Integrative Therapies and Preconception Health. Debbie Ringdahl DNP, RN, CNM

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1 Integrative Therapies and Preconception Health Debbie Ringdahl DNP, RN, CNM

2 Definitions Preconception Health primary care? CAM complementary (together with) and alternative medicine (in place of) Integrative Medicine combines treatments from conventional medicine and CAM for which there is evidence of safety and effectiveness

3 CAM Usage in United States

4 What do we know about the use of integrative therapies within the context of preconception health?

5 Barriers to Preconception Care Only a few conditions have data supporting intervention before conception rather than intervention early in pregnancy. Jack, B., Atrash, H., Bickmore, T., Johnson, K. (2008). The future of preconception care: A clinical perspective, Women s Health Issues, 18S, S19-S25.

6 Barriers to Integrative Therapies Use Misinformation, inadequate research, access, reimbursement, health care provider knowledge Authors' conclusions The small number of randomized controlled trials, together with the poor methodological quality and significant clinical heterogeneity, means that the current evidence is not sufficiently extensive or rigorous to support the use of any form of acupuncture for the treatment of insomnia. Larger high quality clinical trials employing appropriate randomization concealment and blinding with longer follow-up are needed to further investigate the efficacy and safety of acupuncture for the treatment of insomnia. Cochrane Database, Acupuncture for insomnia (2007)

7 Clinical Content of Preconception Care Jack, B. et al. (2008). Women s Health Issues, 18S, S19-S25 Health promotion* Immunizations Infectious diseases Medical conditions* Psychiatric conditions* Parental exposures* Psychosocial risks* Medications* Reproductive History Special Populations* Men*

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10 VITAL MOM V vitamins and minerals I immunize T tests A ask about genetic and obstetric history, spouse abuse L lose cigarettes, alcohol, and recreational drugs M medical conditions and medications O occupational exposures M modify: diet, exercise, stress, employment, caffeine intake Konchak, P. (2001). Preconception care: VITAL MOM A guide for the primary care provider, JAOA, 101(2), S1-S9.

11 Integrative Therapies in Preconception Care: Health Promotion and Disease Prevention Stress reduction Improve immune system Support self-care Manage anxiety/depression Nutritional support Musculoskeletal system support?infertility

12 Psychological distress during pregnancy is a significant risk factor in predicting adverse perinatal outcomes. Beddoe, A, Yang, C., Kennedy, H., Weiss, S., and Lee, K. (2009). The effects of mindfulness-based yoga during pregnancy on psychological and physical distress. JOGNN, 38,

13 Classification of Alternative Medicine Practices (NCCAM) Whole Medical Systems Mind-Body Medicine Biologically Based Practices Manipulative and Body-Based Practices Energy Medicine

14 Grades of Evidence Grades reflect the level of scientific evidence in support of the efficacy of a given therapy for a specific condition A strong scientific evidence B good scientific evidence C unclear or conflicting scientific evidence D fair negative scientific evidence F strong negative scientific evidence From Natural Standard evidence-based grading

15 Whole Medical Systems Whole medical systems are built upon complete systems of theory and practice. TCM - Health is achieved by maintaining the body in a "balanced state. Acupuncture Grade A pain Grade B fibromyalgia 53 Cochrane Database systematic reviews, 22 new protocols Assisted conception, smoking cessation, asthma, depression, insomnia, migraine prophylaxis, IBS Protocols - constipation, chronic fatigue, PCOS, PMS, dysmenorrhea, fibromyalgia, uterine fibroids

16 Mind-Body Medicine Uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Yoga Grade B anxiety, asthma, depression, psychiatric disorders, substance abuse Grade C eating disorders, fatigue, headache, insomnia, IBS, pain Growing evidence to suggest that yoga works to enhance stress-coping mechanisms and mindbody awareness Study: The effects of yoga during pregnancy, reduced pain and anxiety Beddoe, A, Yang, C., Kennedy, H., Weiss, S., and Lee, K. (2009). The effects of mindfulness-based yoga during pregnancy on psychological and physical distress. JOGNN, 38,

17 Biologically Based Practices Use substances found in nature, such as herbs, foods, and vitamins % Americans report use Used for prevention and management of chronic health problems Drug interactions Safety/toxicity History taking Up-to-date resources The Natural Medicines Comprehensive Database naturaldatatbase.com Grade A - folic acid 400 micrograms (0.4 milligrams) daily Grade C DHEA, flaxseed, ginger, ginseng, vitamin A, C, E, St. John s wort

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19 Manipulative and Body-Based Practices Based on and/or movement of one or more parts of the body Massage Cochrane - Low back pain, mechanical neck disorders, HIV/AIDS Grade B - quality of life (cancer) Grade C alcohol dependence, anxiety, asthma, chronic pain, depression, headaches, immune function, musculoskeletal conditions, PMS, stress

20 Energy Medicine Reiki: Grade C: depression, pain Energy therapies involve the use of energy fields Reiki, Therapeutic Touch, Healing Touch Psychological symptoms, pain relief Therapeutic Touch: Grade B: stress, pain Healing Touch: Grade C depression, pain, stress

21 Resources Evidence-Based Data Bases Cochrane Data Base AMED Allied and Complementary Medicine Natural Standard Monographs - pregnancy and related conditions com Online resources NCCAM U of MN Center for Spirituality and Healing online modules

22 WHAT ARE HEALING PRACTICES?ACUPUNCTURE AROMATHERAPY AYURVEDIC MEDICINE BIOFEEDBACK BOTANICAL MEDICINE BREATHWORK CHINESE HERBS CHIROPRACTIC CLINICAL HYPNOSIS CRANIOSACRAL THERAPY CREATIVE THERAPIES CUPPING DRAML FRICTION DIETARY THERAPIES FOOD AS MEDICINE HEALING ENVIRONMENT HEALING TOUCH HOLISTIC PREGNANCY & CHILDBIRTH HOMEOPATHY IMAGERY INTIUITION IN HEALTHCARE MASSAGE THERAPY MEDITATION MIND- BODY THERAPIES MINDFUL MOVEMENT MOXIBUSTION NATUROPATHY OSTEOPATHY PRAYER QIGONG REFLEXOLOGY REIKI SHAMANISM SHIATSU SOCIAL SUPPORT THERAPEUTIC TOUCH TRADITIONAL CHINESE MEDICINE TUI-NA YOGA

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