1Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, No. 1, Section 1, Jen-Ai Road, Taipei 100, Taiwan, R.O.C.
2Department of Nursing, Fooyin University, Kaohsiung, Taiwan, R.O.C.
3Division of Gynecology, Traditional Chinese Medicine, Taipei City Hospital, Taiwan, R.O.C. 4Department of Internal Medicine, National Taiwan
University Hospital, Taipei, Taiwan, R.O.C. 5Department of Nursing, National Taipei College of
Nursing, Taipei, Taiwan, R.O.C. * Correspondence author.
Received: Oct 14, 2004 Accepted: Feb 21, 2005
Prevalence and related factors of Chinese herbal medicine use in
pregnant women of Taipei, 1985-1987
CHAO-HUA CHUANG1,2, JUNG-NIEN LAI1,3, JUNG-DER WANG1,4,
PEI-JEN CHANG5, PAU-CHUNG CHEN1,*
Objectives: The use of herbal medicines during pregnancy is becoming fashionable. The
purpose of this study is to explore the prevalence and related factors of pregnant women using Chinese herbal medicines in Taipei. Methods: During 1985-87, a total of 10,756 pregnant women with 26 or more weeks of gestation who came to the Taipei Municipal Maternal and Child Hospi-tal for prenaHospi-tal care, were interviewed by trained interviewers using structured questionnaires to obtain detailed information. Multiple logistic regressions were used to estimate odds ratios of the dichotomous outcomes such as Chinese herbal medicines, medicines and supplements during dif-ferent time periods. Results: The use of at least one herbal medicine was 6.9% before pregnancy and 42.3% during pregnancy. Before pregnancy, women used significantly more Chinese herbal medicines associated with lower family incomes, primipara, gynecological diseases, and irregular cycles of menstruation. During pregnancy, pregnant women with characteristics of lower education, a non-professional job, previous spontaneous or induced abortion or stillbirth, and women carried HBsAg virus tended to use Chinese herbal medicines. Conclusions: This mid-1980s' survey showed that Chinese herbal medicines were frequently used before and during pregnancy in Taipei women, especially among those with low socio-economic levels. It deserves future studies to clarify their potential health effects on fetuses and enquire about such habits during prenatal care. (Taiwan J
Public Health. 2005;24(4):335-347)
Key Words: Chinese herbal medicine, pregnant women, prevalence, related factors
Traditional medicine or complementary and alternative medicine (TM/CAM) is becoming more widely used in most countries throughout the world [1-7]. One of the popular practices of TM/CAM is herbal medicine [1-8]. Many wom-en use herbal medicines during their pregnancy [9-13], and such practices are considered as part of dietary supplements in the United States . Because use of all kinds of medicines during pregnancy might produce potential adverse ef-fects on mothers and fetuses, such practices raise concerns among public health practitioners and
consumers on the issue of safety and efficacy [9-10,15].
Studies of maternal drug consumption dur-ing pregnancy have been carried out over the last several decades [16-22]. Although many studies have been published on medication used in pregnancy, there was a general lack of evidence for safety and efficacy about use of herbal med-icines in pregnancy. In fact, most of them fo-cused on simple botanical products, i.e. Echina-cea  or Raspberry . Even though the result was not consistent [10,23-24], one animal study demonstrated that ginseng, a commonly used herbal medicine, exerted direct teratogenic effects on rat embryos . Besides, common use of herbal medicine also involved following additional problems, which include misidentifi-cation of herbs, contamination from microbes, heavy metals, or pesticides, might be adulterated with western medicines, and potential herbal toxicity [26-29]. Though such practices may produce potential hazards, it is still becoming fashionable in western countries [1,30].
In addition to the concerned effects of herb-al medicines, policy makers might herb-also be inter-ested in the related factors of such practices among people. Previous studies showed education, health status or philosophies are relat-ed factors associatrelat-ed with using CAM [31-33], especially on the Traditional Chinese Medicine uses in Taiwan . A study conducted in Tai-wan showed that health states and health concern were more influential than gender, age, education, and urbanization of residential areas . In a word, relatively little has been known about the overall prevalence, related factors, and the safety or efficacy of using herbal medicines for preg-nant women. In this study, the prevalence and the related factors of using Chinese herbal medi-cines during pregnancy were examined on a prenatal clinic in a municipal hospital for mater-nal and child health.
MATERIALS AND METHODS
It was a cross-sectional study. Between 1985 and 1987, the study was conducted at the Taipei Municipal Maternal and Child Hospital (TMMCH). Each pregnant woman with 26 or more weeks' gestation who came to this hospital for antenatal care was enrolled into the study and interviewed by three standardized interviewers using structured questionnaires to obtain de-tailed information . A total of 10,756 preg-nant women were recruited from July 1985 to June 1987. The risk factors of industrial and occupational classifications were validated. An exposure validation, which linked job titles with exposures at the workplace was conducted dur-ing the study . One medical assistant re-viewed and abstracted information from medical records of mothers and newborns. Cord blood samples were also collected and blood lead mea-surements were conducted [38-39]. All study participants provided informed consent, which was approved by the National Taiwan Universi-ty College of Public Health Ethics Review Board. Data on maternal age, education, occupation, and family income were obtained from the inter-view questionnaire. Education was stratified into four groups: university and college or above, senior high school, junior high school, and pri-mary school and below. The classifications of occupations were according to the modified Tai-wan version of International Classification of Occupations , which was later summarized into six groups: professional occupations, cleri-cal occupations, sales, services, fabricators, and housewives. Family income was defined as the total parental monthly income (NT$, new Tai-wan dollars, 1 US$ ≈ 33 NT$, in 2004) with four categories: 40,000 or higher, 30,001-40,000, 20,001-30,000, and 20,000 or lower per month. Previous gynecological, obstetric history and irregular cycle of menstruation were ob-tained from the interview questionnaire.
Perina-tal outcomes included previous spontaneous abor-tion or stillbirth, previous induced aborabor-tion, pre-vious LBW (low birth weight) or preterm delivery. Gynecological diseases included uter-us diseases, ovary or fallopian tube diseases and infertility. LBW refers to babies with birthweight below 2,500gm and preterm delivery to babies born before 37 completed weeks (259 days) of gestation , as measured from the first day of the last menstrual period (LMP). Irregular cycle of menstruation was defined as three groups: regular, irregular and uncertainty. Regular group meant the frequency of menstruation differed below seven days.
Laboratory data on the test for hepatitis B virus in the current pregnancy were obtained from the maternal medical records, which were abstracted and coded. The use of Chinese herbal medicines, medicines, and vitamin supplements or iron preparations during prenatal period was obtained from questionnaires on prenatal care visits. Medicines were defined as medication prescribed by doctors for dysfunctional uterine bleeding or oral contraceptive use during one-year period before current pregnancy or medica-tion for nausea or vomiting or treatment for threatened abortion during pregnancy. Chinese herbal medicine was defined as any botanical material or preparation with therapeutic or other human health benefits, which contains either raw or processed ingredients from one or more plants. Materials of inorganic or animal origin may also be present . Supplements were defined as vitamins or iron preparation. The content of interview about herbal medicines was reported previously . In brief, data were gathered on several common and less common Chinese herb-al medicines according to three different time periods: the one year period before pregnancy, the first trimester, and the second and third trimesters. Tiao-Jing-Wan, Jung-Jiang-Tang, and Bai-Fung-Wan were generally taken before preg-nancy only; Ba-Zhen-Tang, Szu-Wu-Tang,
Ginseng, and Huanglian might be taken before and during pregnancy; and An-Tai-Yin/ Shih-San-Wei, and Dang-Gui- Saho-Yao-San were usually taken during pregnancy only. The de-tailed content of Chinese herbal medicines was shown in the appendix.
"Before pregnancy" was the period limited to only one-year before pregnancy. First trimes-ter was defined as the time period from the date of conception (taken as the first date of LMP) to day 90 of gestation, second trimester from day 91 to day 180, and third trimester from day 181 to the date of birth. Pregnancy was defined as the time period from the date of conception to the date of birth .
The frequencies of use of Chinese herbal medicines, medicines, and supplements were first stratified according to different periods of pregnancy. Multiple logistic regression analyses were performed to estimate odds ratio with 95% confidence intervals of these dichotomous out-comes according to different determinants, in-cluding maternal age, maternal education, ma-ternal occupation, family income per month (NT$), parity, previous spontaneous abortion or stillbirth, previous induced abortion, previous LBW or preterm delivery, gynecological disease, irregular cycle of menstruation, and maternal HBsAg test. This study was analyzed using SPSS for Windows, Release 10.0.
Frequency distributions of use of Chinese herbal medicines, medicines and supplements were shown in Table 1. The overall prevalence of pregnant women taking Chinese herbal medi-cines and supplements highly increased. Chi-nese herbal medicines, medicines and supple-ments were 6.9%, 9.5% and 1.1% before pregnancy, and 42.3%, 17.4% and 43.0% during pregnancy accordingly.
co-efficients among the Chinese herbal medicines, medicines, and supplements used before or each trimester was from 0.001 to 0.216. There were 16.1% and 70.2% of pregnant women who used Chinese herbal medicines, medicines, or supple-ments before and during trimesters, respectively as shown in Figure 1. The percentages of all of three, any two, and only one of them used was 0.0%, 0.0%-0.6%, 0.4%-8.8% before pregnancy, and 4.4%, 3.9% -15.8%, and 5.1% -18.9% dur-ing pregnancy, accorddur-ingly.
The characteristics of the subjects we inter-viewed were summarized in Table 2, which also showed the results of multiple logistic regres-sions for various related factors of using differ-ent medicines before and during pregnancy. Most of the subjects were 20 to 34 years old (95.3%) with a senior high school education (49.1%), and family incomes per month were usually above 20,000 NT$ (65.6%). The most popular jobs were clerk (29.4%) and housewives (32.9%). About half of them were nulliparae (49%). The
prevalence of previous spontaneous abortion or stillbirth was 8.8%; that of previous induced abortion was 30.8%; while those of previous LBW or preterm delivery, gynecological diseases, irregular cycles of menstruation were 4.5%, 8.8%, and 20.6%, accordingly. The carri-er rate of hepatitis B virus was 14.2%.
After adjustment for all other covariates, older pregnant women (≥35 years) were signifi-cantly less likely to use medicines before pregnancy. Young pregnant women with an age below 20 had a significantly lower probability of taking Chinese herbal medicines during pregnancy. In general, pregnant women with lower educational level and family income per month were more likely to use Chinese herbal medicines and less to use supplements during pregnancy after adjusting for other covariates. There appeared to be an increased trend of use of Chinese herbal medicines before pregnancy along with decreased monthly family income. Women with professional jobs were significantly less Table 1. Prevalence of Chinese herbal medicines, medicines and supplements use in pregnant women
of Taipei (N=10,756)
Use in pregnant women Before pregnancy First trimester Second and third During pregnancy trimesters
Chinese herbal medicines
Any one 738 (6.9) 1929 (17.9) 3204 (29.8) 4555 (42.3)
For dysfunctional uterine bleeding 325 (3.0) - -
-For treatment for threatened abortion - 1405 (13.1) 2835 (26.4) 3760 (35.0)
For nausea or vomiting - 221 (2.1) 36 (0.3) 244 (2.3)
Other reasons 466 (4.3) 347 (3.2) 380 (3.5) 695 (6.5)
Any one 1020 (9.5) 1629 (15.1) 237 (2.2) 1876 (17.4)
For dysfunctional uterine bleeding 362 (3.4) - -
-Oral contraceptives 687 (6.4) - -
-For treatment of threatened abortion - 1307 (12.2) 213 (2.0) 1495 (13.5)
For nausea or vomiting - 428 (4.0) 28 (0.3) 442 (4.1)
Any one 117 (1.1) 905 (8.4) 4432 (41.2) 4626 (43.0)
Iron preparation 8 (0.1) 27 (0.3) 83 (0.8) 95 (0.9)
Vitamins 91 (0.8) 828 (7.7) 4106 (38.2) 4273 (39.7)
Other micro-nutrients 37 (0.3) 96 (0.9) 418 (3.9) 454 (4.2)
likely to use Chinese herbal medicines during pregnancy compared with all other occupations. As was also shown in Table 2, primipara was significantly more likely to use Chinese herbal medicines and supplements but less likely to use medicines before pregnancy. There ap-peared a decreased trend of use of Chinese herbal medicines, medicines, and supplements along with increased parity during pregnancy.
Before pregnancy, women with irregular cycles of menstruation were more likely to take both medicines and Chinese herbal medicines, but women with gynecological diseases tended to take Chinese herbal medicines. Pregnant wom-en with a previous history of spontaneous abor-tion or stillbirth were less likely to take medicines. Pregnant women with a previous history of in-duced abortion were less likely to take Chinese herbal medicines and supplements, but more likely to take medicines. During pregnancy, the subjects with any previous history of spontane-ous or induced abortion, or stillbirth tended to take both Chinese herbal medicines and medicines. Pregnant women with previous LBW or preterm delivery or gynecological diseases tended to take medicines. However, pregnant
women who were carriers of the hepatitis B virus tended to take Chinese herbal medicines. There was no significant difference in supplements used before (except women with previous in-duced abortion) or during pregnancy, which cor-roborated our prior conjecture. It was interesting to find that pregnant women with a previous history of gynecological problems or diseases tended to use Chinese herbal medicines before pregnancy but they used more western medi-cines during their pregnancy.
We found a high overall prevalence rate (42.3%) of pregnant women using Chinese herb-al medicines during pregnancy in Taiwan, and such uses seemed to increase in frequency during second and third trimesters, which was different from the trend on the use of medicines. As the figure is much higher than those reported outside of this country [9,11-13], we must first assess the representativeness of our sample and the validity of our measurement before reaching any conclusion.
Compared with the national census data Figure 1. Relationship of Chinese herbal medicines, medicines, and supplements used before (left)
Related factors of pregnancy-related Chinese herbal medicines utilization in pregnant women of Taipei (N=10,756)
Before pregnancy During pregnancy Chinese herbal Medicines Supplements Chinese herbal Medicines Supplements medicines aOR (95% CI) aOR (95% CI) medicines aOR (95% CI) aOR (95% CI) Related factors No. (%) aOR (95% CI) aOR (95% CI) Age (years) ≤ 19 161 (1.5) 0.53 (0.23,1.22) 1.32 (0.83,2.12) -0.63 (0.45,0.88) * 0.75 (0.47,1.18) 0.71 (0.50,1.00) 20-34 a 10251 (95.3) 1.00 1.00 1.00 1.00 1.00 1.00 35+ 344 (3.2) 0.96 (0.62,1.51) 0.43 (0.25,0.75) * 0.70 (0.22,2.24) 0.86 (0.69,1.08) 1.24 (0.94,1.64) 1.13 (0.90,1.42) Education University + a 2592 (24.1) 1.00 1.00 1.00 1.00 1.00 1.00
Senior high school
5281 (49.1) 0.95 (0.77,1.19) 1.01 (0.83,1.22) 0.41(0.26,0.66) ## 1.09 (0.98,1.22) 1.10 (0.96,1.27) 0.80 (0.72,0.89) ##
Junior high school
1795 (16.7) 1.19 (0.89,1.57) 1.08 (0.84,1.39) 0.30(0.15,0.61) ** 1.28 (1.11,1.49) # 1.04 (0.85,1.27) 0.59 (0.51,0.69) ## Primary school -1086 (10.1) 1.01 (0.73,1.41) 1.06 (0.79,1.42) 0.36 (0.17,0.80) * 1.34 (1.13,1.59) # 1.12 (0.89,1.40) 0.52 (0.44,0.62) ## Occupation Professional a 919 (8.5) 1.00 1.00 1.00 1.00 1.00 1.00 Clerical 3158 (29.4) 1.00 (0.73,1.38) 0.87 (0.67,1.14) 1.02 (0.50,2.06) 1.32 (1.12,1.55) # 1.06 (0.87,1.30) 1.03 (0.88,1.20) Sales 1160 (10.8) 1.10 (0.75,1.60) 0.98 (0.71,1.35) 0.99 (0.40,2.43) 1.35 (1.12,1.64) ** 0.88 (0.69,1.13) 0.87 (0.72,1.05) Services 421 (3.9) 1.13 (0.69,1.85) 1.10 (0.74,1.63) 0.44 (0.05,3.56) 1.43 (1.11,1.84) ** 1.24 (0.91,1.70) 1.22 (0.95,1.57) Fabricators 1559 (14.5) 1.02 (0.70,1.49) 0.83 (0.60,1.14) 0.80 (0.30,2.19) 1.48 (1.22,1.79) ## 1.00 (0.78,1.27) 0.95 (0.79,1.15) Housewives 3539 (32.9) 0.99 (0.70,1.38) 0.96 (0.72,1.27) 1.46 (0.71,3.02) 1.26 (1.06,1.50) ** 0.99 (0.80,1.23) 0.92 (0.78,1.09)
Family income per month (NT$) 40,001+
a 1086 (10.1) 1.00 1.00 1.00 1.00 1.00 1.00 30,001-40,000 2117 (19.7) 1.22 (0.88,1.70) 1.00 (0.77,1.31) 1.53 (0.76,3.08) 0.94 (0.80,1.10) 1.09 (0.89,1.34) 0.93 (0.80,1.08) 20,001-30,000 3846 (35.8) 1.41 (1.02,1.93) * 0.94 (0.73,1.22) 1.68 (0.84,3.36) 1.07 (0.92,1.24) 1.11 (0.91,1.35) 0.90 (0.78,1.05) ≤ 20,000 2764 (25.7) 1.53 (1.10,2.14) * 0.93 (0.71,1.22) 1.59 (0.74,3.42) 1.09 (0.93,1.27) 1.01 (0.82,1.25) 0.82 (0.70,0.96) * Unknown 942 (8.8) 1.34 (0.90,1.99) 0.92 (0.66,1.27) 1.82 (0.74,4.48) 1.16 (0.96,1.41) 1.24 (0.97,1.60) 0.76 (0.63,0.92) ** Parity 0 a 5267 (49.0) 1.00 1.00 1.00 1.00 1.00 1.00 1 4020 (37.4) 1.54 (1.29,1.84) ## 0.84 (0.72,0.99) * 7.27 (4.17,12.69) ## 0.76 (0.69,0.83) ## 0.78 (0.69,0.88) ## 0.74 (0.68,0.81) ## 2+ 1303 (12.1) 1.29 (0.97,1.71) 1.05 (0.82,1.34) 3.31(1.43,7.66) ** 0.73 (0.63,0.84) ## 0.52 (0.43,0.64) ## 0.59 (0.51,0.69) ##
Related factors of pregnancy-related Chinese herbal medicines utilization in pregnant women of Taipei (N=10,756) (conti
nued) Before pregnancy During pregnancy Chinese herbal Medicines Supplements Chinese herbal Medicines Supplements medicines aOR (95% CI) aOR (95% CI) medicines aOR (95% CI) aOR (95% CI) Related factors No. (%) aOR (95% CI) aOR (95% CI)
Previous spontaneous abortion or stillbirth Never
a 9645 (89.7) 1.00 1.00 1.00 1.00 1.00 1.00 Ever 947 (8.8) 1.13 (0.88,1.45) 0.68(0.52,0.89) ** 0.86 (0.46,1.62) 1.22 (1.07,1.41) ** 1.92 (1.64,2.25) ## 1.12 (0.98,1.29)
Previous induced abortion Never
a 7272 (67.6) 1.00 1.00 1.00 1.00 1.00 1.00 Ever 3318 (30.8) 0.64 (0.53,0.76) ## 1.18 (1.03,1.36) * 0.44 (0.28,0.71) # 1.12 (1.03,1.22) ** 1.71 (1.54,1.90) ## 1.05 (0.97,1.15)
Previous low birthweight or preterm delivery Never
a 10276 (95.5) 1.00 1.00 1.00 1.00 1.00 1.00 Ever 480 (4.5) 1.05 (0.74,1.51) 1.19 (0.85,1.65) 1.17 (0.58,2.35) 1.15 (0.95,1.40) 1.30 (1.01,1.66) * 1.09 (0.90,1.34) Gynecological diseases No a 9811 (91.2) 1.00 1.00 1.00 1.00 1.00 1.00 Yes 945 (8.8) 1.43 (1.12,1.82) ** 0.95 (0.75,1.20) 1.10 (0.67,1.68) 1.10 (0.96,1.26) 1.63(1.39,1.91) ## 1.13 (0.98,1.30)
Irregular cycle of menstruation No
a 8544 (79.4) 1.00 1.00 1.00 1.00 1.00 1.00 Yes 2212 (20.6) 1.59 (1.34,1.89) ## 2.38 (2.07,2.74) ## 1.06 (0.67,1.68) 1.07 (0.97,1.18) 0.98 (0.87,1.11) 0.98 (0.89,1.08)
Maternal HBsAg test Negative
a 8664 (80.6) 1.00 1.00 1.00 1.00 1.00 1.00 Positive 1522 (14.2) 1.10 (0.89,1.35) 0.94 (0.78,1.14) 1.10 (0.66,1.83) 1.12 (1.00,1.25) * 1.03 (0.89,1.19) 0.99 (0.88,1.10) No results 403 (3.7) 0.94 (0.63,1.42) 0.91 (0.64,1.30) 0.79 (0.25,2.54) 1.14 (0.93,1.40) 1.19 (0.92,1.53) 1.21 (0.98,1.48)
Abbreviations: aOR: adjusted odds ratio; CI: confidence interval; HbsAg: hepatitis B virus surface antigen; NT$: new Taiwan dol
lars. a: Reference category; *: p < 0.05; **: p < 0.01; #: p < 0.001; ##: p < 0.0001
during the period of 1985-1987 , our sample seemed to have a higher proportion of women with an education of senior high school or above (73.2 % versus 34.7%), employment (67.1% versus 45.4%) and professional job (8.5% versus 0.5%). According to the Table 2, women with longer period of education were less likely to use Chinese herbal medicine after controlling other potential confounders. Thus, the prevalence rate in this study probably underestimates the real figure. Moreover, since our study only recruited pregnant women after 26 weeks of gestation, we were unable to evaluate any pregnancy with an outcome of spontaneous or induced abortion during early stage of pregnancy. Because preg-nancy outcomes with any sign of threatened abortion were usually referred to a doctor for treatment, we might have also slightly underes-timated the use of both Western and Chinese herbal medicines as some of these cases were not included if actual abortion occurred later on. However, all the information on use of medi-cines was obtained before the delivery of new-born baby, so the recall bias might be only minimal, if it exists. And, a lot of work was simultaneously conducted to assure the quality of data collected from interviews, including val-idation of occupational exposure of husband's  and that of subject's, as well as the pregnan-cy history . Therefore, measurement errors were assumed minimal. Since random misclassi-fication generally leads toward a null effect , the odds ratio for related factors of use of herbal medicines were at most underestimated.
One of the most probable reasons for such a high prevalence rate of Chinese herbal medi-cines use was the culture effect . Taiwanese people who take Chinese herbal medicines gen-erally consider that they can improve health or change the constitution of human body before pregnancy, or may help fetal growth and prevent premature delivery. Thus, we were not surprised to discover that women with a previous history of
irregular cycle of menstruation or gynecological diseases were more likely to take Chinese herbal medicines before pregnancy. Some of them prob-ably also tried to use Chinese herbal medicines during pregnancy to prevent recurrent spontane-ous abortion or stillbirth, or improve sero-con-version of viral hepatitis B, as shown in Table 2. The prevalence rates of the subjects with diabetes, hypertension, and hemorrhage during pregnancy were 0.2%, 0.7% and 0.6%, respectively, and were not related to the use of Chinese herbal medicines, medicines, and supplements in preg-nancy (data not shown).
There was a low prevalence of women who used Chinese herbal medicines, medicines, or supplements together before pregnancy or in each trimester of pregnancy. However, 20.2% of the pregnant women in our study used both Chinese herbal medicines and supplements in different trimesters. Therefore, we found similar related factors including parity, previous abor-tion or stillbirth, pervious low birthweight or preterm delivery, and gynecological diseases with the exception of education. This phenome-non did not exist in the pregnant women who used either Chinese herbal medicines and med-icines (8.5%) or medmed-icines and supplements (8.3%).
According to traditional Taiwanese custom, women are taught by their mothers or mother-in-laws to take Chinese herbal medicines such as Sheng-Hua-Tang  and Szu-Wu-Tang to re-cuperate from the delivery of a newborn baby. Such a practice usually lasts from the date of childbirth to more than one month after delivery. Our data showed that multipara used more Chi-nese herbal medicines and supplements before pregnancy than nullipara might be the findings resulting from the above practice. There was an increased trend of using medicines, Chinese herb-al medicines, and supplements in nullipara dur-ing pregnancy, which might be related to the
more cautious attitude and anxiety about their first pregnancy. Young pregnant women with an age below 20 were found less likely to take herbal medicines than older women during pregnancy, which might partially be explained by the reduced influence from her family (including their mothers) because of leaving home early.
Women with lower education were found to use more Chinese herbal medicines, but less supplements during pregnancy, while subjects with a higher family income or a professional job used less Chinese herbal medicine before and during pregnancy, respectively. Comparing to other CAM studies [11,31-32], our study showed an almost completely reversed trend. One of the major reasons was that Western women of high socio-economic levels might have a greater op-portunity to receive new foreign knowledge and use herbal medicines earlier, while taking Chi-nese herbal medicines before or during pregnan-cy and after delivery is a traditional culture for Taiwanese.
Since the data of this study were collected in mid-1980, it raised a concern whether such prac-tices have persisted so far. After 1995, the Chi-nese herbal medicine was included in the Taiwan National Health Insurance. According the Na-tional Health Insurance data, the frequency ra-tios of using Chinese herbal medicine and West-ern medicine outpatient services among patients with complications of pregnancy, childbirth and the puerperium increased consistently during 1998-2002 and were 0.027, 0.028, 0.033, 0.034, and 0.055 accordingly . In addition, there has been no special movement among people or any governmental regulation change on the use of Chinese herbal medicines in pregnancy dur-ing the last two decades. Thus, our study still provided important information about the com-mon practice of use of Chinese herbal medicines in pregnant women in Taiwan.
There is another major difference on the use
of herbal medicines between Western countries and those of traditional Chinese medicines, which usually comprise multiple products from plants and animals and can usually be purchased from local Chinese herbal stores [28,43], as also shown in appendix of this study. Moreover, we found that overall 75% of pregnant women directly bought their Chinese herbal medicines from lo-cal Chinese herbal stores. For example, 98% of Huanglian which pregnant women used was obtained from the Chinese herbal stores without any prescription. This phenomenon reminded us that it is crucial for hospital staff to enquire about such habits during prenatal care.
In conclusion, this 1980s' survey showed that Chinese herbal medicines were frequently used before and during pregnancy in Taipei women, especially among those with low socio-economic level. It deserves future studies to clar-ify their potential health effects on fetuses and enquire about such habits during prenatal care.
This study was partly supported by the grants from the Bureau of Health Promotion, Department of Health, Taiwan (BHP-PHRC-92-4 and DOH93-HP-1702).
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The using time and the major category of herbal medicines: Only before pregnancy:
1. Tiao-Jing-Wan ( !a compound product; pill): Rehmanniae Radixet Rhizom, Citrus Sinensis Exocarpium, Eucommiae Cortex, Ligustici Rhizoma, Paeoniae Lactiflorae Radix, Angelicae Radix, Cistanchis Caulis, Foeniculi Fructus, Corydails Tuber, Citrus Undeveloped Exocarpiu, Linderae Radix, Cyperi Rhizoma, Scutellariae Radix, Sepiae Os, and Honey.
2. Jung-Jiang-Tang ( !a compound product; decoction): PaeoniaeLactifloraeRadix, Angelicae Radix, Cinnamomi Cortex, Ligustici Rhizoma, Atractylodis Rhizoma, Hoelen, Moutan Radicis Cortex, CitrusSinensisExocarpium, Cyperi Rhizoma, Rehmanniae Radixet Rhizom, Glycyrrhizae Radix, Persicae Semen, Coptidis Rhizoma , Zingiberis Rhizoma, Caryophylli Flos, and Ginseng Radix.
3. Bai-Fung-Wan ( !a compound product; pill): Cyperi Rhizoma, Atractylodis Rhizoma, Astragali Radix, Ginseng Radix, Ligustici Rhizoma, Hoelen, Angelicae Radix, Zingiberis Rhizoma, Cyperi Rhizoma, Foeniculi Fructus, Paeoniae Lactiflorae Radix, Cinnamomi Cortex, Psoraleae Ftuctus, Artemisiae Argyi Folium, Linderae Radix, Glycerrhizae Radix, and Evodiae Fructus.
Before and during pregnancy:
1. Ba-Zhen-Tang ( !a compound product; decoction): Angelicae Sinensis Radix, Chuanxiong Rhizoma, Paeoniae Alba Radix, Rehmanniae Radixet Rhizoma, Ginseng Radix, Atractylodis Macrocephalae Rhizoma, Poria, Glycyrrhizae Radix, Zingiberis Rhizoma, and Jujubae Fructus. 2. Szu-Wu-Tang ( !a compound product; decoction): Rehmanniae Radix, Paeoniae Radix,
Angelicae Sinensis Radix, and Chuanxiong Rhizoma. 3. Ginseng ( a single product): Ginseng Radix.
4. Huanglian ( a single product; capsule): Coptidis Rhizoma. Only during pregnancy:
1. An-Tai-Yin/ Shih-San-Wei ( !"#$%a compound product; decoction): Fritillariae Bulbus, Z i n g i b e r R h i z o m a , A n g e l i c a e R a d i x , G l y c y r r h i z a e R a d i x , L i g u s t i c i R h i z o m a , PaeoniaeLactifloraeRadix, Astragali Radix, Notopterygii Rhizoma, Magnoliae Cortex, Schizonepetae Herba, Citri Immaturus Fructus, Artemisiae Argyi Folium, and Cuscutae Semen.
2. Dang-Gui-Saho-Yao-San ( !"#a compound product; powder): Angelicae Radix, Paeoniae Lactiflorae Radix, Hoelen, AlismatisRhizoma, Ligustici Rhizoma, and Atractylodis Rhizoma.