Disclosure of herbal medicine use to health care providers among pregnant women in Nepal: Does Antenatal Care Matter?

Purpose: Despite the scarcity of the evidence supporting its efficacy and safety, the consumption of herbal medicines (HM) during pregnancy has been widely reported due to the belief that they are safer and more natural. However, certain pharmacological characteristics of herbs can cause a detrimental effect on both pregnant women and the fetus, and because HM use is often self-prescribed and is unsupervised by health professionals, safety issues in HM use remain to be a major public health concern. One of the ways to overcome this issue is to increase patient disclosure of HM use to physicians, as improved physician-patient communication on HM use provides room for appropriate medical intervention when complications/adverse reactions arise from concurrent use of HM and conventional medicine. In Nepal, the use of HM is also widespread and is culturally embedded, yet little is known about the pattern of HM use during pregnancy and whether proper physician-patient communication on HM use has been practiced. Therefore, this study aims to explore the pattern of HM use among pregnant women in Nepal, to identify potential predictors of HM use during pregnancy, and to examine factors associated with physician disclosure on HM use. Methods: A descriptive cross-sectional study was conducted using data from 400 postpartum women at Maternity and Women’s Hospital located in Kathmandu, Nepal from July 4, 2017 to August 12, 2017. All postpartum women aged 15 to 49 were invited to take part in the survey before they were discharged from the hospital. Descriptive statistics were used to describe the sociodemographic and pregnancy-related characteristics of study respondents. A chi-square test was performed to identify differences in sociodemographic and pregnancy-related characteristics between users and non-users of HM. Furthermore, among HM users, a chi-square test was also used to compare pregnancy outcomes between the group who disclosed HM use to physicians and the group who did not. Lastly, a logistic regression analysis was conducted to examine potential predictors of HM use and to identify the factors associated with physician disclosure on HM use. Results: Herbal medicines were used by 241 (60.3%) participants in their previous pregnancy, and travel time to health facility (p=0.045), use of HM prior to previous pregnancy (p<0.001), and gravidity (p=0.018) were significantly associated with HM use in pregnancy. Ginger was the most commonly used modality of HM in Nepal (n=111, 46.1%), and the most commonly reported indications for HM use were cough, cold, flu (72.6%), nausea/vomiting (39.8%), and heartburn/indigestion (23.6%). Overall, 21.6% of HM users reported side effects of HM use in pregnancy, and the most popular source of HM information were family and friends (n=236, 98.3%). The disclosure rate of HM use with healthcare providers was 54.8%, and potential predictors of patient disclosure on HM use were pregnant women’s education level (p=0.022) and the number of antenatal care(ANC) visits (p=0.008). Conclusion: This study found that the use of HM during pregnancy was common in Nepal. However, most women obtained HM-related information from informal sources and did not disclose HM use to physicians. ANC visits and women’s education levels were found to be associated with disclosure of HM use to physicians. This highlights the need for public education and awareness programs on the safe use of HM and encourage pregnant women’s disclosure of HM use. Furthermore, to provide optimal care and promote coordination between HM and conventional medicine, health care providers should stay up to date with the knowledge of HM use.