The pregnancy period, when risk benefit analyses are particularly complex, poses specific questions in medical care. At the same time that a woman’s physiology and metabolism change in the course of pregnancy, not only her health but also that of the embryo/foetus is to be considered. In this context, and given the often assumed and perceived favourable risk-benefit ratio of the corresponding therapies, approaches from integrative medicine appear as particularly pertinent in the area of obstetrics. Moreover, this type of medicine intentionally relies on lifestyle advice, which enlarges the range of possibilities for preventive and low-risk interventionions to improve health status around pregnancy.
The use of medications prepared from the plant Bryophyllum pinnatum in obstetrics deserves particular attention (for a recent review see (1)). Bryophyllum was introduced in 1921 by Rudolf Steiner for the treatment of “hysteria”, eventually leading to its use for sedation, which is still commonly used in anthroposophic medicine (see (2)). The effectiveness of B. pinnatum in the treatment of sleep disorders has been investigated (3), one of the studies having been performed during pregnancy (4). In 1970, the German gynaecologist Werner Hassauer (1928-1993) introduced B. pinnatum in the setting of an anthroposophic hospital in the treatment of premature labour (5). At this time, bedrest and – despite their associated side-effects – beta-agonists were the only available treatments for premature delivery, still the main cause of neonatal mortality and morbidity. After the first retrospective pilot study was published, several retrospective studies were performed which showed good effectiveness and very good tolerability of B. pinnatum as a tocolytic agent (6-8). A recent online survey in Switzerland showed that in gynaecology and obstetrics B. pinnatum (50% tablets) is being prescribed for pregnant women (9). With two-thirds of the patients being treated at the University Hospital of Zurich, this survey showed as well that B. pinnatum is also being used in conventional settings. The clinical evidence for tocolytic effects of B. pinnatum has been supported with experimental data obtained in an organ model (10, 11) as well as in a cellular model (12).
Several factors associated with an anthroposophic lifestyle might influence health of pregnant women and of their offspring: consumption of organic or biodynamic food, reduced use of conventional therapies, extent of activities with high mobility, the goal of living as much as possible in accordance with nature and, after birth, long breast-feeding period (13). A first indication that some parameters of a lifestyle related to anthroposophy could affect the prevalence of a given disease was a Swedish observational study in the late 1990s, which showed a reduced risk of atopic diseases for children attending Steiner schools compared to those attending neighbourhood schools (14). These observations were later corroborated by an international study performed in five European countries (15) and by the PARSIFAL-study (16). Interestingly, the fatty acid composition of the milk of women consuming organic dairy products and ruminant meat was different from that of women consuming the same products from conventional production (17) and this difference was accentuated in the case of biodynamic production (18). The relevance of these observations became clearer when an independent analysis revealed that comparable differences in the fatty acid composition of human milk had a positive impact on atopic diseases in the corresponding children (19). Although foetal exposure to some metals might be elevated in women with an anthroposophic lifestyle (still within the normal range and probably due to a diet rich in vegetables (20)), an anthroposophic lifestyle has very recently been shown to be associated with a lower incidence of food allergen sensitisation in early childhood (21).
Finally, the increasing complexity of decision-making processes during pregnancy cannot be ignored and the need for good quality decision aids is high (22). The positive influence on several pregnancy-related outcomes of subjective factors like calm, relaxation, and a feeling of safety, should not be neglected.
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PD Dr Ana Paula Simões-Wüst
University Hospital Zurich
Clinic Arlesheim, Switzerland;
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(1) Fürer, K., et al., Bryophyllum pinnatum and Related Species Used in Anthroposophic Medicine: Constituents, Pharmacological Activities, and Clinical Efficacy. Planta Med, 2016.
(2) Simões-Wüst, A.P., et al., Prescribing Pattern of Bryophyllum Preparations among a Network of Anthroposophic Physicians. Forsch Komplementmed, 2012. 19(6): p. 293-301.
(3) Simões-Wüst, A.P., et al., Sleep Quality Improves During Treatment With Bryophyllum pinnatum: An Observational Study on Cancer Patients. Integr Cancer Ther, 2015. 14(5): p. 452-9.
(4) Lambrigger-Steiner, C., et al., Sleep quality in pregnancy during treatment with Bryophyllum pinnatum: an observational study. Phytomedicine, 2014. 21(5): p. 753-7.
(5) Hassauer, W., K. Schreiber, and D. Von der Decken, Ein neuer Weg in der tokolytischen Therapie. Erfahrungsheikunde, 1985. 34: p. 683-687.
(6) Daub, E., Vorzeitige Wehentätigkeit. Ihre Behandlung mit pflanzlichen Substanzen, eine klinische Studie. 1989, Stuttgart: Urachhaus.
(7) Vilaghy, I., [Decreasing the rate of premature delivery with phytotherapy-results from general practice] Senkung der Fruhgeburtenrate mit Phytotherapie--Ergebnisse aus der Praxis. Ther Umsch, 2002. 59(12): p. 696-701.
(8) Plangger, N., et al., Intravenous tocolysis with Bryophyllum pinnatum is better tolerated than beta-agonist application. Eur J Obstet Gynecol Reprod Biol, 2006. 124(2): p. 168-72.
(9) Fürer, K., et al., The Application of Bryophyllum pinnatum Preparations in Obstetrics and Gynaecology - a Multicenter, Prospective Observational Study. Forsch Komplementmed, 2015. 22(4): p. 231-6.
(10) Gwehenberger, B., et al., Effect of Bryophyllum pinnatum versus fenoterol on uterine contractility. Eur J Obstet Gynecol Reprod Biol, 2004. 113(2): p. 164-71.
(11) Wächter, R., et al., Leaf press juice from Bryophyllum pinnatum (Lamarck) Oken induces myometrial relaxation. Phytomedicine, 2011. 19(1): p. 74-82.
(12) Simões-Wüst, A.P., et al., Juice of Bryophyllum pinnatum (Lam.) inhibits oxytocin-induced increase of the intracellular calcium concentration in human myometrial cells. Phytomedicine, 2010. 17(12): p. 980-6.
(13) Simões-Wüst, A.P., et al., Influence of alternative lifestyles on self-reported body weight and health characteristics in women. Eur J Public Health, 2014. 24(2): p. 321-7.
(14) Alm, J.S., et al., Atopy in children of families with an anthroposophic lifestyle. Lancet, 1999. 353(9163): p. 1485-8.
(15) Floistrup, H., et al., Allergic disease and sensitization in Steiner school children. J Allergy Clin Immunol, 2006. 117(1): p. 59-66.
(16) Alfven, T., et al., Allergic diseases and atopic sensitization in children related to farming and anthroposophic lifestyle-the PARSIFAL study. Allergy, 2006. 61(4): p. 414-21.
(17) Rist, L., et al., Influence of organic diet on the amount of conjugated linoleic acids in breast milk of lactating women in the Netherlands. Br J Nutr, 2007. 97(4): p. 735-43.
(18) Simões-Wüst, A.P., et al., Consumption of dairy products of biodynamic origin is correlated with increased contents of rumenic and trans-vaccenic acid in the breast milk of lactating women. Organic Agriculture 2011. 1(3): p. 161-166.
(19) Thijs, C., et al., Fatty acids in breast milk and development of atopic eczema and allergic sensitisation in infancy. Allergy, 2011. 66(1): p. 58-67.
(20) Fagerstedt, S., et al., Anthroposophic lifestyle influences the concentration of metals in placenta and cord blood. Environ Res, 2015. 136: p. 88-96.
(21) Fagerstedt, S., et al., Anthroposophic lifestyle is associated with a lower incidence of food allergen sensitization in early childhood. J Allergy Clin Immunol, 2016. 137(4): p. 1253-6 e1-3.
(22) Berger, B., C. Schwarz, and P. Heusser, Watchful waiting or induction of labour--a matter of informed choice: identification, analysis and critical appraisal of decision aids and patient information regarding care options for women with uncomplicated singleton late and post term pregnancies: a review. BMC Complement Altern Med, 2015. 15: p. 143.