Ask pregnant patients about alternative products, practices

SAN FRANCISCO – Only 29% of pregnant women who were taking complementary and alternative medication products, such as dietary supplements, had discussed them with their doctor, judging from the findings of one recent study of 500 patients.

"This is really important. We should talk to our patients about their use of integrative medicine," Margaret A. Chesney, Ph.D. said.

The safety of most complementary and alternative medication (CAM) products on the market is assumed, not proved. The products are not standardized, their labeling may not be accurate, and some products are contaminated, particularly dietary supplement products from China, she said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

The study found that 28% of 250 obstetric patients in a faculty-led practice and 9% of 250 obstetric patients in a resident-led practice were using CAM products. Of the women using the products, 29% said they had spoken with their health care provider about their use (J. Reprod. Med. 2012;57:390-6). Older women and whites were more likely to use CAM products, which may be related to socioeconomic status, said Dr. Chesney, director of the university’s Osher Center for Integrative Medicine.

Published studies of the utility of CAM during pregnancy are few and preliminary, but their findings suggest that ginger may help nausea in pregnancy, yoga might help reduce pain and discomfort, and mindfulness-based stress reduction techniques could reduce pregnancy-related anxiety and depression. Acupuncture, on the other hand, did not seem to help with infertility, and there’s no evidence to support claims of it helping labor pain, she said.

Ginger was effective as vitamin B₆ in reducing first-trimester nausea, retching, and vomiting in a randomized, controlled trial involving 291 patients who were less than 16-weeks pregnant. The women took either 350 mg ginger or 25 mg vitamin B₆ three times per day for 3 weeks. Nausea and vomiting were assessed at 7, 14, and 21 days (Obstet. Gynecol. 103:639-45). The investigators made their own ginger pills by loading capsules with crystallized ginger, Dr. Chesney noted.

The findings need to be replicated, "but there are not a lot of bad side effects from ginger, so it’s something to consider" for patients experiencing nausea in pregnancy, she said.

A review of three poorly designed randomized, controlled trials of yoga in 298 pregnancy women suggests that yoga might significantly reduce pain, discomfort, and perceived stress and improve scores for physical domain in quality of life measures during pregnancy, but the studies’ designs did not meet guidelines from the Consolidated Standard of Reporting Trials.

Despite claims that acupuncture can help improve fertility, there was no difference in pregnancy rates in 160 women who were undergoing in vitro fertilization who were randomized to treatment with acupuncture or a sham procedure, a randomized, double-blind study found (Fertil. Steril. 2011;95:583-7). No good evidence is available to support separate claims that acupuncture can reduce labor pain, Dr. Chesney added.

A pilot study of 27 pregnant women who participated in nine weekly classes and a retreat to learn mindfulness-based stress reduction techniques found that their scores for mindfulness and positive affect significantly increased, with decreases in scores for pregnancy anxiety, depression, and negative affect at the end of the trial compared with the start (J. Child Fam. Stud. 2010;19:190-202).

That preliminary evidence was good enough that the National Institutes of Health are funding a larger study of mindfulness-based stress reduction in pregnancy, she said.

Dr. Chesney reported having no financial disclosures.

[email protected]

On Twitter @sherryboschert

SAN FRANCISCO – Only 29% of pregnant women who were taking complementary and alternative medication products, such as dietary supplements, had discussed them with their doctor, judging from the findings of one recent study of 500 patients.

"This is really important. We should talk to our patients about their use of integrative medicine," Margaret A. Chesney, Ph.D. said.

The safety of most complementary and alternative medication (CAM) products on the market is assumed, not proved. The products are not standardized, their labeling may not be accurate, and some products are contaminated, particularly dietary supplement products from China, she said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

The study found that 28% of 250 obstetric patients in a faculty-led practice and 9% of 250 obstetric patients in a resident-led practice were using CAM products. Of the women using the products, 29% said they had spoken with their health care provider about their use (J. Reprod. Med. 2012;57:390-6). Older women and whites were more likely to use CAM products, which may be related to socioeconomic status, said Dr. Chesney, director of the university’s Osher Center for Integrative Medicine.

Published studies of the utility of CAM during pregnancy are few and preliminary, but their findings suggest that ginger may help nausea in pregnancy, yoga might help reduce pain and discomfort, and mindfulness-based stress reduction techniques could reduce pregnancy-related anxiety and depression. Acupuncture, on the other hand, did not seem to help with infertility, and there’s no evidence to support claims of it helping labor pain, she said.

Ginger was effective as vitamin B₆ in reducing first-trimester nausea, retching, and vomiting in a randomized, controlled trial involving 291 patients who were less than 16-weeks pregnant. The women took either 350 mg ginger or 25 mg vitamin B₆ three times per day for 3 weeks. Nausea and vomiting were assessed at 7, 14, and 21 days (Obstet. Gynecol. 103:639-45). The investigators made their own ginger pills by loading capsules with crystallized ginger, Dr. Chesney noted.

The findings need to be replicated, "but there are not a lot of bad side effects from ginger, so it’s something to consider" for patients experiencing nausea in pregnancy, she said.

A review of three poorly designed randomized, controlled trials of yoga in 298 pregnancy women suggests that yoga might significantly reduce pain, discomfort, and perceived stress and improve scores for physical domain in quality of life measures during pregnancy, but the studies’ designs did not meet guidelines from the Consolidated Standard of Reporting Trials.

Despite claims that acupuncture can help improve fertility, there was no difference in pregnancy rates in 160 women who were undergoing in vitro fertilization who were randomized to treatment with acupuncture or a sham procedure, a randomized, double-blind study found (Fertil. Steril. 2011;95:583-7). No good evidence is available to support separate claims that acupuncture can reduce labor pain, Dr. Chesney added.

A pilot study of 27 pregnant women who participated in nine weekly classes and a retreat to learn mindfulness-based stress reduction techniques found that their scores for mindfulness and positive affect significantly increased, with decreases in scores for pregnancy anxiety, depression, and negative affect at the end of the trial compared with the start (J. Child Fam. Stud. 2010;19:190-202).

That preliminary evidence was good enough that the National Institutes of Health are funding a larger study of mindfulness-based stress reduction in pregnancy, she said.

Dr. Chesney reported having no financial disclosures.

[email protected]

On Twitter @sherryboschert

SAN FRANCISCO – Only 29% of pregnant women who were taking complementary and alternative medication products, such as dietary supplements, had discussed them with their doctor, judging from the findings of one recent study of 500 patients.

"This is really important. We should talk to our patients about their use of integrative medicine," Margaret A. Chesney, Ph.D. said.

The safety of most complementary and alternative medication (CAM) products on the market is assumed, not proved. The products are not standardized, their labeling may not be accurate, and some products are contaminated, particularly dietary supplement products from China, she said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

The study found that 28% of 250 obstetric patients in a faculty-led practice and 9% of 250 obstetric patients in a resident-led practice were using CAM products. Of the women using the products, 29% said they had spoken with their health care provider about their use (J. Reprod. Med. 2012;57:390-6). Older women and whites were more likely to use CAM products, which may be related to socioeconomic status, said Dr. Chesney, director of the university’s Osher Center for Integrative Medicine.

Published studies of the utility of CAM during pregnancy are few and preliminary, but their findings suggest that ginger may help nausea in pregnancy, yoga might help reduce pain and discomfort, and mindfulness-based stress reduction techniques could reduce pregnancy-related anxiety and depression. Acupuncture, on the other hand, did not seem to help with infertility, and there’s no evidence to support claims of it helping labor pain, she said.

Ginger was effective as vitamin B₆ in reducing first-trimester nausea, retching, and vomiting in a randomized, controlled trial involving 291 patients who were less than 16-weeks pregnant. The women took either 350 mg ginger or 25 mg vitamin B₆ three times per day for 3 weeks. Nausea and vomiting were assessed at 7, 14, and 21 days (Obstet. Gynecol. 103:639-45). The investigators made their own ginger pills by loading capsules with crystallized ginger, Dr. Chesney noted.

The findings need to be replicated, "but there are not a lot of bad side effects from ginger, so it’s something to consider" for patients experiencing nausea in pregnancy, she said.

A review of three poorly designed randomized, controlled trials of yoga in 298 pregnancy women suggests that yoga might significantly reduce pain, discomfort, and perceived stress and improve scores for physical domain in quality of life measures during pregnancy, but the studies’ designs did not meet guidelines from the Consolidated Standard of Reporting Trials.

Despite claims that acupuncture can help improve fertility, there was no difference in pregnancy rates in 160 women who were undergoing in vitro fertilization who were randomized to treatment with acupuncture or a sham procedure, a randomized, double-blind study found (Fertil. Steril. 2011;95:583-7). No good evidence is available to support separate claims that acupuncture can reduce labor pain, Dr. Chesney added.

A pilot study of 27 pregnant women who participated in nine weekly classes and a retreat to learn mindfulness-based stress reduction techniques found that their scores for mindfulness and positive affect significantly increased, with decreases in scores for pregnancy anxiety, depression, and negative affect at the end of the trial compared with the start (J. Child Fam. Stud. 2010;19:190-202).

That preliminary evidence was good enough that the National Institutes of Health are funding a larger study of mindfulness-based stress reduction in pregnancy, she said.

Dr. Chesney reported having no financial disclosures.

[email protected]

On Twitter @sherryboschert