A female at 28 weeks gestation was referred to pediatric cardiology for a fetal arrhythmia. The echocardiogram revealed premature constriction of the fetal ductus arteriosus. Her work up was unremarkable except for her use of an herbal supplement, grape seed extract, which is advertised as a potent anti-inflammatory medication, and has biochemical properties similar to other medications that have been shown to cause premature ductal constriction. The use of herbal remedies increases each year. Although the public is inundated with radio, television, and internet advertisements for these products, little unbiased information regarding the possible dangers of toxicity or adverse reactions exists. As physicians, we need to be aware of these products, and counsel our patients accordingly.
References
[1]
Barnes, P.M., Bloom, B. and Nahin, R.L. (2008) Complementary and Alternative Medicine Use among Adults and Children: United States, 2007. National Health Statistics Report, No. 12, National Center for Health Statistics, Hyattsville, MD.
[2]
Smith, G.C. (1998) The Pharmacology of the Ductus Arteriosus. Pharmacological Reviews, 50, 35-58.
[3]
Gewillig, M., et al. (2009) Premature Foetal Closure of the Arterial Duct: Clinical Presentations and Outcome. European Heart Journal, 30, 1530-1536. http://dx.doi.org/10.1093/eurheartj/ehp128
[4]
Bagchi, D., et al. (2000) Free Radicals and Grape Seed Proanthocyanidin Extract: Importance in Human Health and Disease Prevention. Toxicology, 148, 187-197. http://dx.doi.org/10.1016/S0300-483X(00)00210-9
[5]
Zhang, W.Y., et al. (2006) Procyanidin Dimer B2 [Epicatechin-(4beta-8)-epicatechin] Suppresses the Expression of Cyclooxygenase-2 in Endotoxin-Treated Monocytic Cells. Biochemical and Biophysical Research Communications, 345, 508-515. http://dx.doi.org/10.1016/j.bbrc.2006.04.085
[6]
Moise Jr., K.J. (1993) Effect of Advancing Gestational Age on the Frequency of Fetal Ductal Constriction in Association with Maternal Indomethacin Use. American Journal of Obstetrics and Gynecology, 168, 1350-1353. http://dx.doi.org/10.1016/S0002-9378(11)90763-7
[7]
Van den Veyver, I.B., et al. (1993) The Effect of Gestational Age and Fetal Indomethacin Levels on the Incidence of Constriction of the Fetal Ductus Arteriosus. Obstetrics & Gynecology, 82, 500-503.
[8]
Koren, G., et al. (2006) Nonsteroidal Antiinflammatory Drugs during Third Trimester and the Risk of Premature Closure of the Ductus Arteriosus: A Meta-Analysis. Annals of Pharmacotherapy, 40, 824-829. http://dx.doi.org/10.1345/aph.1G428
[9]
Meier, P. (2001) Academy Endorses Legislation to Regulate All Dietary Supplements. American Academy of Pediatrics News.