Pei-Jen Chang

Chinese herbal medicine use in Taiwan during pregnancy and the postpartum period: A population-based cohort study

BACKGROUND Using Chinese herbal medicines during pregnancy and postpartum is common in the Chinese community. OBJECTIVE The purpose of this current study is to explore the use of Chinese herbal medicines by women during pregnancy and postpartum in Taiwan. DESIGN It is an on-going prospective longitudinal study design. SETTING AND PARTICIPANTS We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. Subjects underwent a home interview 6 months after their deliveries between June 2005 and July 2006. A structured questionnaire was successfully administered to 87.8% of the sampled population. RESULTS At least one Chinese herbal medicine was used by 33.6% and 87.7% of the interviewed subjects during pregnancy and the postpartum period, respectively. An-Tai-Yin, Pearl powder, and Huanglian were the most commonly used during pregnancy, while Shen-Hua-Tang and Suz-Wu-Tang were the most commonly used by postpartum women. Pregnant women aged 20-34, with high education, threatened abortion, chronic disease, and primipara appeared to use more Chinese herbal medicines than others in the sample. Postpartum women with high education, primipara, normal spontaneous delivery, and breastfeeding were found to use more Chinese herbal medicines; but women with pregnancy-related illness used less. CONCLUSIONS Chinese herbal medicines are frequently used by women during pregnancy and the postpartum period in Taiwan and those with high education and primipara used more such herbs. Due to limited safety information on these herbs, we would advise caution regarding their use either during pregnancy or postpartum breastfeeding period. Moreover, it is important for nurses/midwifes enquiring about such habits, and providing the adequate education to women during prenatal and postpartum care to prevent potential side effects.

Herbal medicines used during the first trimester and major congenital malformations : An analysis of data from a pregnancy cohort study

AbstractBackground: Major congenital malformations place a considerable burden on the affected child, the family and society. Any kind of medicine used during pregnancy might have a harmful impact; therefore, such practice has raised concerns. The objective of the current study was to explore the relationship between the use of herbal medicines by pregnant women during the first trimester of pregnancy and the risk of major congenital malformation in their live born infants. Methods: This was a cross-sectional analysis of data from a prospective pregnancy cohort, which was established between 1984 and 1987. To assemble the cohort, pregnant women of ≥26 weeks of gestation who came to the Taipei Municipal Maternal and Child Hospital in Taiwan for prenatal care were enrolled in the study and interviewed using a structured questionnaire. Detailed information, including herbal medicine use during different periods of pregnancy, was obtained during the interview. Past medical history, current obstetric data and details on conventional medicines used during pregnancy were abstracted from medical records. Data on birth weight, gestational duration and characteristics of live born infants were gathered from the Taiwan national birth register. Congenital malformation information was obtained from multiple sources: the newborn examination record (1984–7); the national death register (1984–2003); and Taiwan National Health Insurance data (1996–2000). Multiple logistic regression was used to estimate the odds ratio [OR] of major congenital malformation by herbal medicines used during the first trimester. Results: A total of 14 551 live births were analysed. After adjustment for confounding factors, taking huanglian during the first trimester of pregnancy was found to be associated with increased risk of congenital malformations of the nervous system (adjusted OR 8.62, 95% CI 2.54, 29.24). An-Tai-Yin was associated with an increased risk of congenital malformations of the musculoskeletal and connective tissues (adjusted OR 1.61, 95% CI 1.10, 2.36) and the eye (adjusted OR 7.30, 95% CI 1.47, 36.18). Conclusion: We found evidence for a possible link between the use of specific herbal medicines during the first trimester of pregnancy and increased risks of specific groups of congenital malformations. We could not investigate whether the adverse effects were related to direct toxicity from the herbal medicines, or were from misuse, contamination or uncontrolled confounding. Nonetheless, we would advise caution regarding use of herbal medicines during pregnancy, and we suggest that further investigation of these findings is warranted.

Risk factors on the menstrual cycle of healthy Taiwanese college nursing students.

Background:  The purpose of this study was to explore risk factors, including age at menarche, body mass index (BMI), psychiatric stress and physical exercise on the menstrual cycle of healthy Taiwanese college nursing students.

Working hours and risk of gestational hypertension and pre-eclampsia

BACKGROUND The potential impact of employment on maternal health, particularly in relation to gestational hypertension and pre-eclampsia, has been subject to research. However, there is limited evidence on associations between shift work and long working hours on the incidence of these conditions. AIMS To evaluate potential associations between maternal shift work and long working hours during pregnancy and gestational hypertension or pre-eclampsia. METHODS Multistage stratified systematic sampling was used to recruit 24 200 post-partum women from the Taiwan national birth registration database in 2005. Subjects underwent home interview 6 months after their deliveries by structured questionnaire to obtain characteristics of maternal employment and potential confounders. Diagnosis of gestational hypertension and pre-eclampsia was obtained from the birth registration. RESULTS There was no association between employment status and gestational hypertension or pre-eclampsia. Also, no significant association between gestational hypertension or pre-eclampsia and maternal shift work or long working hours during pregnancy was found in all or primiparous women. CONCLUSIONS There was no convincing evidence that maternal shift work or long working hours had a higher risk of gestational hypertension or pre-eclampsia. However, further research is warranted to confirm these negative findings.

Favorable Neonatal Outcomes Among Immigrants in Taiwan: Evidence of Healthy Immigrant Mother Effect

BACKGROUND Although racial/ethnic disparities in neonatal and infant health are well known, positive associations between migration and perinatal health exist among immigrant mothers in western countries. There are unique marriage migration, East Asia culture, universal national health insurance system, and adequate social support in Taiwan that may differ from the situation in western countries. We aimed to assess the neonatal outcomes among live births to married immigrant mothers in recent years in Taiwan. METHODS We conducted a population-based analysis among all the live births in Taiwan during the period 1998-2003 to assess neonatal outcomes, including incidence of low birth weight and preterm birth and of early and late neonatal mortality, according to maternal nationality. Logistic regression was used to estimate the odds ratios (ORs) associated with low birth weight and preterm birth, and Cox proportional hazards were used to estimate the relative risks (RRs) associated with mortality in the neonatal period. RESULTS There were a total of 1,405,931 single live births, including 6.6% born to immigrant mothers and 93.4% born to Taiwanese mothers. Disparities existed among the intercultural couples, including paternal age, parental educational level, and residential distribution. Fewer low birth weight and fewer preterm babies were born to immigrant mothers than to Taiwanese mothers. In addition, babies born to immigrant mothers had lower early neonatal and neonatal mortalities than those born to Taiwanese mothers. There were lower risks of having a low birth weight (adjusted OR [AOR] 0.73, 95% confidence interval [CI] 0.70-0.75) or preterm (AOR 0.72, 95% CI 0.69-0.74) baby and lower hazard ratios (HRs) of having an early neonatal death (adjusted HR [AHR] 0.68, 95% CI 0.56-0.82) or neonatal death (AHR 0.74, 95% CI 0.64-0.87) in babies born to immigrant mothers. There is a gradual increase in the risks of adverse neonatal outcomes associated with increases in length of residence. CONCLUSIONS Evidence of a healthy immigrant mother effect on neonatal health is clear. Despite lower parental education, advancing paternal age, and spatial distribution disparity, babies born to married immigrant mothers in Taiwan had favorable neonatal outcomes.

Herbal medicines during pregnancy and childhood cancers: an analysis of data from a pregnancy cohort study

To the Editor Pregnant women using herbs is common in Taiwan and mainland China, but relatively little is known about the safety of taking herbal medicines during pregnancy. Our previous study showed a possible link between the use of specific herbal medicines during the first trimester of pregnancy and an increased risk of specific congenital malformations. Thus, this analysis was conducted to explore the relationship between herbal

The Effect of Prenatal and Postnatal Environmental Tobacco Smoke Exposure on Infant Health

Objectives: Environmental tobacco smoke (ETS) is a common indoor pollutant. Fetuses, neonates, and young children are most at risk from ETS exposure. In this study, we evaluated the relationship of exposure to prenatal and postnatal ETS to birth outcomes (including preterm delivery [PTD], low birth weight [LBW], and small for gestational age [SGA]) and child health outcomes (including emergency visits and hospitalizations). Methods: In this pilot project of the Taiwan Birth Cohort Study, we used a self-reported questionnaire. We interviewed 2,048 mothers 6 months after their deliveries and recruited 1,725 mother-newborn pairs. We analyzed the association of adverse birth outcome and child health with exposure to prenatal and postnatal ETS using regression models, and analyzed relationships between birth outcome and child health and frequency of exposure to prenatal and postnatal ETS using the test for trend. Results: We found a significant association between exposure to ETS during pregnancy and PTD, SGA, emergency visits, and hospitalizations of infants. In addition, infant exposure to ETS via maternal smoking during or after pregnancy contributed to significant crude relationships between LBW, SGA, emergency visits, and hospitalizations, but these relationships were completely explained by the effects of covariates other than SGA. We also observed that paternal smoking during or after pregnancy dose-dependently increased hospitalization risks of infants. Moreover, the mean adjusted BW decrement was 222.3 g in newborns exposed to ETS from maternal smokers. Conclusions: Although maternal smoking risks are very low in Taiwan, prenatal or postnatal ETS exposure still impacts children. Our findings highlight the emerging challenge of prenatal and postnatal ETS exposure to the public health.

Prevalence and related factors of Chinese herbal medicine use in pregnant women of Taipei, 1985-1987

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 Hospital for prenatal 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 different 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.