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Systematic review and meta-analysis of complementary and alternative medicine use during pregnancy in Iran
Seyede Maryam Najibi1,2, Seyede Hamide Rajaie2, Mahdie Hajimonfarednejad2,3
1Department of Health Services Management, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Objective:
This systematic review and meta-analysis aimed to determine the prevalence, patterns and associated factors of complementary and alternative medicine (CAM) use among pregnant women in Iran.
Design:
A systematic review and meta-analysis of observational studies.
Data Sources:
A comprehensive search was conducted in PubMed/MEDLINE, Web of Science, Scopus, ScienceDirect and major Iranian databases from inception to 30 November 2024.
Eligibility Criteria For Selecting Studies:
We included observational studies published in peer-reviewed journals that assessed CAM use among pregnant women in Iran and reported prevalence estimates or relevant associated factors.
Data Extraction And Synthesis:
Data extraction and quality assessment were performed independently by two reviewers using a standardised form and the Quality Assessment Tool. Meta-analyses of proportions were performed using the DerSimonian and Laird random effects model. The between-study heterogeneity was assessed using the I-squared (I²) statistic. Subgroup analysis, 95% prediction intervals (95% PrIs) and sensitivity analysis were conducted to explore the sources of heterogeneity and to evaluate the robustness of the overall effects, respectively. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO.
Results:
20 studies with a total of 8106 participants were included. The pooled prevalence of CAM use was 49% (95% CI 39% to 59%). The between-study heterogeneity was very high (I2=94.69%) with a wide 95% PrIs range of 3%-94%. The very high between-study heterogeneity and the wide range of PrI for the pooled prevalence were not explained by the quality of the studies, geographical regions of Iran or the methods of data collection. Mentha longifolia, Zataria multiflora and Boswellia thurifera were the most commonly used herbs. Across the included studies, the first trimester of pregnancy was most frequently reported as the period of CAM use, with socioeconomic factors identified as significant predictors. Family and friends were the primary sources of information regarding CAM. The most common reasons for CAM use included gastrointestinal issues, respiratory problems such as colds and coughs, and the desire to improve general health. Only 31% of participants disclosed their use of CAM to their healthcare provider.
Conclusions:
Nearly half of pregnant women in Iran use CAM, yet disclosure to healthcare providers is low. An actionable implication is the critical need to integrate routine enquiry about CAM use into standard antenatal care to ensure safe practice. Further research is recommended to evaluate the effectiveness, safety and outcomes of CAM use among pregnant women.
Prospero Registration:
CRD42024618490.
