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Sir,

We applaud Professor Ernst for his excellent review calling attention to the growing use and possible implications of herbal medicine products during pregnancy. We recently evaluated the use of these remedies among pregnant women at our tertiary care centre1. In the 734 of 1203 pregnant woman who answered our questionnaire (61% response rate), 7.1% used herbal medicines, a frequency that was significantly less than the 22% in the general hospital population before surgery in our institution2. Forty-six percent of pregnant women who used herbal remedies did so at the recommendation of their health care provider. Use of herbal remedies was more common among pregnant women aged 41–50 years (a small but growing population due to assisted reproductive technologies). The most commonly used remedies were echinacea, St-John's-wort and ephedra.

We find the increasing use of such remedies of concern as they remain unregulated in production and use. As epidural analgesia is a popular form of pain relief in labour, the potential for increased bleeding tendencies3 and alterations in maternal haemodynamics remain a significant concern. Professor Ernst's work and our own emphasise the need for obstetricians and midwives to ask their patients routinely about the use of such products, to be familiar with their side effects and interactions with other drugs and to conduct clinical trials to investigate the effects of such agents.

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