at some point during pregnancy. The prevalence of herbal use anytime during pregnancy was 9.4 percent. The prevalence during pregnancy was highest (6.9 percent) during the first trimester.
Excluding the 86 mothers whose only use of herbs involved herbal teas, the prevalence of herb exposure before or during pregnancy was 8.9 percent.
The most commonly reported products used early in pregnancy were ginger, which has been shown to help ease morning sickness, without side effects to the unborn child, and ephedra, an herbal stimulant that was banned in the U.S. in 2004 after reports linked it to heart attacks, strokes and at least 155 deaths.
The products used most often throughout pregnancy were herbal teas and chamomile, which has also been shown to ease morning sickness.
Herb exposure was more prevalent in women older than 30 and with more than 12 years of education. Of the 10 states studied, Iowa had the lowest rate of herbal use (5.4 percent) and Utah had the highest (16.5 percent).
“The fact that use of herbal products was greatest during the first trimester raises concerns about fetal safety, because this is a critical period of fetal organ development,” Broussard noted.
“Providers should inform patients that it would be prudent to err on the side of caution regarding use of herbal products just before and during pregnancy because little is known about their potential risks.”
Related
- Most Pregnant Women Never Tested for the Most Common Birth Defect
Three out of five women who have given birth to a child with a congenital heart defect (CHD) — the number-one birth defect and leading killer of infants and newborns — were never tested for the defect during pregnancy. This is according to a survey just released by Little Hearts, Inc.
These findings come just as CHD Awareness Week begins (Feb. 7 – 14). The Little Hearts survey found that 60 percent of parents did not know their child had a CHD until after giving birth — because the mothers were not tested for heart defects during pregnancy.
Of these parents, nearly three out of four (71.6 percent) wished they had known their child had a CHD during pregnancy — mostly because they would have given birth at a hospital more equipped to handle the care of newborns with a CHD (41.6 percent).
“Congenital heart defects kill more children than childhood cancer, and yet, pregnant women are not routinely tested — and newborns are not routinely screened — for this defect,” says Lenore Cameron, President and Executive Director, Little Hearts, Inc. “Early detection is absolutely critical to the successful treatment of congenital heart defects and, in countless cases, it saves lives.”
Those families that did know their child had a CHD before giving birth (40.0 percent) reaped tremendous benefits from knowing in advance:
- Three out of five (59.5 percent) said they gave birth at a hospital more equipped to handle the care of newborns with a CHD
- One in five (19.8 percent) prepared themselves mentally and emotionally for the arrival of a seriously ill child
- Others did their homework: 14.9 percent of respondents said they arranged for a pediatric cardiologist in advance of their baby’s arrival, and 5.8 percent said that knowing in advance was most beneficial because it gave them time to do research on CHDs during the pregnancy
More Survey Results
- Four out of five respondents (81.7 percent) said neither parent of the heart child had any family history of CHDs
- Giving birth to a child with a CHD was more common for women in their 30s (65.2 percent) than in any other age group
- Three out of four respondents (76.1 percent) said the mother did not take prescription drugs (which is considered a CHD risk factor) while pregnant with the heart child
- Almost all respondents (96.4 percent) have only one child with a congenital heart defect; 3.6 percent have two or more children with a CHD
Nearly three out of five respondents (58.0 percent) said their heart child has two or more CHDs; 42.0 percent said their heart child has one CHD
- The most common CHD among children of respondents was Hypoplastic Left Heart Syndrome (30.3 percent), a very serious heart defect that occurs when the left side of the heart does not develop completely
- Most Pregnant Women Never Tested for the Most Common Birth Defect
Three out of five women who have given birth to a child with a congenital heart defect (CHD) — the number-one birth defect and leading killer of infants and newborns — were never tested for the defect during pregnancy. This is according to a survey just released by Little Hearts, Inc.
These findings come just as CHD Awareness Week begins (Feb. 7 – 14). The Little Hearts survey found that 60 percent of parents did not know their child had a CHD until after giving birth — because the mothers were not tested for heart defects during pregnancy.
Of these parents, nearly three out of four (71.6 percent) wished they had known their child had a CHD during pregnancy — mostly because they would have given birth at a hospital more equipped to handle the care of newborns with a CHD (41.6 percent).
“Congenital heart defects kill more children than childhood cancer, and yet, pregnant women are not routinely tested — and newborns are not routinely screened — for this defect,” says Lenore Cameron, President and Executive Director, Little Hearts, Inc. “Early detection is absolutely critical to the successful treatment of congenital heart defects and, in countless cases, it saves lives.”
Those families that did know their child had a CHD before giving birth (40.0 percent) reaped tremendous benefits from knowing in advance:
- Three out of five (59.5 percent) said they gave birth at a hospital more equipped to handle the care of newborns with a CHD
- One in five (19.8 percent) prepared themselves mentally and emotionally for the arrival of a seriously ill child
- Others did their homework: 14.9 percent of respondents said they arranged for a pediatric cardiologist in advance of their baby’s arrival, and 5.8 percent said that knowing in advance was most beneficial because it gave them time to do research on CHDs during the pregnancy
More Survey Results
- Four out of five respondents (81.7 percent) said neither parent of the heart child had any family history of CHDs
- Giving birth to a child with a CHD was more common for women in their 30s (65.2 percent) than in any other age group
- Three out of four respondents (76.1 percent) said the mother did not take prescription drugs (which is considered a CHD risk factor) while pregnant with the heart child
- Almost all respondents (96.4 percent) have only one child with a congenital heart defect; 3.6 percent have two or more children with a CHD
Nearly three out of five respondents (58.0 percent) said their heart child has two or more CHDs; 42.0 percent said their heart child has one CHD
- The most common CHD among children of respondents was Hypoplastic Left Heart Syndrome (30.3 percent), a very serious heart defect that occurs when the left side of the heart does not develop completely
- Pregnant Women Who Smoke Caught Lying by Scientists
A new study casts doubt on the accuracy of self-reported smoking during pregnancy. The study, published last week in the British Medical Journal, involved a random sample of 3,475 pregnant women in Scotland. Researchers compared the women’s self-reported smoking status with results of blood tests that measured the women’s recent nicotine exposure.
According to the results, 24% of women admitted smoking during their pregnancy, yet the “gotcha” blood tests revealed that the real percentage of smokers was more like 30%—meaning that one-fifth of smokers were well…pleading the fifth.
How does that translate to the U.S.? Among reproductive age women in the U.S., an estimated 22% smoke. And even if a 9-month hiatus from the habit was an easy order, not all women consider pregnancy sufficient reason to stop puffing.
Between 10 and 12% of American women smoke during pregnancy, according to the Centers for Disease Control and Prevention. The CDC also estimates that 30% of low birth weight babies (often weighing less than 5.5 pounds), 10% of premature births, and 5% of infant deaths in the U.S. are a result of prenatal smoking.
Back in Scotland, the study authors conclude by calling for better methods of identifying pregnant smokers so that accurate data is used to form policy and provide patient care, such as greater access to smoking cessation services.
- Study ties common antibiotics with birth defects
Researchers studying antibiotics in pregnancy have found a surprising link between common drugs used to treat urinary infections and birth defects. Reassuringly, the most-used antibiotics in early pregnancy — penicillins — appear to be the safest.
Bacterial infections themselves can cause problems for the fetus if left unchecked, experts said, so pregnant women shouldn’t avoid antibiotics entirely. Instead, women should discuss antibiotics choices with their doctors.
The new study is the first large analysis of antibiotic use in pregnancy. It found that mothers of babies with birth defects were more likely than mothers with healthy babies to report taking two types of antibiotics during pregnancy: sulfa drugs (brand names include Thiosulfil Forte and Bactrim) and urinary germicides called nitrofurantoins (brand names include Furadantin and Macrobid).
It was the first time an association had been seen between urinary tract treatments and birth defects, said lead author Krista Crider, a geneticist with the Centers for Disease Control and Prevention, which funded the research.
Used for many decades, the antibiotics in question predate the Food and Drug Administration and its requirements for rigorous safety testing. The FDA now grades all drugs for safety to the fetus based on available research, but rigorous studies are so lacking in many cases, that no antibiotics get the highest grade of “A.”
Sulfa drugs are the oldest antibiotics and some animal studies have found harm during pregnancy. Nitrofurantoins previously have been viewed by doctors as safe to treat urinary tract infections during pregnancy.
The study, appearing in November’s Archives of Pediatrics and Adolescent Medicine, may cause doctors to change the drugs they choose to treat pregnant women with infections. The findings were released Monday.
The researchers analyzed data from more than 13,000 mothers whose infants had birth defects and nearly 5,000 women who lived in the same regions with healthy babies.
The women were interviewed by phone from six weeks to two years after their pregnancies. Those who remembered taking antibiotics during the month before conception through the first three months of pregnancy were identified as exposed to antibiotics.
The women’s memories could have been faulty, a substantial weakness of the study, which the authors acknowledged. About one-third of the women who took antibiotics couldn’t remember the specific type of drug they took.
It’s also unclear whether the birth defects were caused by the drugs or by the underlying infections being treated, Crider said.
Birth defects linked to sulfa drugs included rare brain and heart problems, and shortened limbs. Those linked to nitrofurantoins (ny-troh-fyoor-AN’-toyns) included heart problems and cleft palate. The drugs seemed to double or triple the risk, depending on the defect.
The FDA recommends that pregnant women discuss medications with their doctors, said FDA spokeswoman Sandy Walsh. The agency has proposed changes to prescription drug labeling that would require more complete information for women of childbearing age, pregnant women and those who breastfeed.
- Many Pregnant Women Take Drugs Harmful to Baby
With the help of their doctors, women planning to become pregnant should take an inventory of the medications they take, researchers from Canada advise.
In a study, they found that many pregnant women still take medications long known to cause birth defects.
Some medications with known fetal risk, such as drugs that control epilepsy, are essential during pregnancy, Dr. Anick Berard, at the University of Montreal in Quebec, noted in an email correspondence to Reuters Health.
Other medications, such as those that treat severe acne, anxiety and psychiatric drugs, antibiotics, and many drugs prescribed for heart disease and medical conditions, “can and should be avoided,” according to Berard.
Women should understand the side effects of any drug they are taking — especially drugs treating a chronic condition — and plan pregnancies to avoid or minimize risks such drugs pose to babies, Berard added.
For the 5 years between January 1998 and the last day of 2002, Berard and colleagues analyzed the prescriptions filled by pregnant women for drugs available at the time and known to pose fetal risks.
Their report, in BJOG: An International Journal of Obstetrics and Gynecology, shows 56 percent of 109,344 pregnant women filled at least one medication prescription. A total of 6.3 percent (6,871 women) did so for at least one medication known to pose a risk to the fetus.
“These pregnancies were associated with an elevated number of (pregnancy terminations) and babies born with major (birth defects) in comparison with the expected numbers in the population,” they note.
Specifically, terminations occurred in 47 percent of the pregnancies exposed to drugs with known fetal risks. Six percent of these pregnancies ended in miscarriage.
By contrast, in the much larger non-exposed group about 36 percent of the pregnancies had been terminated and fewer than 5 percent ended in miscarriage.
Berard’s team further identified birth defects in 8.2 percent of 2,842 infants exposed to risky drugs during gestation and available for assessment, compared with 7.1 percent of the 59,287 infants not exposed. This is “a statistically significant difference,” they note.
They emphasize, however, that it cannot be concluded that the drug exposure caused the birth defects. These pregnancies may have also been exposed to other harmful agents or maternal health conditions, they point out.
There are approximately 35 different types of CHDs. Some may be treated with surgery, medicine and/or devices, such as artificial valves and pacemakers. In the last 25 years, advances in the treatment of heart defects have enabled half a million U.S. children with serious CHDs to survive into adulthood. However, many cases of sudden cardiac death in young athletes are caused by undiagnosed CHDs and childhood-onset heart disease.
There are approximately 35 different types of CHDs. Some may be treated with surgery, medicine and/or devices, such as artificial valves and pacemakers. In the last 25 years, advances in the treatment of heart defects have enabled half a million U.S. children with serious CHDs to survive into adulthood. However, many cases of sudden cardiac death in young athletes are caused by undiagnosed CHDs and childhood-onset heart disease.
