Human Reproduction, Vol.27, No.11 pp.

3161–3167, 2012
Advanced Access publication on August 27, 2012 doi:10.1093/humrep/des303

ORIGINAL ARTICLE Early pregnancy

Herbal supplements in pregnancy:

unexpected results from a multicentre
study
F. Facchinetti 1,*, G. Pedrielli 1, G. Benoni 2, M. Joppi 3, G. Verlato4,
G. Dante 1, S. Balduzzi 5, and L. Cuzzolin 2
1
Unit of Obstetrics, Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy 2Department of Public Health and
Community Medicine, Section of Pharmacology, University of Verona, Verona, Italy 3Division of Obstetrics and Gynaecology, Hospital of
Rovereto, Rovereto, Italy 4Department of Paediatrics, University of Padua, Padua, Italy 5Statistics Unit, Department of Oncology,
Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy

*Correspondence address. Tel: +39-059-422251; E-mail: facchi@unimore.it

Submitted on March 6, 2012; resubmitted on June 27, 2012; accepted on July 18, 2012

study question: How common is the use of herbal supplements during pregnancy and does it adversely affect the pregnancy outcome?
summary answer: The use of herbal products during pregnancy is very common and daily almond oil spreading is associated with
preterm birth (PTB).
what is known and what this paper adds: Herbal drugs are often promoted as ‘natural’ and ‘safe’ and such claims attract
pregnant women. More than a quarter of Italian pregnant women consume herbs every day for at least 3 months during pregnancy. We raise an
alert over the habit of daily almond oil spreading since it seems to be associated with PTB.
design: A multicenter retrospective cohort study performed over a 15-month period.
participants and setting: Seven hundred women interviewed within 3 days of childbirth, in three public hospitals in northern Italy.
main results and role of chance: One hundred and eighty-nine women were considered ‘regular users’, since they consumed
herbs every day, for at least 3 months. Almond oil, chamomile and fennel were the most commonly used herbs. Both length of gestation and
birthweight were affected by herb consumption. Almond oil users showed more pre-term birth (29 of 189) than non-users (51 of 511).
After adjusting for multiple pregnancies, smoking, advanced age and drug intake, almond oil users maintained an increased risk to give birth
,37th week (odds ratio ¼ 2.09, 95% confidence interval: 1.08 –4.08).
bias, confounding and other reasons for caution: The association between daily spreading of almond oil and PTB
only raises a hypothesis that requires confirmation in larger trials devoted to this topic. The relatively small sample size did not allow the inves-
tigation of other adverse pregnancy outcomes in herb users.
generalizability to other populations: The population under investigation did not significantly differ from the general
population attending the same hospitals.
study funding/competing interest(s): No conflict of interest exists. The study has been supported by a public grant from the
University of Modena and Reggio Emilia.
trial registration number: None
Key words: herbal treatments / low birthweight / preterm birth / almond oil / pregnancy

men (Lloyd and Hornsby, 2009; Brinkhaus et al., 2011). Multiple

Introduction surveys have shown that women, especially those of white
The use of herbal and complementary medical treatments has ethnicity, middle-age and with high levels of education and
increased in many countries over the past decade. Women are income, are more likely to be users of such ‘alternative’ medicines
more frequent users of complementary/alternative medicine than (Tesch, 2003).

& The Author 2012. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
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 3162
Accordingly, companies that sell to Western markets now offer a
significant number of herbal supplements with different intended pur-
poses, some of which are specifically marketed to pregnant women.
The rationale is 3-fold: (i) pregnancy is a condition that requires a
greater intake of nutrients to assure adequate support to the new,
growing organism; (ii) pregnancy is associated with minor complaints
(e.g. nausea and constipation) that require relief but in some cases
are not treated with conventional drugs that are believed to be
harmful to the fetus and (iii) women and doctors trust that the best
outcome in pregnancy can only be reached by removing hazards
(e.g. anaemia or pregnancy-related complications) and that this goal
can be achieved through a variety of different treatments.
Several studies conducted in Europe, the USA and Australia indicate
that between 7 and 45% of pregnant women use herbal products
(McFarlin et al., 1999; Forster et al., 2006; Louik et al., 2010;
Nordeng et al., 2011). Pregnant women choose these types of treat-
ments because they consider herbs to be natural compounds and
therefore safer compared with conventional drugs (McKenna and
McIntyre, 2006). However, although the adverse effects of certain
herbal treatments are well documented, data on the safety of
herbal consumption during pregnancy are very limited (Donald and
Snodgrass, 2005).
Concerns about the outcome of pregnancy in herbal users are
therefore quite justified. A previous study found no statistically signifi-
cant differences related to herbal consumption, with the exception of
a higher rate of neonates that were small for their gestational age
among herb users (Ernst, 2002). Deeper analysis of the data suggested
that a regular intake of chamomile and liquorice (taken from the be-
ginning of pregnancy) increased episodes of threatening miscarriage
and preterm labour.
The aim of the present study was to investigate the use of herbal
products among a large sample of pregnant Italian women and verify
its possible influence on pregnancy outcomes.
Materials and Methods
A multicentre cohort study was conducted over a 15-month period
(March 2010 – May 2011) at the maternity wards of three general hospitals
located in northeastern Italy (Padua, Rovereto and Modena, towns with
214 000, 38 000 and 185 000 inhabitants, respectively). Modena and
Padua are university hospitals with 3400 and 4000 deliveries/year,
respectively, whereas Rovereto is a community hospital with 920
deliveries/year.
Interviews were performed twice a week. Considering that women gen-
erally stay in the hospital for 2 – 4 days depending on the mode of partur-
ition, this schedule allowed for the inclusion of almost every eligible
subject. A total of 3818 deliveries occurred on interview days. Only
Italian women (2672) were included in the study; immigrant women
(34.3%) were excluded under the assumption that they might follow differ-
ent traditions in the use of herbs.
All women received oral information about the study, and written
consent was obtained before the interview. The study was approved by
the respective local ethics committees.
Data were collected via a pre-structured questionnaire through a
face-to-face interview carried out by a specially trained gynaecologist.
This approach was chosen under the assumption that an interviewer-
administered questionnaire would provide more reliable and complete
data than a self-administered questionnaire. The latter methodology is
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Facchinetti et al.
often associated with lower adhesion, inappropriate compilation and mis-
interpretation of the questions (Kelsey et al., 1996). Each interview lasted
10– 15 min.
The questionnaire was anonymous, pre-tested and included basic
background data for the interviewed subjects: age, marital status,
number of children, level of education, occupational status and place
of residence (urban or rural area). The 20 questions of the first
section (Appendix) were designed to elicit information regarding the
type(s) of herbal product consumed (a provided list included products
reported to be commonly sold in Italy); details of its use (dosage, formu-
lation, route of administration and frequency); timing of administration
(first, second and third trimester); symptom/disease or other reasons
for consumption; place of purchase; relationship/communication with
healthcare providers; general product knowledge with respect to
quality, type of use and risks; source of information; level of satisfaction
and adverse reactions observed. In another section, data about the sub-
ject’s pregnancy history (primiparity, smoking and alcohol habits, chronic
diseases, morbidities during pregnancy and medication use) and newborn
(gestational age, birthweight, gender, Apgar score, problems at birth and
treatments) were collected. At the beginning of the interview, before
asking about the use of herbs, the definition of an herbal compound
was given as ‘any remedy produced from a herb or herbs with the
intent to cure or prevent illness, alleviate symptoms or achieve better
health’.
A woman was considered a ‘regular user’ of herbal products if she had
been taking herbs every day for at least 3 months of her pregnancy. Our
analysis focused on this subpopulation, taking into account that only
regular consumption is likely to influence the outcome of pregnancy.
Data were stored and analysed using a Delphi TM7 professional study
program (database).
Statistical analyses were performed using STATA software, version 11
(StataCorp 2009, Stata Statistical Software: Release 11. College Station,
TX: StataCorp LP).
To identify differences associated with socio-demographic features (e.g.
age, primiparity, education level, smoking habit and drug consumption)
among herbal users and non-users, univariate logistic regressions were
performed, using herbal consumption as the response variable.
The main outcome measures were preterm birth (PTB: delivery before
the 37th week of pregnancy), low birthweight (LBW: infant weighing
,2500 g) and small for gestational age (SGA: birthweight ≤10th percent-
ile according to sex and gestational age). Delivery before the 35th week of
pregnancy, gestational age at birth (in days), birthweight (in grams) and
Apgar score at fifth minutes ,8 were also considered. The impact of
herb use on pregnancy outcome measures was estimated for categorical
variables using univariate logistic regressions in which herb use was set
as the predictor variable. Student’s t-test was used for continuous vari-
ables. Multivariate logistic models were constructed to evaluate the asso-
ciations between herb use and pregnancy outcomes while adjusting for
other variables, such as maternal age, twin pregnancy, smoking and drug
intake. Odds ratios (ORs) and their 95% confidence intervals (CIs) were
obtained from the logistic regressions. A P – value of ,0.05 was consid-
ered significant.
Results
In total, 725 women were randomly contacted, with a response rate
of 97% (25 refused to participate). The remaining 700 women were
interviewed within 3 days of childbirth.
The socio-demographic features that could have been related to
adverse pregnancy outcomes for the enrolled population did not
differ from those of other women attending the same hospitals
 Hazards of herbs in pregnancy 3163

(Table I), with the exception of a smoking habit, which was less fre- Among the herb users (297 subjects), 189 (64%) were considered
quent in the included population. ‘regular users’. Clinical and socio-demographic features of regular
Of the 700 subjects, 297 (42%) reported that they had taken one or users were similar to the remaining population, with the exception
more herbal products at least once during their pregnancy. Twenty- of drug consumption patterns. Regular herbal users consumed fewer
seven women (10%) took herbs in the first trimester, 54 (18%) in antibiotics and anti-inflammatory agents than non-users (assuming
the second trimester and 139 (47%) in the third trimester. no drug intake as the reference category; Table III).
Specific herbal intake as well as the length of consumption is Pregnancy outcomes according to herbal use are reported in
reported in Table II. The most frequently used products were Tables IV and V. The risk of LBW infants was statistically higher
almond oil (topical application) and chamomile (oral route). Other among regular users when compared with non-users (P ¼ 0.031).
commonly used herbs were fennel, valerian and echinacea (oral Similarly, birthweight was significantly lower among regular users (Stu-
route). Reasons for intake were minor complaints related to preg- dent’s t-test; P ¼ 0.038). The risk of delivery ,37 weeks was margin-
nancy, such as stretch marks, anxiety, sleep disturbances, capillary ally significant (P ¼ 0.049), whereas differences in the length of
frailty, fluid retention and constipation. pregnancy were not statistically significant.
Drug intake during pregnancy included antibiotics (291 cases, 42%), As the majority of subjects used almond oil and/or chamomile, uni-
non-steroidal anti-inflammatory drugs (333 cases, 48%) and tocolytics variate logistic regressions were carried out to assess their influence
(17 cases, 2%). on the pregnancy outcome. Regular users of almond oil (123 subjects)
Side effects of herbal supplementation use were observed in four were at a higher risk of PTB (OR ¼ 2.09; 95% CI: 1.07– 4.08, P ¼
cases: rash and itching after continuous topical application of almond 0.030) when compared with non-users. Regular users of chamomile
oil or aloe (three cases), constipation after regular consumption of a (56 subjects) showed a higher risk of LBW infants (OR ¼ 2.1; 95%
tisane containing a mix of herbs, including fennel (one case). CI: 0.99 –4.60, P ¼ 0.052) when compared with non-users, although
this did not reach statistical significance.
Two multivariate logistic models were constructed. In the first
Table I Features of the included population with model, a possible association between PTB and almond oil use was
respect to the general population attending the evaluated, adjusting for age, smoking habit, twins and drug intake.
hospitals during the study period. PTB was significantly associated with both twin pregnancy (OR ¼
16.36; 95% CI: 5.07 –52.80, P ¼ 0.000) and almond oil use (OR ¼
Included Attending P-value 2.09; 95% CI: 1.08 –4.08, P ¼ 0.030; Table VI). In the second
population population
model, a possible association between LBW and almond oil use was
(n 5 700) (n 5 2583)
........................................................................................ evaluated, adjusting for chamomile use, age, primiparity, education
Age .40 years 36 (5.1%) 157 (6.1%) NS level, smoking habit and drug intake. The occurrence of an LBW
Education 150 (21.4%) 527 (20.4%) NS infant remained significantly associated with smoking habit only
,8 years (OR ¼ 2.75; 95% CI: 1.25 –6.08, P ¼ 0.012; Table VII). No other
Primiparity 390 (55.7%) 1401 (54.2%) NS associations were found between herbal use and PTB, SGA or LBW
Smokers 49 (7%) 357 (13.8%) 0.000 infants.
PTB ,37weeks 80 (11.4%) 240 (9.3%) NS We also evaluated several other confounding factors that could
possibly explain the excessive PTB occurring among regular herbal
NS, not significant; PTB, pre-term birth. users. As reported in Table VIII, the presence of infection seems to
have been equally distributed in herbal users and non-users. Although
information was only available for one centre (Modena), markers of
prenatal care also appeared to be similar among groups.
Table II List of the herbs most commonly taken in
pregnancy and the length of consumption. Discussion
a
Type of herb This study shows that the use of herbal products during pregnancy was
Almond oil 168 (56.6%) very common among the interviewed women, who were representa-
Chamomile 106 (35.7%) tive of the general population attending the birth centres participating
Fennel 30 (10.1%) in the study. These data confirm the prevalence of herb use reported
Valerian 10 (3.4%) in a previous investigation (Cuzzolin et al., 2010).
Echinacea 4 (1.3%) A comparison of these findings with other epidemiological surveys
Length of consumption
revealed that Italian women seem more prone to herbal intake than
women of other countries, e.g. the USA, Norway, the UK and Aus-
Occasionally/1 week 14 (4.7%)
tralia (McFarlin et al., 1999; Forster et al., 2006; Louik et al., 2010;
1– 2 months 94 (31.6%)
Nordeng et al., 2011). Almost half of our interviewees used at
Up to 3 months 52 (17.5%)
least one herbal product, and more than one quarter used herbs
Whole pregnancy 137 (46.1%) every day for at least 3 months of their pregnancy. Besides cultural
a
The sum of percentage is .100% since some women took more than one product. attitudes, these differences might be explained by differing methods
of investigation. Indeed, the major strength of our study is that the

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 3164 Facchinetti et al.

Table III Socio-demographic features of the population, according to herbal product consumption.

Regular herbal users Non-users (n 5 511) P-value OR (95% CI)

(n 5 189)
.............................................................................................................................................................................................
Age (years)
,25 9 (4.8%) 37 (7.2%) Reference category
25–34 102 (54.0%) 292 (57.1%) NS 1.44 (0.67– 3.08)
35–40 69 (36.5%) 155 (30.3%) NS 1.83 (0.84– 4.00)
.40 9 (4.8%) 27 (5.3%) NS 1.37 (0.48– 3.91)
Primiparity
Non-primiparous 72 (38.1%) 238 (46.6%) Reference category
Primiparous 117 (61.9%) 273 (53.4%) 0.045 1.42 (1.01– 1.99)
Education (years)
≤8 34 (18%) 116 (22.7%) Reference category
.8 155 (82%) 395 (77.3%) NS 1.34 (0.88– 2.05)
Smoking habit
Non-smoker 171 (90.5%) 480 (93.9%) Reference category
Smoker 18 (9.5%) 31 (6.1%) NS 1.63 (0.89– 2.99)
Drug consumption
No drugs 20 (10.6%) 20 (3.9%) Reference category
Antibiotics 75 (39.7%) 216 (42.3%) 0.002 0.35 (0.18– 0.68)
Anti-inflammatory 78 (41.3%) 255 (49.9%) 0.001 0.31 (0.16– 0.60)
Tocolytic 9 (4.8%) 8 (1.6%) NS 1.13 (0.36– 3.50)
Others 7 (3.7%) 12 (2.3%) NS 0.58 (0.19– 1.79)

Table IV Pregnancy outcome according to herbal use (univariate analysis): categorical variables.

Regular herb users (n 5 189) Non-users (n 5 511) OR (95% CI) P-value

.............................................................................................................................................................................................
Delivery ,37 weeks 29 (15.3%) 51 (10%) 1.63 (1.00–2.66) 0.049
Delivery ,35 weeks 11 (5.8%) 19 (3.7%) 1.60 (0.75–3.43) NS
LBW (,2500 g) 24 (12.7%) 38 (7.4%) 1.81 (1.05–3.11) 0.031
SGA 12 (6.3%) 18 (3.5%) 1.86 (0.88–3.93) NS
Apgar fifth minutes ,8 5 (2.6%) 8 (1.6%) 1.72 (0.56–5.34) NS

Data are expressed as the number of events (%); LBW, low birthweight; NS, not significant.

Table VI Factors associated with PTB according to

multivariate logistic regression.

Variables Adj OR 95% CI P-value

........................................................................................
Table V Pregnancy outcome according to herbal use:
Almond oil application 2.09 1.08– 4.08 0.030
continuous variables.
Maternal age 25– 35 years 0.80 0.29– 2.20 NS
Regular herbs Non-users P-value Maternal age 35– 40 years 0.58 0.19– 1.73 NS
users (n 5 189) (n 5 511) Maternal age .40 years 1.81 0.49– 6.68 NS
........................................................................................
Gestational age at 271.0 + 16 273.0 + 15 0.099 Twin pregnancy 16.36 5.07– 52.80 0.000
birth (days) Smoking 1.51 0.62– 3.70 NS
Birthweight (g) 3141 + 649 3244 + 556 0.038 Drugs intake 1.72 0.49– 6.04 NS

Data are expressed as the mean + standard deviation; NS: not significant. NS, not significant.

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 Hazards of herbs in pregnancy 3165

Unexpectedly, the daily application of almond oil to the abdomen to

Table VII Factors associated with LBW according to alleviate stretch marks was significantly associated with the occurrence
multivariate logistic regression.
of PTB, even after controlling for confounding factors such as smoking
Variables Adj OR 95% CI P-value habit and multiple pregnancies. This finding, however, should be inter-
........................................................................................ preted with caution due to the retrospective nature of our
Almond oil application 0.76 0.27– 2.10 NS investigation.
Chamomile use 1.49 0.52– 4.23 NS Several possible reasons for the association between almond oil and
Maternal age 25– 35 years 1.74 0.49– 6.15 NS shortening of gestation can be advanced. Spreading of oil on the
Maternal age 35– 40 years 2.05 0.54– 7.74 NS abdomen could mechanically stimulate the myometrium, thereby indu-
Maternal age .40 years 3.33 0.70– 15.9 NS cing premature contractions. Indeed, physical stress such as strenuous
Primiparity 0.72 0.39– 1.33 NS work is known to induce preterm delivery (Hobel et al., 1999; Ruiz
Education ≤8years 0.64 0.35– 1.18 NS
et al., 2002). The observation that herbal users specifically received
more treatments targeting uterine contractions (tocolytics), despite
Smoking 2.75 1.25– 6.08 0.012
a lower consumption of conventional drugs seems to support the hy-
Drugs intake 0.74 0.24– 2.32 NS
pothesis that almond oil application induced PTB through chronic
LBW, low birthweight; NS, not significant. uterine stimulation.
Alternatively, one could argue that one or more components of
almond oil might penetrate the tissue and produce some uterotonic
effects. In fact, almond oil has been successfully used as a solvent to
Table VIII Antenatal cares and clinical/histological carry herbal cocktails for the treatment of dysmenorrhoea in
suspicion of infections in women undergoing PTB, Korean high-school girls (Hur et al., 2012), suggesting that this com-
according to herb consumption. pound can effectively target the myometrium.
We therefore searched for reports relating active constituents of
Regular herbal Non-users almond oil to PTB. Interestingly, vitamins C and E are present in
users (n 5 29) (n 5 51) P-value
........................................................................................ high amounts in oils extracted from sweet almonds (Gruenwald
First prenatal exam 3/24 (12.5)a 1/9 (11.1) NS et al., 2000; Vaivre-Douret et al., 2009). The prophylactic administra-
.12 weeks tion of both vitamins to thousands of pregnant women was indeed
Prenatal 1/24 (4.2) 1/9 (11.1) NS associated with adverse pregnancy outcomes, such as perinatal mor-
examination ≥3 tality, premature birth and premature rupture of membranes (Xu
Ultrasound 9/24 (37.5) 3/9 (33.3) NS et al., 2010; Conde-Agudelo et al., 2011). Moreover, almond oil con-
examination ≥3 tains a high percentage of oleic and linoleic acids, known to be precur-
p-PROM 11/29 (37.9) 14/42 (33.3) NS sors of prostaglandins (Kodad and Socias, 2008). Thus, depending on
Histological 8/25 (32) 9/39 (23.1) NS the relative content and absorption of Omega-3 and Omega-6 fatty
chorioamnionitis acids, almond oil could potentially stimulate or inhibit uterine contrac-
Histological funisitis 0/25 (0) 1/39 (2.5) NS tions (Proctor and Murphy, 2001).
This is not the first report to demonstrate that herbal products
Data are incomplete because they were not available in every hospital. p-PROM,
premature rupture of the membranes. negatively interfere with pregnancy outcomes. Other authors have
a
Number with percentage in brackets. pointed out the possibility that herbal use during pregnancy may not
be safe, mainly based on the general conviction that plant extracts
have undetermined biological activities and their adverse events are
data were obtained from structured questionnaires filled out in a unknown (Ernst, 2002; Donald and Snodgrass, 2005; Holst et al.,
face-to-face interview soon after childbirth rather than from mailed 2011; Vitalone et al., 2011). A study performed in Canada found an
questionnaires or national registries. The latter methods allow association between flax intake and PTB (Moussaly and Bèrard,
larger sample sizes, although the quality of the information obtained 2010), whereas Boivin and Schmidt (2009) reported that the use of
is less precise. complementary and alternative medicines was associated with a
Of paramount importance, most of the interviewees reported a lower rate of ongoing pregnancy in an infertile population waiting for
consumption of herbs over a large proportion of their pregnancy, sug- assisted reproductive techniques.
gesting that their reasons for use were not solely limited to the relief of A potential limitation of our study is the small number of partici-
transient complaints such as nausea, cough or constipation. This atti- pants in relation to the heterogeneous behaviour of women self-
tude correlates with the reduced consumption of conventional drugs prescribing herbal medicines. Another source of heterogeneity lies
observed in the same women. in the diversity of marketed products. Moreover, because our
Interestingly, studies of herbal use among pregnant women have design was retrospective, it was not always possible to obtain informa-
reported different trends in preferred herbs. Although the topical ap- tion about certain potentially important confounding factors.
plication of almond oil and the consumption of chamomile infusions Psychosocial and biological factors, including infections and inflam-
were the most common in our population, in other populations, matory responses, have been suggested to play major roles in PTB
ginger (Louik et al., 2010) or ginseng (Holst et al., 2008) were the syndrome (Romero et al., 1994). We evaluated some of these
most popular herbs. factors as possible explanations of the excessive PTB occurring

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 3166
among regular herbal users. Unfortunately, this was possible for only a
subgroup of the women. Nevertheless, both users and non-users
received similarly adequate prenatal care, and the rate of chorioamnio-
nitis and premature rupture of the membranes was comparable
between the groups.
In conclusion, the use of herbal products during pregnancy is common
and popular despite being poorly studied. This frequent use is particular-
ly worrisome because many of these compounds are taken without an
expert physician’s advice and are often not supported by adequate infor-
mation. Healthcare providers should not ignore the use of herbs during
pregnancy and should be made aware of the actual properties of the
herbs to develop better counselling strategies. The association
between the daily topical use of almond oil and PTB raised a hypothesis
that requires further confirmation. It is important to emphasize that
more data are needed to clarify the causality of this relationship.
Authors’ roles
F.F. and G.B., substantial contribution to conception and design; G.D.
and G.P., substantial contribution of acquisition and interpretation of
data; M.J. and G.V., acquisition of data; S.B., analysis of data; F.F,
B.G. and C.L., drafting the article.
Funding
This study has been supported by an internal grant of the University of
Modena and Reggio Emilia.
Conflict of interest
None declared.
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Appendix: Items included in the
pre-structured questionnaire
(first session)
Have you taken any herbal medication during current pregnancy?
If yes, in which period?
If no, do you consider this kind of therapy as useful?
If no, do you consider this kind of therapy as safe?
Have you used any herbal product before you became pregnant?
Which plant/herb have you taken (see list)?
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For which health problem or symptom?
With which dose, formulation, route of administration and frequency?
Where did you purchase the herbal product?
Who introduced you to the herbal therapy?
In case of choice without a medical prescription/advice, did you
communicate it to your physician afterwards?
If no, why not?
Why did you choose an herbal product rather than a traditional drug?
Did you inform the pharmacist (herbalist) of your pregnancy?
Did you receive information about quality, risks and instructions
about the assumption of an herbal product?
If yes, who provided them?
Did you perceive benefits from taking this kind of therapy?
Did you observe side effects?
If yes, which?
If yes, did you communicate to your physician?