Dietary supplements in preconception care
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Dietary Supplements in Preconception Care. Paula Gardiner MD MPH Katherine Gergen-Barnett MD Christine Pecci MD Brian Jack MD Boston University Medical School. How are herbs regulated in the U.S. ?. DSHEA’s Definition of Dietary Supplements.

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Dietary Supplements in Preconception Care

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Dietary supplements in preconception care

Dietary Supplements in Preconception Care

Paula Gardiner MD MPH

Katherine Gergen-Barnett MD

Christine Pecci MD

Brian Jack MD

Boston University Medical School


How are herbs regulated in the u s

How are herbs regulated in the U.S. ?


Dshea s definition of dietary supplements

DSHEA’s Definition of Dietary Supplements

  • Product (other than tobacco) that contains one or more of the following dietary ingredients:

    • a vitamin, mineral, herb or other botanical, or amino acid

    • a dietary substance for use by man to supplement the diet by increasing the total daily intake, or a concentrate, metabolite, constituent, extract, or combinations of these ingredients


1994 dietary supplement health and education act

1994 Dietary Supplement Health and Education Act

  • Supplements can be marketed without testing efficacy

  • Safety need not be proved before marketing

  • Require good manufacturing practices

  • Structure/function product claims allowed

  • Label claims do not require extensive evidence

  • FDA approval not needed for marketing claims


Various forms

Various Forms

  • Oral

    • Encapsulated or tablet

    • Tinctures

    • Dried herb

    • Raw whole herb

    • Infusion (e.g. tea)

    • Decoction (boiled down tea)

  • Topical

    • Ointments

    • Essential Oils

    • Creams

    • Powders

    • Plasters

    • Poultices


Which supplements are women using

Which supplements are women using ?


Dietary supplements in preconception care

Overall Herbal Therapy Use in the U.S.

1997 (2)

2007 (4)

1990 (1)

2002 (3)

U.S. Adult Population Using Herbal Therapies

(1) Eisenberg DM et al. NEJM 1993; 1998

(3) Kaufman et al. JAMA 2002;287:337-44.

(4) NHIS (Barnes et al. CDC No. 343, 2002).

(5) NHIS (Barnes et al. CDC 2007).


Disclosure of dietary supplements use to medical professional

Disclosure of Dietary Supplements Use to Medical Professional

  • 35% of adults taking herbs share this information with a health care professional

    • Cohen RJ, et al, Gardiner P et al, Blendon RJ, et al.


What about preconception

What about preconception?


Specific aims

Specific Aims

  • Factors associated with herb usage in women ages 18 to 45 (N=9067)

  • Rates of specific herb use

  • Rate of discussion of herb use with medical professionals


Methods

Methods

  • Secondary database analysis

  • National Health Interview Survey (2002)

    • The NHIS is an in-person household survey conducted by the Census Bureau for the National Center for Health Statistics

  • U.S. adults in civilian, non-institutionalized household population

  • 31,044 adults interviewed


Outcome variable

Outcome Variable

“DURING THE PAST 12 MONTHS, did you use natural herbs for your own health or treatment?”

  • 20% of women of reproductive age in the U.S. used an herb in the prior 12 months (n=1827)


Disclosure of herb use to conventional professional

Disclosure of Herb Use to Conventional Professional

  • 33 % of herb users disclosed their herb use to conventional medical professionals

  • 26% of women with chronic conditions used an herb in the last 12 months.


Outcome use of herbs multivariate regression

Outcome: Use of herbs Multivariate Regression

Age, years

  • 18-29 - reference

  • 30-45 1.18 [1.03, 1.35]

  • Model was adjusted for race, income, over the counter and prescription medication use, and own health status


Outcome use of herbs multivariate regression1

Outcome: Use of herbs Multivariate Regression

  • Education Level

    • < High School - reference

    • High School 1.41 [1.09, 1.82]

    • Some College 1.76 [1.39, 2.23]

    • College Grad 2.44 [1.89, 3.14]


Outcome use of herbs multivariate regression2

Outcome: Use of herbs Multivariate Regression

  • Region

    • Northeast - reference

    • Midwest 0.77 [0.63, 0.93]

    • South 0.82 [0.68, 0.98]

    • West 1.41 [1.16, 1.71]

  • Insurance

    • Yes - reference

    • No 1.26 [1.08, 1.48]


Outcome use of herbs multivariate regression3

Outcome: Use of herbs Multivariate Regression

  • Alcohol use in last 12 months

    • None - reference

    • Infrequent/light 1.43 [1.22, 1.66]

    • Moderate/heavy 1.66 [1.33, 2.06]

    • Unknown status 0.91 [0.54, 1.54]

  • Smoking Status

    • Never - reference

    • Current 1.18[1.01, 1.39]

    • Former 1.51 [1.26, 1.81]


Outcome use of herbs multivariate regression4

Outcome: Use of herbs Multivariate Regression

  • Physical activity

    • Low - reference

    • Moderate 1.53[1.28, 1.84]

    • High 2.07[1.79, 2.39]


Conclusions

Conclusions

  • Nearly one in five women of reproductive age report using an herb in the last 12 months

  • Most commonly used herbs were: echinacea (46%), ginseng (21%), gingko (17%), and garlic (15%)

  • 33 % inform medical professionals about their use of natural herbs.

  • Factors were associated with herb use include: being older, uninsured, high physical activity, drinking alcohol, being a former smoker, living in the West, and being highly educated


What about pregnant women

What about pregnant women?


Boston medical center bmc

Boston Medical Center (BMC)

Methods - a pilot cross-sectional survey of post-partum inpatients (n=160) and a chart review of birth outcomes English speaking, over 18 years old

Patients were asked about: “herbs, plant medicines, and home remedies” use during pregnancy

Outcomes - disclosure of herbal use with prenatal health care providers

satisfaction with their providers’ counseling on herbs


Post partum bmc

Post Partum BMC

  • Age - 18-44 years of age

  • Education - 17% < than high school; 40% high school graduates; 43% some college

  • 65% - English is the primary language

  • 44% - Born outside of the United States


Racial ethnic groups

Racial Ethnic Groups


Prevalence

Prevalence

  • 43 % Herb use during pregnancy

  • 65 % prenatal vitamins during pregnancy


Dietary supplements in preconception care

Specific Herb Use


Other products

Green Tea

Cranberry

Mother’s tea

Pregnancy Tea

Blue cohosh

Floridix

Haitian Tea

Coconut juice

Lemon

Vitamin E

Cinnamon

Olive leaf

Cloves

Black seed

Black seed’s in wine

Omega fatty acids

Other products


Is it documented in the chart

Is it documented in the chart?


Disclosure of herb use to prenatal provider

Disclosure of Herb Use to Prenatal Provider

  • 19 % discussed their herb use with their prenatal care provider

    • 36% herb users

  • Of those who did discuss herb use, only 9% of women were satisfied with their providers counseling about herbs

    • 19% herb users


Limitations

Limitations

  • English only

  • Term “herbs, plant medicines, and home remedies” may have been misleading to respondents leading to under reporting

  • Small sample size


Final conclusions

Final Conclusions

  • Pregnant women use herbs

  • Many do not talk with their health care providers

  • Use a variety of different herbs

  • Difficult to study

  • Safety is a concern


Questions

Questions


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