Volume 207 - Issue 3
What risks do herbal products pose to the Australian community?
Author: Adam Morton
Med J Aust 2017; 207 (3): 134. || doi: 10.5694/mja17.00153
Published online: 7 August 2017
Published online: 7 August 2017
To the Editor:
I thank Byard and colleagues1 for their review of risks of herbal products to the Australian community, which highlighted the high rates of use in younger women with a tertiary education and in patients with chronic diseases or comorbidities. Refugee and migrant women represent a group with potentially high rates of use of herbal products as well as other traditional practices, particularly during pregnancy. Ethnobotany surveys found that 90% of women in eastern Ivory Coast and 80% of women in Mali used medicinal plants during pregnancy.2 A prospective cohort study found that 45% of women in China consumed Chinese herbal medicine during pregnancy and the postpartum period.3 The ingestion of soil, clay or chalk has been observed in up to 84% of pregnant women in African countries, and may be complicated by hypokalaemic paralysis, iron and zinc deficiency, lead poisoning, intestinal obstruction and parasitic infestation.4,5
It is commonly reported that migrant women transfer cultural practices to their new country. In the United Kingdom, geophagia is associated with immigrants from South Asia and West Africa.6 Likewise, Congolese and Zimbabwean women commonly consume clay during pregnancy after migrating to Cape Town.7 In addition, the use of skin lightening creams has been reported in 69% of pregnant women on their third-trimester attending a standard maternal centre in Dakar, which may result in maternal Cushing’s syndrome and adrenal insufficiency and in fetal intrauterine growth restriction. Most case reports in the literature describing Cushing’s syndrome due to skin lightening creams have been on African women who had migrated to Australia, the United States or Europe.8 Skin lightening creams may also contain mercury, with the risk of birth defects and irreversible neurological damage to the child. These products are usually obtained over the counter in African shops, and thus are not subject to any form of safety regulation.
A further difficulty is that migrant women may not disclose their use of herbal medicines or other traditional products, even when questioned specifically. Therefore, health professionals in Australia should be aware of the risk of use of herbal and other natural products and practices by migrant women, particularly during pregnancy. Engagement with matriarchal figures, nurses and doulas within migrant communities may be valuable in identifying the extent of these practices.
Competing interests
No relevant disclosures.
References
- Byard R, Musgrave I, Maker G, Bunce M. What risks do herbal products pose to the Australian community? Med J Aust 2017; 206: 86-90.
- Fawcett EJ, Fawcett JM, Mazmanian D. A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. Int J Gynaecol Obstet 2016; 133: 277-283.
- Tang L, Lee AH, Binns CW, et al. Consumption of Chinese herbal medicines during pregnancy and postpartum: a prospective cohort study in China. Midwifery 2016; 34: 205-210.
- Malan DF, Neuba DF. Traditional practices and medicinal plants use during pregnancy by Anyi-Ndenye women (Eastern Côte d’Ivoire). Afr J Reprod Health 2011; 15: 85-93.
- Nergard CS, Ho TP, Diallo D, et al. Attitudes and use of medicinal plants during pregnancy among women at health care centers in three regions of Mali, West-Africa. J Ethnobiol Ethnomed 2015; 11: 73.
- Abrahams PW, Davies TC, Solomon AO, et al. Human geophagia, calabash chalk and undongo: mineral element nutritional implications. PloS One 2013; 8: e53304.
- Hunter-Adams J. Interpreting habits in a new place: migrants’ descriptions of geophagia during pregnancy. Appetite 2016; 105: 557-561.
- Morton A, Menon A, O’Moore-Sullivan T. A young African woman with hyperglycaemia. Aust Fam Physician 2016; 45: 206-207.