Gestation is marked by deep changes that interfere with the woman’s life, such as changes related to the body, its physiology and its metabolism^[1]. In addition, socioeconomic and demographic influences during gestation also include emotional variables and physical changes in the woman’s life span, which influenced eating habits and choices^[2-5].

Among these choices is the use of medicinal plants and a phytotherapeutic therapy during pregnancy. Phytotherapy is a type of culture that uses the measurement of the use of medicinal plants in pharmaceutical forms, but without the identification of active substances. The Consolidated General Rules of Analogy and Certification of Certification of Analogic Analog and Health and Clinical Development (English).

However, women can not be used on medicines without the advice of a health professional. Although they have been used, their efficacy has not yet been scientifically proven, and they have been conditioned for the health of the pregnant woman, such as the possible embryotoxic, abortive or teratogenic factors^[6,7]. Thus, a table by Yankowitz and Niebyl[8] classifies the five categories of risks for the use of medications at certain times, should also beuseful for herbal medicines.

The oral use of medicinal plants by pregnant women corresponds to an empirical knowledge, inherited from their sociocultural affiliation^[9]. However, investigate the perceptions and meanings of pregnancies on pregnancy-relatedphenomena^[10,11], as the concerns and meanings of pregnant women about therapy for the woman as a whole.

From these considerations, it becomes important to look at the use of herbal and medicinal plants during gestation, understanding the vision in the pregnant woman, as well as taking into consideration the psychosocial and physical factors of gestation and how they are can interfere or influence practice. Thus, the present study aimed to understand the perception of pregnant women regarding the use of medicinal and phytotherapeutic plants.

Methodology

The present article deals with an integrative review, which is done in six stages, where a first step is a matter of decision or a question of revision. Then select a sample of scientific data to be revisited, followed by the categorization and evaluation of the studies. Interpreting the results of the search or revision of knowledge is an effective process. The dates were deactivated using databases: PubMed, Scientific Eletronic Online Libray (SciELO), Medline and Google academic, through the following keywords: phytotherapy; medicinal plants; gestation; pregnancy; perception; representations.

To guide this review, elaborate a question as follows: “Whatis the acronym of pregnantwomen about the use of medicinal plants and / or herbal products?”, Obeying the following inclusion criteria: a reference on the practice of using medicinal plants and herbal medicines by pregnant women. They were recently indexed in the data bases mentioned above, which were exposed to Portuguese and Portuguese between 2006 and 2016, and that the results were available in full.

Articles with restricted access were excluded. In order to obtain the articles, a research of the titles and summaries of the curricula was carried out, in order to as certain an appropriation of the study with a question raised by the investigation. At the end of the research were found the 12 transfers, which is common and exclusive, it fits the pre-established selection criteria. For the extraction of data from a dossier were analyzed as members of the research, we investigated the identification of the article, characteristics of the literature addressed in the studies, evaluation of methodological rigor, direction studied and results of the studies. The presentation of the data and discussion was made in a descriptive way, using an application in the revision of the information on herbal and medicinal plants (TABLE 1).

Table 1: Information of the articles included in the integrative review according to the guiding question.

Results and Discussion

The articles included in the present review were carried out in the following countries: Brazil, Guatemala, Kenya, Benin and Gabon. Table 1 shows the authors of the articles, besides the sample and location, objectives, methodology, results and conclusion.

Regarding the form of use, most of the women referred to the use of medicinal plants in the form of “teas”^[12,13]. In the article by Pires and Araújo^[14], pregnant women demonstrate confidence in medicinal plants because they understand that they have natural substances and are therefore less aggressive or harmless than medications. The data corroborate with the results of Macena et al.^[12] in which the majority of pregnant women believe that, because it is natural, plants do not have side effects. Rangel & Bragança^[13] found characteristics indicated by pregnant women as a natural, traditional (homemade), effective, healthy, free, reliable, chemical-free, “come from God”, simple and easy to use remedy.

Corroborating with the results found in this review, Almeida et al.^[15] in a study investigating how residents of the Federal District use medicines, herbal medicines and vitamins and how they perceive the risk of this use for health, the researchers found that the analgesic was considered one of the safer medicines by the study population, along with vitamins, herbal medicines and syrups. Thus, this perception of safety can lead to inappropriate and often abusive use, increasing the risk of adverse effects associated with these compounds.

The idea that medicinal plants and herbal medicines are innocuous, and that they do not present any toxicity potential because they are common in nature. This fact can lead to serious consequences for the health of the population, such as: side effects, interactions with other medications and even intoxications. It is necessary to implement effective education and information measures that contribute to the rational use of medicinal plants and herbal medicines^[16].

As therapeutic agents, however, medicinal plants should be used under appropriate indication, dosage and preparation forms and directed by a health professional. These should address this practice with women through the discussion of contraindications and the possible interaction of these herbs with other medications that the woman is already using during pregnancy^[17]. Therefore, government campaigns or programs are necessary to inform pregnant women about the use of medicinal plants during pregnancy^[18,19].

In the study by Towns and Andel^[20], when referring to the view of health professionals, they brought positive and negative claims to women’s health regarding the use of herbal medicines, the information clearly showed that the national policies of the African countries of the study do not authorize this practice in the Cheers. They were cited situations by these professionals in which the patients used plants to accelerate uterine contractions, which led to uterine rupture. Professionals also expressed concern about the lack of scientific information on the effects of medicinal plants and the lack of standard dosage for use.

Based on the vision of health professionals, highlighted in the article of the current review, Oliveira^[21] points out that the lack of knowledge of health professionals in the field of herbal medicine and medicinal plants is another factor that deserves attention, so, as they know little, be lower and population orientation will be weaker. In addition, the low investment in research in this area is another aspect that deserves to be considered, further aggravating the knowledge on the part of professionals and scholars in the area.

It is worth mentioning that phytotherapy, together with other Integrative and Complementary Practices (PICs), were incorporated into the Unified Health System (SUS) in Brazil, through Administrative Rule 971, dated May 3, 2006, thus, in addition to the use of medicinal plants, other practices are included, such as: Traditional Chinese Medicine, Acupuncture, Homeopathy, Social Therapy, Chronotherapy and Anthroposophic Medicine^[22,23].

The World Health Organization (WHO), through the document “WHO Strategy on Traditional Medicine 2002-2005”, also supports and encourages the incorporation of PICs into national health systems, providing standards and technical guidance in order to promote the exchange information and good use of traditional medicine^[24].

Thus, the Ministry of Health in its 2009 publication, by publishing the Core Guidelines for Family Health Care (NASF) encourages them to support family health teams (FHS) in valuing other treatment options natural medicine and PICs. However, for the implementation of such practices, it is emphasized the need of the professionals to know what they exist in their territory, respecting the popular knowledge; besides understanding the health-disease process, from the perspective of homeopathy, and to know the productive chain of medicinal and phytotherapeutic plants. Although such practice is encouraged in Brazil, for specific groups, such as pregnant women, care should be taken to guide these women^[25,26].

In the study by Macena et al.^[12] 66.6% of the women said they did not inform the doctor about the practice of phytotherapy because, according to them, “they are known plants” and “they do not like to use it”, and only 33.4% reported on use. Mothupi 17 also found a low percentage of users (12.5%) who had reported this practice to health professionals, and about 20% used phytotherapy concomitantly with other medications.

The article by Pontes et al.^[18] points out the main medicinal plants used by pregnant women, which were: boldo, lemon balm, cinnamon, elderberry, clover, clove, pomegranate, sweet herb and garlic. Macena et al.^[12] also sought to verify the use of medicinal plants by pregnant women, the ones mentioned by the women were: boldo, cidreira grass, mint, camomile, rosemary, fennel and poejo. Rangel and Bragança^[13] pointed out as the most used, plants cited in the two previous studies: lemon balm, boldo, fennel and chamomile. However, all plants cited in all three studies were included in the list of herbs contraindicated during gestation according to Resolution SES / RJ No. 175726.

On the basis of this same Resolution, found in the articles included in this review, Freitas et al.^[9] found in their study, five of the plants mentioned in this list of contraindicated plants during gestation were: sweet grass, holy grass, camomile, boldo It is worth noting that the contraindication is due to its toxic potential, teratogenic and abortive. Still in relation to this study, more than half of the pregnant women reported using phytotherapy in pregnancy, other plants, in addition to the five mentioned, and were also mentioned by the women in the study.

In the study by Michel et al.^[19], which aimed to explore the perceptions of treatment through medicinal plants to treat women’s health (pregnancy, delivery, menstruation and menopause), participants, residents of Guatemala, believe that ceremonies performed are essential for the effectiveness of a medicinal plant. They also considered that women have a weaker constitution than men due to the debilitating effects of menstruation, pregnancy, and postpartum recovery; there are numerous cultural taboos and restrictions on the health of women in this population. This view, in this study, contributes to a better understanding of popular beliefs and cultural concepts about women’s health. Thus, actions in this field require more complex practices than simple guidelines to the population.

Understanding the specificities of how cultural groups identify themselves in certain circumstances or health facts does not prevent their participation in the elaborations on their own health being evaluated, then it is necessary that the health services take on this more complex competence when dealing with health of the population. Thus, the exercise of health promotion and the adaptation to the codes and symbologies existing in the different localities or local groups, intends to attend to the notions of health and well-being of each one of these groups, understanding this function of the diverse health practices and the forms of significance that may arise^[27,28].

The main motivations of using plants are to treat constipation, to feed (for being nutritious), treat fever, use as a sedative, to combat pain and anxiety. In general, they were cited to treat gestational symptoms^[18,20]. Also, the fight against diseases such as: anemia, hypertension; in addition to the stimulation of breast milk, to strengthen and protect the fetus, to prepare the body for childbirth, to promote the general health and well-being of the mother. Regarding delivery, they were mainly reported to facilitate labor and to aid in the removal of the placenta 20. Mothupi 17 found that the main reasons for using phytotherapy for women were: back pain, toothache, indigestion and infectious diseases such as respiratory infections, and malaria. In addition, most users practiced herbal medicine only to increase or maintain health. Michel et al.^[19] also found the use for menstrual cramps and as abortive and even contraceptive methods.

The article by Pontes et al.^[18] also sought to relate the practice of phytotherapy to abortion. Of the women who had a spontaneous abortion, three used boldo, although they did not associate this use as a causal agent. The scarcity of studies relating the practice of phytotherapy with adverse effects during gestation deserves attention and care, many studies reinforce the lack of evidence for the release of its use during pregnancy^[28-30].

The literature is still scarce with research relating adverse effects in pregnancy with the use of medicinal plants. Malan and Neuba^[28] researched about the use of plants during pregnancy, being a common practice in Africa, as explained earlier, the present review included research in three African countries. In Côte d’Ivoire, despite modern prenatal medical prescriptions, most pregnant women resort to traditional medicine to ensure the development of a healthy fetus and assist in labor. However, there is not enough research on traditional medicine in this country, the plants used by these women need to be better known.

In the study by Rangel and Bragança^[13] some pregnant women showed insecurity about the correct use of the plant species, they said that it could harm the fetus because they are dangerous or toxic. Women’s knowledge points, for example, that the more “bitter” the plant, the greater the risk for the concept. In the Mothupi study^[17], female users and non-users of herbal medicines were not sure about the safety and contraindications of this practice during pregnancy.

Knowledge about the mode of use and indications of medicinal plants was obtained through popular information and through relatives, related to a popular knowledge that is passed over time, few pregnant women use herbal medicines for medical guidance and many would like their doctors prescribe natural medicines^[12,13,17]. Thus, emphasizing these data found in the articles of the present review, Arruda^[31] points out that the places of sale of medicinal plants generally do not invest in advertising, the disclosure occurs spontaneously, by word of mouth, among consumers themselves, due to the tradition of its use and the indication by loved ones, like family and acquaintances.

Conclusion

Therefore, it is observed that, in general, the pregnant women demonstrate confidence with the use of herbal and herbal products during pregnancy because they think that they are more natural and therefore harmless to the health, although some women show certain insecurity in its use. The most cited plants as used in gestation were to treat symptoms of pregnancy itself. This practice, most of the time, is not informed to the health professionals who accompany them and many pregnant women would like their doctors to prescribe the plants when necessary. Although not investigated in the present review, the positioning of health professionals regarding this use by pregnant women, there is insecurity in the orientation, due to the lack of research in the area aimed at gestation. In addition, the policies of some countries are different regarding the release of herbal medicine for the health of the general population. In Brazil, there are some policies aimed at the integrative practices in health that even stimulate the orientation by the professionals for the use of medicinal plants and herbal medicines. But regarding gestation, there are several restrictions on its use, with published resolutions in the country. In addition, the main plants used by women in the present study were with forbidden herbs in gestation, according to legislation.

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