Background
Methods
Type of studies
Search strategy
Eligibility criteria
Safety documentation of identified herbal medicines
Classification | Description |
---|---|
Safe to use in pregnancy | Available human evidence suggests the herb can be safely used in pregnancy. |
Use with caution | Available human evidence for the herb is limited so it should not be used without consulting a qualified health care practitioner. |
Potentially harmful to use in pregnancy | Available evidence has shown adverse impacts on pregnancy or fetus following the use of the herb |
Information unavailable | No reference was found regarding use of the herb in pregnancy |
Data extraction and management
Results
Selection of studies
Study quality
No. | Study | Quality Assessment Items | Relevance to Current Study | % scorea
| ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | G | H | I | J | |||
1 | Al-Riyami et al. [41] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 70.0 |
2 | Jaradat et al. [17] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 90.0 |
3 | Amasha et al. [18] | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 60.0 |
4 | Hashem Dabaghian et al. [36] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 80.0 |
5 | Hwang et al. [38] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 70.0 |
6 | Orief et al. [49] | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 70.0 |
7 | Rahman et al. [19] | 1 | 0 | 0 | 1 | 1 | 1 | 0 | 1 | 0 | 0 | 50.0 |
8 | Tabatabaee [42] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 80.0 |
Characteristics of studies
(Author. Year) | Study objective | Study location | Study design; source of study subjects | Sample size (Mean age) | Herbal use N (%) |
---|---|---|---|---|---|
Al-Riyami et al. 2011 [41] | To evaluate medication use pattern in a university tertiary hospital in the Sultanate of Oman. | Oman | CSS; using structured questionnaire, women attending antenatal clinic | 139 (28 ± 5) | 33 (23.8%) |
Jaradat et al. 2013 [17] | Aims of this study were to measure the prevalence and predictors of herb use among a group of Palestinian pregnant women and the possible influence of herbal consumption on pregnancy outcomes. | Palestine | CSS; using questionnaire, women in postnatal ward of a public hospital | 300 (NR) | 120 (40%) |
Amasha et al. 2012 [18] | To determine the prevalence of the use of home remedies to relieve pregnancy-related complaints among pregnant Jordanian women. | Jordan | CSS; using a semi-structured questionnaire, women attending antenatal clinic | 332 (NR) | 198 (59.6%) |
Hashem Dabaghian et al. 2012 [36] | To determine the prevalence of herbal medicine use in pregnant women attending some Tehran (Iran) governmental hospitals for prenatal care. | Iran | CSS; using a semi-structured questionnaire, women attending perinatal clinic | 600 (27.03 ± 4.8) | 402 (67%) |
Hwang et al. 2016 [38] | To gain insights into the prevalence and factors leading to the use of complementary and alternative medicine (CAM) among pregnant women in Iraq. | Iraq | CSS; using structured questionnaire, women attending antenatal clinic | 335 (26.1 ± 6.9) | 180 (53.7%) |
Orief et al. 2014 [49] | To elucidate the use of herbal medicines in pregnant women and to explore patterns of herbal medication use including dietary supplements in pregnant women in Alexandria, Egypt. | Egypt | CSS; using questionnaire, women attending family health center | 300 (26.9 ± 4.9) | 82 (27.3%) |
Rahman et al. 2009 [19] | To determine whether the use of herbal medicines during pregnancy is associated with women’s attitude towards herbal medicines, and what are their sociodemographic features. | Malaysia | CSS; using structured questionnaire, women registered with birth registration record were surveyed during child health clinic sessions | 210 (31 ± 6.5) | 110 (52.4%) |
Tabatabaee 2011 [42] | To evaluate the drug utilization pattern during pregnancy in Kazeroon, south of Iran. | Iran | CSS; using structured questionnaire, two days after childbirth at postnatal ward | 513 (25.7 ± 4.7) | 158 (30.8%) |
Total | 2729 | 1283 (47.01%) |
Most frequently used herbal medicines
No. | Herba
| Number of users (Total = 1283) | Route | Time of use (Trimester of gestation)b
| Reported traditional use |
---|---|---|---|---|---|
1 | Peppermint (Mentha piperita)2, 3, 4, 5, 6, 8
| 292 (22.8%) | Oral | 1st, 2nd, 3rd | Flu, cough, heartburn, bloating, flatulence, stomach/abdominal pain, nausea, vomiting, facilitate delivery, relaxation |
2 | Aniseed (Pimpinella anisum)1, 2, 3, 6
| 188 (14.7%) | Oral | 1st, 2nd, 3rd | Flu, cough, stomach/abdominal pain, vomiting, diuretic, chest pain, laxative, flatulence, infections, relaxation |
3 | Olibanum (Frankincense - Boswellia sacra)4, 8
| 166 (12.9%) | Oral | 1st, 2nd | Increasing neonate’s intelligence |
4 | Flixweed seed (Descurainia sophia)4, 8
| 156 (12.2%) | Oral | 3rd | Cold, constipation, prevention of neonatal hyperbilirubinemia |
5 | Ginger (Zingiber officinale)1,2,3,4,5,6,8
| 147 (11.5%) | Oral | 1st, 2nd, 3rd | Flu, cold, cough; nausea, vomiting; weight reduction |
6 | Chamomile (Matricaria chamomilla)2, 5, 8
| 121 (9.4%) | Oral | 1st, 3rd | Flu, cough, stomach/abdominal pain, vomiting, diuretic, chest pain, laxative, flatulence, pharyngitis, relaxation |
7 | Sage (Salvia officinalis)2, 3
| 112 (8.7%) | Oral, vaginal | NR | Flu, vomiting, heartburn, abdominal pain, infections, teeth pain |
8 | Cinnamon (Cinnamomum verum)2, 4, 5, 8
| 100 (7.8%) | Oral | 1st, 2nd, 3rd | Anemia, bloating, stomach/abdominal pain, laxative, facilitate delivery |
9 | Fenugreek (Trigonella foenum-graecum) 2, 3, 6
| 80 (6.2%) | Oral | 1st, 2nd, 3rd | Cough, infections, constipation, piles, |
10 | Black seed (Nigella sativa)1, 3, 5
| 79 (6.2%) | Oral | NR | Colic, gases, nutritional supplement, infections |
11 | Pennyroyal (Mentha pulegium)4
| 78 (6.1%) | Oral | 1st, 2nd, 3rd | Breathing problems |
12 | Coconut oil (Cocos nucifera)7
| 69 (5.4%) | Oral, topical | NR | Nausea, vomiting, heartburn, constipation, smooth body and hair |
13 | Borage (Borago officinalis)4, 8
| 66 (5.1%) | Oral | 1st, 2nd, 3rd | Cold, constipation, tranquilizer |
14 | Thyme (Thymus vulgaris)1, 2, 3, 5
| 56 (4.4%) | Oral | NR | Flu, cough, digestive disorders, infections (pharyngitis, urinary tract, bronchitis) |
15 | Ammi (Ammi visnaga)8
| 50 (3.9%) | Oral | 1st, 2nd, 3rd | Nausea, vomiting, and other gastrointestinal problems |
16 | Chicory (Cichorium intybus)4
| 47 (3.7%) | Oral | 3rd | Prevention of neonatal jaundice |
17 | Green tea (Camellia sinensis)4, 6
| 47 (3.7%) | Oral | 1st, 2nd, 3rd | Sedative |
18 | Chahar tokhmeh [Quince + Alyssum + Greater plantain + Basil] (Cydonia oblonga + Lobularia maritima + Plantago major + Ocimum basilicum)
4
| 41 (3.2%) | Oral | 1st, 2nd, 3rd | Respiratory infections |
19 | Garlic (Allium sativum)5, 6
| 37 (2.9%) | Oral | 1st, 2nd, 3rd | Enhance immune system for herself and healthy baby |
20 | Dates (Phoenix dactylifera)2
| 34 (2.6%) | Oral | NR | Energy, facilitate delivery, laxative |
21 | Castor oil (Ricinus communis)5
| 33 (2.6%) | Oral | NR | Induce labor |
22 | Egyptian willow (Salix aegyptiaca)4
| 32 (2.5%) | Oral | 3rd | Sedative |
23 | Licorice (Glycyrrhiza glabra)4, 5, 8
| 31 (2.4%) | Oral | 1st, 2nd, 3rd | Cold, bloating, stomach-ache |
24 | Basil (Ocimum basilicum)
8
| 28 (2.2%) | Oral | 2nd, 3rd | Prevention of neonatal hyperbilirubinemia |
25 | Oregano (Origanum vulgare)4
| 27 (2.1%) | Oral | 1st, 2nd, 3rd | Cough |
26 | Cumin (Cuminum cyminum)2, 5, 8
| 24 (1.9%) | Oral | 1st, 2nd | Flatulence, abdominal pain, facilitate labor |
27 | Jujube (Zyzyphus jujube)4
| 23 (1.8%) | Oral | 1st | Nausea |
28 | Aloe (Aloe vera)4
| 18 (1.4%) | Topical | 3rd | Skin cracks |
29 | Kacip Fatimah (Labisia pumila)7
| 13 (1.0%) | Oral | NR | Facilitate labor, loss of libido |
30 | Eucalyptus (Eucalyptus globulus)4
| 12 (0.9%) | Inhalation | 1st, 2nd, 3rd | Breathing problems |
31 | Olive oil (Olea europaea)5
| 11 (0.9%) | Oral | NR | Healthy development of fetus |
Indications of using herbal medicines
Safety classification
Sr. | Herb (or mixture) | Study subjects in references studies | Documentation on safety |
---|---|---|---|
Safe to use in pregnancy | |||
1 | Ginger (Zingiber officinale) | Human | |
2 | Garlic (Allium sativum) | Human | |
3 | Dates (Phoenix dactylifera) | Human | One prospective human study did not report any harmful effect on mother and fetus [53]. |
4 | Olive (Olea europaea) | Human | |
5 | Coconut oil (Cocos nucifera) | Human | No health hazards are reported in conjunction with the use of coconut oil as food or drug or even in raw form [28]. |
6 | Aloe (Aloe vera) | Human | |
7 | Peppermint (Mentha piperita) | Human | |
8 | Aniseed (Pimpinella anisum) | Human | |
9 | Olibanum (Frankincense - Boswellia sacra) | Human | |
10 | Chamomile (Matricaria chamomilla) | Human | |
11 | Quince (Cydonia oblonga) | Human | A recent controlled study has shown benefit against mild nausea and vomiting in human pregnancy without any adverse effect [58]. |
12 | Green tea (Camellia sinensis) | Human | |
13 | Eucalyptus (Eucalyptus globulus) | Human | |
Use with caution | |||
1 | Basil (Ocimum basilicum)
| NA | |
2 | Greater plantain (Plantago major) | NA | |
3 | Oregano (Origanum vulgare) | NA | |
4 | Castor oil (Ricinus communis) | Human | |
5 | Jujube (Zyzyphus jujube) | NA | No scientific report available on its use and safety during pregnancy. Evidence regarding safety has not been conclusively established [25]. Therefore, it should be only used in pregnancy with supervision of a qualified health care practitioner. |
Information unavailable about safety in pregnancy | |||
1 | Flixweed seed (Descurainia sophia) | NA | No scientific report available on its use and safety during pregnancy. |
2 | Black seed (Nigella sativa) | NA | No scientific report available on its use and safety during pregnancy in humans. Traditionally believed to slow down or stop uterus from contracting if taken in doses higher than commonly found in food. |
3 | Kacip Fatimah (Labisia pumila) | NA | No scientific report available on its use and safety during pregnancy. |
4 | Cumin (Cuminum cyminum) | NA | |
5 | Chicory (Cichorium intybus) | NA | |
6 | Borage (Borago officinalis) | NA | |
7 | Alyssum (Lobularia maritima) | NA | No scientific report available on its use and safety during pregnancy. |
Potentially harmful in pregnancy | |||
1 | Pennyroyal (Mentha pulegium) | Human | |
2 | Licorice (Glycyrrhiza glabra) | Human | |
3 | Sage (Salvia officinalis) | Human | |
4 | Ammi (Ammi visnaga) | NA | Human or animal studies not available in current literature but its active constituent, khellin, has uterine stimulating activity; therefore, it is contraindicated during pregnancy [61]. |
5 | Thyme (Thymus vulgaris) | NA | |
6 | Fenugreek (Trigonella foenum-graecum) | Animal | |
7 | Cinnamon (Cinnamomum verum) | Animal | |
8 | Egyptian willow (Salix aegyptiaca) | NA |