Maternal and Foetal Outcomes Following Intra-Partum Complementary and Alternative
Medicine ingestion: A Prospective Cohort Study
Dohbit JS1,2, Meka ENU1,2, Noa NC2,3, Essiben F2,4, Nguedje ML2, Joel Noutakdie Tochie5*, Ofakem II2, Valirie Ndip Agbor6,7, Jan Rene Nkeck8, Mbia KZ2 and Foumane P1,2
1 Departement of Gynaecology and Obstetrics, Yaoundé Gynaeco-Obstetrics and Paediatric Hospital, Cameroon
2 Departement of Gynaecology and Obstetrics, University of Yaoundé, Cameroon
3 Paul and Chantal Biya Hospital Centre for endoscopic surgery and human reproduction, Cameroon
4 Departement of Gynaecology and Obstetrics, Yaoundé Central Hospital, Cameroon
5 Departement of Surgery and Specialities, University of Yaoundé, Cameroon
6 Ibal Sub divisional Hospital, Oku, North West Region
7 Department of Clinical Research, Health Education and Research Organisation (HERO), Cameroon
8 Departement of Internal Medicine, University of Yaoundé, Cameroon
Submission: August 20, 2018;Published: November 02, 2018
*Corresponding author: Joel Noutakdie Tochie, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Joseph Tchooungui Akoa, Yaounde, Cameroon.
How to cite this article: Dohbit J, Meka E, Noa N, Essiben F, Nguedje M, et al. Maternal and Foetal Outcomes Following Intra-Partum Complementary
and Alternative Medicine ingestion: A Prospective Cohort Study. Glob J Reprod Med. 2018; 6(2): 555685. DOI: 10.19080/GJORM.2018.06.555685.
Introduction:Worldwide, 20 to 60% of pregnant women use Complementary and Alternative Medicine (CAM) during pregnancy. In Cameroon, the prevalence is estimated at 31.5%. The main perceived reasons for pregnant women using it include treatment of nausea and vomiting as well as to ease childbirth. Although widely used in Cameroon, no study in has either demonstrated its safety or effectiveness. The aim of this study was to determine the effects of oral CAM intake during labour on the maternal and foetal outcomes.
Methods: A cohort study was conducted from January to April 2016 in two referral maternity departments of Yaounde, Cameroon. We consecutively enrolled all consenting pregnant women in labour after 28 weeks of gestation. Participants were interviewed using a pretested and coded questionnaire. We divided them into two groups; exposed and unexposed. The exposure studied was ingestion of CAM within 72 hours prior to delivery. Variables studied were socio-demographic characteristics, type and frequency of CAM ingested and details of labour. Logistic regression was performed to identify independent variables for CAM use and materno-foetal complications.
Results: We enrolled a total of 603 paturients of whom 147 in the exposed group and 456 in the non-exposed group. The most frequently used CAM were honey and Triumfettapentandra A. The mean participants age was 28.88 ± 6.31 years in the exposed group and 27.90 ± 6.30 years in the non-exposed group. Cohabitation (RR = 1.79, 95% CI 1.10-2.94, p = 0.016) and tertiary level of education (RR = 1.58 95% CI 1.08-2.33, p = 0.012) predisposed to intrapartum CAM ingestion. Women who ingested CAM during labour were more likely to have intra-partum vaginal bleeding (RR = 1.51, 95% CI = 1.10-2.08, p = 0.011), dystocic labour (RR = 1.45, 95% CI = 1.10-1.91, p = 0.007), uterine hyper kinesia (RR = 1.27, 95% CI = 1.06-1.52, p = 0.008) and uterineatony (RR = 7.24, 95% CI = 1.90-27.63, p = 0.002). No correlation was observed between CAM intake and neonatal complications.
Conclusion: Overall, these findings may serve as a preliminary reference to refute CAM use during labour in our resource-constrained environments.
Keywords: Complementary and alternative medicine; Labour; Maternal; Foetal; Outcome
Abbrevations: CAM: Complementary and Alternative Medicine; CI: Confidence Interval; RR: Relative Risks
“Complementary and Alternative Medicine (CAM)” commonly called Traditional medicine in Africa is the sum of all knowledge, skills and practices that are based on the theories, beliefs and
experiences of health preservation, specific to different cultures, whether explainable or not, which are used in health preservation, as well as in the prevention, diagnosis, improvement or treatment of physical or mental illness . In CAM, drugs of the traditional pharmacopoeia, called “herbal medicines” are used. The
World Health Organization estimates that 80% of the general
populations, especially women make use of it [1,2]. According to a
study conducted in 2012 in Cameroon, 31.02% of women use CAM
during the second half of pregnancy . However, its intake during
pregnancy is associated with obstetrical, foetal and neonatal
complications. A study conducted in South Africa reported that
the use of CAM increased the rates of emergency cesarean and
foetal distress . Despite the potential adverse maternal and
foetal out comes of CAM, studies conducted on the subject in
Cameroon are rare. The objective of our study was to identify the
effects of ingestion of CAM during the labour on the maternal and
This was a prospective cohort study conducted from January 1
to April 30, 2016, in the maternity wards of two referral hospitals
in Cameroon - the Gyneco-obstetrics and Pediatric Hospital of
Yaounde and the Central Hospital of Yaounde. An exposed group
(consisting of pregnant women who had ingested CAM within 72
hours prior to delivery) was compared to an unexposed group
(pregnant women who had not ingested CAM within 72 hours
prior to delivery). We excluded all parturients with a gestational
age less than 28 weeks, those who did not consent to participate
to the study, paturients in whom labour was induced, those with
intrauterine fetal death prior to the onset of labour, those with
multiple gestations and those who delivered before hospital
admission and those undergoing elective cesarean section. The
sampling method was exhaustive and consecutive. Assuming a
95% confidence interval (CI), 31.02% rate of CAM use , the
SCHULZ and GRIMES formula was used to obtain a minimum size
of our sample of 89 subjects per group. The sampling method was
exhaustive and consecutive.
A pre-tested questionnaire was used to collect information on
the socio-demographic characteristics (age, level of education, and
marital status), CAM details (type of CAM ingested, frequency of
intake and amount), labour details (reason for admission, duration
of the second period of labour, use of oxytocins, complications
during Labour), delivery details (mode of delivery, APGAR score at
the 1st and 5th minute, delivery complications such as acute foetal
distress and uterine atony).
The data was collected, recorded and analyzed using Epi-info
3.5.4 software. The categorical variables were compared using the
Chi-square test and the Fisher exact test when appropriate. The
factors associated with CAM use were identified by calculating
the risk ratio (RR) with its 95% confidence interval (CI). The
association between CAM use and different variables was
measured using the relative risks (RR) and its 95% confidence
interval (CI). Logistic regression was performed for all variables
whose p value was <0.1.
A total of 603 paturients met our inclusion criteria. One
hundred and forty-seven (147) took CAM during labor or in the 72
hours preceding delivery (exposed group) and 456 who did not
(the non-exposed group). Hence, the incidence rate of CAM in take
during labour was 24.4%. The types of CAM used by parturients
are summarized in Table 1. The most frequently used CAM were
honey in 28.2% and Triumfettapentandra A. (‘’nkui’’) in 23.7% of
the cases. Several parturients used a combination of TM. The main
reasons for the ingestion of CAM were to ease delivery (83.3%), to
induce labour (21.36%) or to treat constipation (10%).
The ages of the parturients ranged from 15-45 years with an
average of 28.88 ± 6.31 years in the exposed group and 27.90±6.30
years in the non-exposed group. The most represented age
group was 25-34 years old. Table 2 shows the distribution of the
population by age. With regards to marital status, 48.3% were
singled and 36.5% married. Women living in liberal unions were
about twice as likely to ingest CAM during labour (RR = 1.79, 95%
CI 1.10-2.94, p = 0.016) compared to their counter parts. Having
at a secondary level of education conveyed protection against the
use of CAM during labour (RR = 0.68, 95% CI 0.47-0.99, p = 0.028).
In contrast, parturients with a tertiary level of education were 1.5
times more likely to use CAM (RR = 1.58 95% CI 1.08-2.33, p =
The most common reason for admission was labour pains
in 57.4%. CAM almost doubled the risk of intra-partum vaginal
bleeding (RR = 1.51, 95% CI = 1.10-2.08, p = 0.011) and dystocic
labour (RR = 1.45, 95% CI = 1.10-1.91, p = 0.007). Furthermore,
parturients who used TM during labour had a 1.27-fold increase
in the risk of uterine hyper kinesia (RR = 1.27, 95% CI = 1.06-1.52,
p = 0.008) and 7-fold increase in uterine atony (RR = 7.24, 95%
CI = 1.90-27.63, p = 0.002). There was no significant association
between neonatal complications and TM intake as seen in Table 3.
This study aimed to determine the effects of oral CAM intake
during labour on the maternal and foetal outcomes. We found
that parturients who ingested CAM during labour had a greater
risk of vaginal bleeding prior to admission, uterine hyper kinesia,
dystocic delivery and uterineatony. TM use during labour had no
effect on foetal outcome.
The incidence of CAM use in thisstudywas24.4%. This
incidence is lower than that of Holst et al in Sweden , and
Mabina et. al in South Africa , who observed incidence rates
of CAM use of 36% and 55%, respectively. This disparity could
be explained by the fact that, their incidences entail the use of
CAM during pregnancy and labour, compared to our study which
focused on intra partum CAM use. About eight different CAM were
reported to being tested by parturients in our cohort, of which
the most common were honey (28.2%), Triumfettapentandra A.
(23.7%), followed by the Hibiscus rosa-sinensis L. (20%). Several
parturients reported to use more than one CAM during labour. The
maximum association observed was three CAM per parturients.
This result is similar to that of Nordeng et al. , who found an
average CAM combination of two per women. Congruent with the
findings of Awouda et al.  and Azriani et al. , the main reason
for CAM consumption during labour was to ease delivery.
The most represented age group was aged between 25-34
years. This is similar to the report of Hepner et al. in Massachusetts
; suggesting that the 25-34 years age group might be a potential
target group to implement preventive strategies for CAM use
during pregnancy and labour. Parturients in liberal unions almost
had a double risk of taking CAM. This result follows the trend
of the general population, as cohabitation is very common in
Cameroon. Secondary education was found to convey protection
against CAM use while tertiary education increased the odds of
CAM in take during labour. These results concur with those of
several authors [2,6,8,10,11]. This can be explained by the fact
that women with a lower level of education are more likely to rely
on the recommendations of their health care providers whom are
often against taking CAM during gestation.
Amongst the complications of CAM ingestion during labor, we
observed a significant risk of uterine hyper kinesia (p = 0.008).
Although we did not precisely identify which CAM had this effect,
this may infer that CAM has a uterotonic property. As for honey,
previous studies revealed that this CAM contains oestrogen,
which could explain the uterotonic action. Furthermore, honey
is rich in carbohydrates, proteins, lipids, organic acids, enzymes,
mineral salts and natural antibiotic factors grouped under the
term inhibin, which all act in synergy to procure stronger uterine
contractions . However, honey also has some toxicity related to
the presence of toxic alkaloids or andrometoxin, a toxin from the
nectar of the colchicine plant . As such, this increases the risk of
uterine atonyin the exposed group.
Another possible explanation is that the hyper kineticuterus
becomes fatigued after sometime of intense contraction and
eventually failing to contract, leading to uterine atony. Lastly, we
did not observe any difference in adverse fetal outcomes between
the exposed and un exposed groups. Concurring findings were
made by Holst et al. , who observed correlation between CAM
use and neonatal complications. The findings from the current
study should be interpreted with in the context of its limitations.
These include the in ability of some parturients to precisely recall
what type of CAM was taken during labour. Also, as the study
population was drawn from only two referral maternities of
Cameroon, preventing the generalizability of the finding she rein.
However, based on a large sample (n=603) of well followed-up
parturients, we have used a cohort design to provide a contribution
of level II scientific evidence on the current scarcity of data on
the maternal and fetal outcomes of intrapartum CAM use in the
tropics. These findings should serve as a preliminary reference
to refute CAM use during labour in our resource constrained
Over all, we found that about one parturient out of every four
uses CAM during labour. Some socio-demo graphic characteristics
such as liberal union and tertiary level of education predispose
pregnant women to CAM ingestion during labour. Oral CAM in
take increased the risk of vaginal bleeding prior to consultation,
uterine hyper kinesia, dystocic delivery and uterineatony.
The authors thank all the staff of the Maternity units of
the Yaounde Central Hospital and the Yaounde of the Gyneco-
Obstetrics and Pediatric Hospital of Yaoundé for partaking in
the care of all the participants included in this study. We also
acknowledge the study participants for their commitment.