Altmed Watch

ALTMED WATCH
The latest research on complementary and alternative medicine

How many pregnant patients use herbal remedies?

To answer that question, Harvard researchers surveyed about 1,200 expectant women around their 20th week. Among the 734 respondents, about 7% were using herbals—17.1% in older parturients (41 and 50 years of age)—with the most common choices being echinacea, St. John's wort, and ephedra. That's far less than the 22% reported in a general presurgical population. But on a more disturbing note, only 14.6% thought of these supplements as medications, suggesting that (1) they were perceived as "natural and safe," and (2) they would not report them to their physicians during a medication history.

The report went on to point out that many of the women taking herbal remedies had been doing so on the advice of a health-care provider. And in fact, other researchers have found that certified nurse midwives frequently recommend herbals to assist in breech version attempts, to stop premature labor, and to help in cervical ripening and labor.

Hepner DL, Harnett M, Segal S, et al. Herbal medicine use in parturients. Anesth Analg. 2002;94:690-693.

Do folate supplements cause multiple births?

In a word, No. There have been a few recent reports suggesting that women who take multivitamin supplements containing folic acid are more likely to have twins, but a population-based cohort study, which included more than 240,000 Chinese women, was unable to find a link between multiple births and 400 µg of folate taken either before ovulation, around conception, or afterward.

Li Z, Gindler J, Wang H, et al. Folic acid supplements during early pregnancy and likelihood of multiple births: a population-based cohort study. Lancet. 2003;361:380-384.

Green tea for weight loss?

As reports of severe adverse reactions to ephedra-containing products continue to mount, odds are that many of your patients will turn to other OTC products to help them lose weight. A recent critical review suggests that green tea may be one of the better alternatives.

While large-scale randomized trials are still needed to provide definitive proof, several smaller studies and a plausible mechanism of action strongly suggest that green tea can serve as an adjunct to a weight loss diet and regular exercise.

A placebo-controlled trial conducted by the University of Geneva, for instance, has found that a 1,500-mg green tea extract containing the active ingredients epigallocatechin and caffeine increases energy expenditure. A separate double-blind French study concluded that 250 mg of whole green tea powder caused significantly greater weight loss in 60 obese women after a month, compared to placebo. And a third investigation reported a 4.6% drop in weight and a 4.5% decrease in waist circumference. In vitro experiments indicate that catechins in green tea increase thermogenesis and fat metabolism.

One caveat mentioned in the literature review: The quantities of green tea needed to have a weight loss effect can also expose patients to large amounts of caffeine and its possible adverse effects, so a decaffeinated formulation may be the better way to go.

Udani J, Spar M. Green tea for weight loss. Alternative Medicine Alert. 2003;6(2):16-18.

Linking certain dietary fats to Alzheimer's disease

Trans fatty acids and saturated fats may contribute to the development of Alzheimer's disease, while polyunsaturated and monounsaturated fats may provide a measure of protection against the disorder. When investigators from Rush-Presbyterian/St. Luke's Medical Center in Chicago followed more than 800 community residents 65 and older for several years, they found that those who consumed the most saturated fat were more than twice as likely to develop the disease, when compared to residents on the lowest intake. Similarly trans fats, which are derived from partially hydrogenated vegetable oils, increased the risk of Alzheimer's by a factor of 2.5. Their data also suggested that the threat of the disease declined about 70% and 20%, respectively, with higher intakes of polyunsaturated and monounsaturated fats.

Morris MC, Evans DA, Bienias JL, et al. Dietary fats and the risk of incident Alzheimer disease. Arch Neurol. 2003;60:194-200.

Maternal coffee consumption linked to risk of stillbirth

Pregnant women who drink eight or more cups of coffee per day have more than twice the risk of stillbirth when compared with those who do not drink caffeine during pregnancy, say researchers from Aarhus University Hospital, Denmark.

More than 18,000 singleton pregnancies were represented in the prospective follow-up study, which involved two questionnaires completed by patients before the first visit for routine antenatal care. The information collected included patient history, age, smoking and alcohol habits, and current intake of daily cups of caffeinated beverages. Record linkage to data on stillbirths in the Danish medical birth register was done using a mother's personal identification number.

In the 18,478 pregnancies, 43% of women did not drink any coffee, 34% drank one to three cups, 18% drank four to seven, and 5% drank eight or more per day. Overall risk of stillbirth was 4.4/1,000 (n=82) and of infant death was 4.0/1,000 (n=74). Compared with women who drank no coffee, women who drank four to seven cups a day had an 80% increased risk of stillbirth and the risk was increased 300% in those who drank eight or more cups. Restriction of analysis to nonsmokers, women who had fewer than three alcoholic drinks per week, were primiparous, and did not have chronic diseases, did not affect the outcome.

Wisborg K, Kesmodel U, Bech BH, et al. Maternal consumption of coffee during pregnancy and stillbirth and infant death in the first year of life: prospective study. BMJ. 2003;326:420.

Omega-3 fats and the neonatal nervous system

The more omega-3 fatty acids a pregnant woman consumes, the more mature her newborn's central nervous system will likely be. At least that's the conclusion hinted at by this recent University of Connecticut study.

The research literature leaves little doubt about the value of omega-3 fatty acids like docosahexaenoic acid (DHA) in the maturation of the embryonic brain. The new investigation has found that infants of mothers who had higher serum DHA levels had sleep patterns that suggested greater CNS maturity, when compared to infants born to mothers with lower DHA levels. More specifically, higher DHA levels were associated with less active sleep and a lower ratio of active-to-quiet sleep. Likewise, infants in the high DHA group had less sleep-wake transitions.

Cheruku SR, Montgomery-Downs HE, Farkas SL, et al. HIgher maternal plasma docosahexaenoic acid during pregnancy is associated with more mature neonatal sleep-state patterning. Am J Clin Nutr. 2002;76:608-613.

Department editor Paul L. Cerrato, MA, Managing Editor of Contemporary OB/GYN, is a guest lecturer at the Institute of Human Nutrition, Columbia University College of Physicians and Surgeons, New York, N.Y.

 

Altmed Watch. Contemporary Ob/Gyn Apr. 1, 2003;48:116, 119.