Patient-physician communication on herbal medicine use during pregnancy: a systematic review and meta-analysis

Abstract

Introduction: Lack of transparent communication between patients and physicians regarding the use of herbal medicine (HM) presents a major public health challenge, as inappropriate HM use poses health risks. Considering the widespread use of HM and the risk of adverse events, it is crucial for pregnant women to openly discuss their HM use with healthcare providers. Therefore, this systematic review and meta-analysis aims to estimate the pooled prevalence of pregnant women's HM use and disclosure to healthcare providers and to examine the relationship between HM disclosure and various maternal and child health (MCH) measures.

Methods: A systematic search of five databases was conducted for cross-sectional studies on HM use during pregnancy published from 2000 to 2023. Data extraction followed a standardised approach, and Stata V.16.0 was used for data analysis. Also, Spearman's correlation coefficient was calculated to examine the association between use and disclosure of HM and various MCH indicators.

Results: This review included 111 studies across 51 countries on the use of HM among pregnant women. Our findings showed that 34.4% of women used HM during pregnancy, driven by the perception that HM is presumably safer and more natural than conventional medical therapies. However, only 27.9% of the HM users disclosed their use to healthcare providers because they considered HM as harmless and were not prompted by the healthcare providers to discuss their self-care practices. Furthermore, a significant correlation was observed between HM disclosure and improved MCH outcomes.

Conclusion: Inadequate communication between pregnant women and physicians on HM use highlights a deficiency in the quality of care that may be associated with unfavourable maternal outcomes. Thus, physician engagement in effective and unbiased communication about HM during antenatal care, along with evidence-based guidance on HM use, can help mitigate the potential risks associated with inappropriate HM use.

Keywords: Health education and promotion; Health policy; Maternal health; Public Health; Systematic review.

Figure 1

Flow diagram of search strategy.

Figure 2

Pooled prevalence of pregnant women’s HM use. Forest plot of random effect meta-analysis. A total of 111 studies reporting the prevalence of pregnant women’s HM use were included for the pooled estimation of HM use. The black diamond dots and dashed line passing through represent the effect size and corresponding 95% CI reported in individual studies, and the green diamond on the bottom and the size of its lateral tips denote the pooled effect size and its 95% CI.

Figure 3

Map of prevalence estimates of herbal medicine use by country. The 111 studies included in this review reported the prevalence of HM use across 51 different countries. Darker colours represent a higher prevalence of HM use.

Figure 4

Correlation between HM utilisation or disclosure rate (%) and MCH indicators. (A) maternal mortality rate (per 100 000 live births), (B) neonatal mortality rate (per 1000 live births), (C) the proportion of births attended by skilled health personnel (%) and (D) antenatal care coverage—at least four visits (%). Scatter plot between the prevalence of HM use or disclosure (x-axis) and MCH indicators (y-axis). The blue dots represent the estimation of various MCH indicators of the study setting at the time each study was conducted. The red line denotes the fitted line of each plot.

Figure 5

Pooled prevalence of pregnant women’s disclosure of HM use. Forest plot of random effect meta-analysis. Out of 111 studies on pregnant women’s HM use, 21 studies reported the HM disclose rate and were included for the pooled estimation of HM disclosure. The black diamond dots and dashed line passing through represent the effect size and corresponding 95% CI reported in individual studies, and the green diamond on the bottom and the size of its lateral tips denote the pooled effect size and its 95% CI.