Women's Health and Complementary and Integrative Medicine

Jon Adams, Amie Steel, Alex Broom, Jane Frawley

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781317337935
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Complementary and integrative medicine (CIM) has become big business internationally, in particular with regards to a range of women's health issues. With this context in mind, Women's Health and Complementary and Integrative Medicine constitutes a valuable and timely resource for those looking to understand, initiate and expand CIM research and evidence-based debate with regards to a wide range of women's health care issues.

The collection brings together leading international CIM researchers from Australia, the USA, the UK, Germany and Canada, with backgrounds and expertise in health social science, statistics, qualitative methodology, clinial trial design, clinical pharmacology, health services research and public health. Contributors draw upon their own CIM research work and experience to explain and review core research and practice issues pertinent to the contemporary field of CIM and its future development with regards to women's health.

The book outlines the core issues, challenges and opportunities facing the CIM-women's health field and its study and will provide insight and inspiration for those practising, studying and/or researching the contemporary relations between CIM and women's health and health care.

Part I
CIM use and women’s life cycle

1 The role of complementary and integrative medicine within preconception care

Contributing to an emerging research field

Abigail Aiyepola, Amie Steel, Jane Frawley and Jon Adams

Introduction

The aim of this chapter is to position and overview the potential of complementary and integrative medicine (CIM) within the empirical study and conceptual approach to the field of preconception health and service delivery. The chapter opens with a consideration of the history and context of preconception care including the emphasis placed on preconception care in contemporary policy documents developed by international health agencies. The chapter then examines current advances in our empirical understanding of the impact of maternal preconception health status on women’s and neonates’ health outcomes. The chapter also explores current knowledge regarding CIM and maternal health, particularly in the context of preconception care, and closes with a consideration of some key areas requiring research attention to help ensure future health service delivery and policy is responsive to women’s needs during the preconception period, particularly as they relate to CIM.

Preconception care: history and context

Cultures throughout human history have emphasised the importance of women maintaining health and being healthy prior to pregnancy (Freda et al., 2006). In recent decades, increasing recognition of the fetal origins of adult disease (FOAD) has contributed to a paradigm shift in the scientific understanding of disease etiology (Barker et al., 1995; Delisle, 2002). Some factors contributing to this paradigm shift include rising incidences of preterm births (Blencowe et al., 2013), paediatric and adult chronic diseases (Gluckman et al., 2008; Shonkoff et al., 2012) and neurodevelopmental disorders such as autism (Kolevzon et al., 2007). In particular, the fetal environment has been found to impact the risk of developing chronic diseases such as obesity (Ehrenthal et al., 2013), diabetes and cardio vascular disease (Le Clair et al., 2009), and cancer (Miligi et al., 2013) through epigenetic and other cellular responses to developmental exposures (Wang et al., 2013). A substantial proportion of FOAD research examining the impact of low birth weight (LBW) as a surrogate marker of poor fetal growth and nutrition (Calkins and Devaskar, 2011) has reported links between LBW and coronary artery disease (Barker, 1995; Rogers and Velten, 2011), hypertension (Vickers et al., 2000), obesity (Oken and Gillman, 2003) and insulin resistance (Yajnik, 2004).

Alongside the growing physiological understanding of FOAD, is a cultural shift within medicine towards prevention and wellness (Hood and Friend, 2011), which is manifest in the policies and strategies underpinning contemporary preconception care (Moos, 2003). Deeper scientific and social investigations into the determinants of health have also contributed to this shift, as evidenced by the recent surge in epigenetic research (Cameron et al., 2008; Knezovich and Ramsay, 2012; Steegers-Theunissen and Steegers, 2015) and increasing emphasis on the social determinants of health (Hogan et al., 2012; Livingood et al., 2010).

These changes in the conceptualisation of disease aetiology have facilitated the development of preconception care as a meaningful preventive measure for achieving positive pregnancy and birth outcomes, as well as the ongoing optimal health of the offspring. Preconception care is an approach to health promotion and preventive medicine focused on interventions that identify and modify biomedical, behavioural and social risks to a woman’s health or pregnancy outcome (Posner et al., 2006). In 2005, the Centers for Disease Control and Prevention in the USA hosted a summit with 35 partner organisations to help identify, among other related issues, a number of defining characteristics of preconception care (ibid.). The summit determined that effective preconception care cannot be achieved via one sole visit with a health professional but is a ‘continuum of care designed to meet the needs of a woman through the various stages of her reproductive life’ (ibid.). The summit participants also agreed that preconception care was, at its core, a health promotion initiative with the primary goal being to promote maternal and child health throughout a woman’s reproductive lifespan, and facilitate each woman to be healthy as she attempts to conceive (ibid.). The summit also posited that one core focus of preconception interventions is to reduce perinatal risk factors.

According to the summit participants, preconception care relates to care before pregnancy, whether it is a first pregnancy or between consecutive pregnancies. Moving beyond the broad pronouncement of the summit, the importance of this component of contemporary health care has been acknowledged by a range of international bodies and organisations representing and regulating health professionals as well as health policy-makers (Christiansen et al., 2012; Committee on Gynecologic Practice, 2005; Johnson et al., 2006; National Institute for Health and Care Excellence, 2011). However, a recent review of preconception policies in six European countries highlights the fragmented, inconsistent and ad-hoc nature of preconception care polices in this space for healthy women and men (Shawe et al., 2015).

The impact of preconception health status on outcomes for women and neonates

Preconception care has received increased attention due to growing evidence that maternal health prior to conception can directly affect the health of the mother and the fetal environment during pregnancy (Committee on Gynecologic Practice, 2005). The majority of research attention in this area over the last 20 years has been directed towards the benefits of folic acid supplementation in preventing birth defects (Berry et al., 1999; Boyles et al., 2011; Khodr et al., 2014; Wilson et al., 2003; Yi et al., 2011). Meanwhile, the broader preconception care research field emphasises the impact of the fetal environment on adverse outcomes such as miscarriage (Nielsen et al., 2006), stillbirth (Signorello et al., 2010), congenital disorders (Shannon et al., 2013) and macrosomia (Strutz et al., 2012).

Maternal health behaviours that are important in the context of preconception care include dietary choices, smoking, alcohol consumption and exposure to communicable diseases (Chandranipapongse and Koren, 2013; Coonrod et al., 2008; Goldenberg and Thompson, 2003; Ji et al., 1997; Kind et al., 2006; Lassi et al., 2014; MacArthur et al., 2008). In terms of diet, nutritional balance can influence ovarian physiology and embryo quality (Kind et al., 2006). Parental smoking preconception has been linked to serious conditions such as cancer (Ji et al., 1997; MacArthur et al., 2008) and congenial heart defects (Lassi et al., 2014) whereas preconception alcohol intake has been found to lead to a possible 30 per cent increase in spontaneous abortion (ibid.). Infection can cause stillbirths (Goldenberg and Thompson, 2003) and while not directly attributable to maternal behaviour, preventable actions can be taken to reduce the risk of infection during the preconception period (Chandranipapongse and Koren, 2013; Coonrod et al., 2008).

Despite these and other contemporary findings highlighting the pressing need for preconception care to be prioritised within the general population, very little research attention has been committed to understanding the use of preconception services by women with chronic health conditions – arguably the sub-population with greatest need for preconception care in the community. A recent systematic review with no date restrictions only identified 14 papers examining this topic worldwide (Steel et al., 2015). The majority of papers identified in this 2015 review target women with type 1 or 2 diabetes, and failed to examine women with other significant health conditions, such as thyroid disorders and epilepsy (Johnson et al., 2006). Based on the outcomes of the review, on average, one in five women with chronic health conditions engage with preconception care, those women who did access preconception care commonly experienced emotional distress as a result, women’s knowledge of preconception care tends to be deficient in a number of areas (Steel et al., 2015).

A second review, examining women’s and health professionals’ attitudes to preconception care delivery, with the vast majority of literature identified as focused upon health professionals’ attitudes (Steel et al., 2016), highlighted the emotional complexity associated with child-bearing decisions and women’s need for better quality information to inform their decision-making with regards to the risks and benefits of related health behaviours. The importance placed on preconception care in policy planning has limited translation into community-based care, according to data from the health professionals included in this review – some clinicians provide preconception services as part of routine care while others only deliver it opportunistically (Christiansen et al., 2012). More concerning was the review finding that indicates insufficient ownership of the delivery of preconception care services among health professionals and a self-identified gap in clinicians’ knowledge with regards to providing effective preconception support (Steel et al., 2016).

Complementary and integrative medicine and maternal health

Complementary and integrative medicine (CIM) are used by women to support their health during pregnancy, birth and the postnatal period. Research reports up to 80 per cent of women consult with a CIM practitioner or use CIM products for pregnancy-related health conditions (Adams et al., 2009; Frawley et al., 2013; Steel et al., 2012). Additional research also describes women’s use of CIM products and treatments during labour to assist with pain management (Steel et al., 2013b) as well as CIM practitioner use in women’s intrapartum birth team (Steel et al., 2013c). Likewise, women report using CIM in the postnatal period to assist with insufficient lactation (Sim et al., 2013).

Despite the substantive advances in preconception care research in recent years and the role CIM is known to play in women’s wider health and health care (Adams et al., 2003; Peng et al., 2014; Rayner et al., 2011) and maternity services (Adams et al., 2009), very little research effort has been assigned to understanding the potential significance of CIM within preconception care. This neglected research area requires urgent attention with a view to helping ensure women and their families, health practitioners and health policy-makers are appropriately informed of all behaviours, decision-making and clinical evidence base regarding this important life stage.

Connecting preconception care and preventive healthcare through CIM

Preventive health care is one aspect of contemporary medicine considered to be practised by all medical providers (physicians) while also existing as a unique medical specialty in its own right (American College of Preventive Medicine, 2017). Preventive health care aims to protect, promote, and maintain health and well-being and to prevent disease, disability, and death in individuals, communities and defined populations (ibid.). Preventive health practitioners combine population-based public health skills, such as health promotion and public education, with knowledge of primary, secondary and tertiary prevention-oriented clinical practice (Hensrud, 2000a). In the United States, preventive medicine is medical specialty practised by physicians who have completed additional training in preventive health care (American College of Preventive Medicine, 2017). However, in line with the diversity of preventive health interventions in place within health systems throughout the world, preventive health care may be practised by health professionals from a range of occupations and found in primary, secondary or tertiary health settings in both developed, transitional and developing countries (Jekel et al., 2007).

In the preventive health care framework, preconception care focuses upon controlling modifiable risk factors to avert the occurrence of disease and, as such, falls within the category of primary prevention (ibid.). Primary preventive health care relies on a number of strategies in a clinical setting to achieve better health outcomes, including health risk assessment and patient counselling and education (Hensrud, 2000b). However, these interventions are under-utilised for numerous clinician, patient and health system-based reasons (Hensrud, 2000a) and current missed opportunities in disease prevention, including underusing high value interventions, such as preconception care, have been linked with substantive increases in the burden of certain diseases (Olsen et al., 2010).

Preventive healthcare is listed among the qualities commonly employed to characterise CIM (Foley and Steel, 2017). Other qualities, such as holism, are also featured among the characteristics of many complementary medicine systems of care (ibid.) and have been described by women as necessary ingredients within preconception service delivery (Steel et al., 2015). Preconception care also features strongly within the curriculum and textbooks of CIM practitioner training programmes (Wardle and Steel, 2010).

Based on preventive medicine research more generally, there are a number of characteristics of primary prevention programmes that equally apply to preconception care (Nation et al., 2003) and highlight the importance of considering CIM when developing preconception care interventions. First, a programme must be comprehensive, meaning it must address all determinants (e.g. socioeconomic status, health literacy) and risk factors (e.g. alcohol consumption, smoking, health status) which may impact on maternal and fetal outcomes (Nation et al., 2003). It is recommended this be achieved through both multiple interventions (i.e. several interventions addressing the targeted health behaviour) and multiple settings (i.e. engage the systems that have impact on the development of the targeted health behaviour). Given the prevalence of CIM use among women during their reproductive years (Adam...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of tables
• Notes on contributors
• Introduction
• PART I CIM use and women's life cycle
• PART II CIM use and women's health issues
• PART III CIM use, women and the health care system
• Index