Herbal Medicine Use and Self-Reported Adverse Reactions During Pregnancy: A Nationwide Survey among Female Korean Medicine Doctors

Herbal Medicine Use and Self-Reported Adverse Reactions During Pregnancy: A Nationwide Survey among Female Korean Medicine Doctors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Herbal Medicine Use and Self-Reported Adverse Reactions During Pregnancy: A Nationwide Survey among Female Korean Medicine Doctors Mi Ju Son, Young-Eun Kim, Anna Kim, Su-Min Seo, Sungha Kim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9014650/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Herbal medicine (HM) has been traditionally used to manage various pregnancy-related conditions, however, systematic safety data remain limited. This study aimed to investigate treatment patterns and self-reported adverse events (AEs) among female Korean Medicine doctors (KMDs) with personal experience of HM use during pregnancy. Methods A nationwide, web-based survey was conducted from November 2024 to August 2025 targeting female KMDs who had used HM during pregnancy within the past year. The questionnaire collected information on prescription patterns, AEs, maternal outcomes, and potential confounders. Descriptive statistics were applied, and group comparisons were performed using independent t-tests and Fisher’s exact tests. Results Of 589 responses, 467 valid responses were analyzed. Among respondents, 375 (80.3%) had live births, 71 (15.2%) were currently pregnant, and 21 (4.5%) had experienced abortion. The most frequently used prescriptions were Antae-eum (35.1%), Bulsu-san (30.4%), and Dalsaeng-san (29.8%). AEs were reported by 3 participants (0.6%), accounting for 4 events in total. All events were non-serious; three involved gastrointestinal symptoms and one involved respiratory symptoms. The gastrointestinal events fully recovered, whereas the respiratory event was recovering at the time of survey. One case demonstrated a positive rechallenge with Bulsu-san. Conclusion This study documented a low self-reported AE rate (0.6%) with herbal medicine use during pregnancy among a professional cohort. Given the cross-sectional, self-reported design, however, underreporting and selection bias cannot be excluded, and these findings should be interpreted as descriptive baseline data rather than definitive safety evidence. Prospective studies incorporating formal causality assessment are warranted to establish more robust safety data. Clinical trial number: not applicable Herbal medicine Pregnancy Adverse events Safety Korean Medicine 1. Introduction During pregnancy, medication use requires careful consideration to ensure the health and safety of both the mother and the fetus.[ 1 ] Following the 1977 FDA guidelines that excluded women of childbearing potential from early-phase trials, substantial evidence gaps persist regarding drug safety in pregnancy and lactation. Teratogenic risks are mainly identified through case reports or small series. Voluntary reporting systems suffer from bias and incomplete follow-up, while cohort and case–control studies face major methodological, financial, and data limitations.[ 1 – 4 ] Medication use during pregnancy is common and has increased over recent decades. Large population-based and multinational studies report that approximately 80% of pregnant women use at least one prescribed or over-the-counter medication, and polypharmacy affects 4.9–62.4% of pregnant women.[ 5 , 6 ] These trends have been documented across diverse settings, including registry-based analyses in Scandinavia[ 7 , 8 ] and self-medication studies in Brazil and Europe, [ 9 , 10 ] yet systematic safety data for medications used during pregnancy remain limited. Globally, herbal medicine (HM) use during pregnancy has been increasingly recognized as a public health concern. A systematic review examining complementary and alternative medicine (CAM) use during pregnancy reported a prevalence ranging from 5.8% to 74.2% across different populations, with HM representing one of the most commonly used modalities. [ 11 ] Among 411 systematically sampled pregnant women, 19.7% reported using HMs during their current pregnancy. [ 12 ] Unlike conventional medicines, many herbal products lack robust evidence regarding efficacy and safety, raising concerns about potential teratogenicity in this vulnerable population. In Korea, HM has been traditionally used to manage various pregnancy-related conditions, including hyperemesis gravidarum, recurrent pregnancy loss, threatened abortion, and prevention of miscarriage.[ 13 ] Patient satisfaction with HM use was relatively high (mean score 3.44 out of 5), with 72.2% of respondents indicating willingness to use HM again in future pregnancies and 66.7% willing to recommend it to other pregnant women.[ 14 ] Despite relatively high satisfaction rates among those who have used HM during pregnancy, public perception remains cautious. A survey on public awareness of KM treatment during pregnancy found that 45.83% of respondents expressed concerns that HM use during pregnancy could potentially cause preterm birth, miscarriage, or congenital anomalies. This negative perception may be attributable, at least in part, to the lack of systematic safety data on HM use during pregnancy. [ 15 ] A previous retrospective study examining HM use during pregnancy in Korea reported that adverse events (AEs) were mostly mild or assessed as having unclear or low causality, with all severe AEs classified as unlikely to be causally related to HM. The incidence of AEs including those with certain or unassessable causality was 1.5%, whereas the incidence based solely on events with confirmed causality was 0.3%.[ 13 ] However, these studies primarily focused on teratogenicity and patient satisfaction, while systematic AE monitoring for specific herbal prescriptions was lacking. Consequently, substantial gaps remain in safety evidence and guideline development for traditional Korean Medicine (KM) during pregnancy. To address these limitations, the present study targeted female Korean Medicine doctors (KMDs) who had personal experience with HM use during their own pregnancies. Female KMDs are uniquely positioned for this investigation: they possess professional knowledge to accurately identify specific herbal prescriptions, can recognize and describe AEs using appropriate medical terminology, and their dual role as both healthcare providers and patients enables more precise recall of treatment details. While this professional cohort does not represent the general pregnant population, it provides a well-defined group capable of generating high-quality descriptive data on prescription patterns and AE experiences, which may serve as a foundation for future pharmacovigilance studies targeting broader populations. Therefore, this study aimed to describe herbal medicine use patterns and self-reported AE experiences among female KMDs who used HM during pregnancy, in order to generate descriptive baseline data that may inform the design of future prospective pharmacovigilance studies on HM safety during pregnancy. 2. Methods 2.1. Study design This was a nationwide, web-based survey designed to investigate AEs associated with herbal decoction use during pregnancy among female KMDs. Female KMDs were selected as the study population because they can accurately report both detailed prescription information and AE experiences from their own HM use during pregnancy, making them uniquely suited for investigating the safety profile of HM use during pregnancy. 2.2. Participants and recruitment The study population consisted of female KMDs who had experience taking HM during pregnancy within the past year and were able to report information on prescription details, AEs, and obstetric outcomes. The survey was developed using Moaform ( https://moaform.com ), a web-based online survey platform. The survey link was distributed via email and text messages to all licensed KMDs registered with the Association of Korean Medicine ( https://www.akom.org/english/index ), which maintains up-to-date contact information for all licensed KMDs in Korea and serves as the official provider of mandatory continuing medical education. The target sample size was calculated as 500 participants based on the following parameters: an estimated population of 7,000 female KMDs in Korea, a 95% confidence level, a proportion estimate of 0.5, and a margin of error of 4.38%, using the finite population correction formula. 2.3. Development of survey questionnaire The questionnaire was a self-administered, web-based survey designed to collect information on HM use and associated AEs during pregnancy. The survey consisted of 35 questions across four sections, with conditional sub-questions based on participant responses, and required approximately 10 minutes to complete. Section A collected treatment-related information, including HM prescriptions used during pregnancy, number of packs consumed, indications for use, timing of exposure by trimester, and concomitant treatments such as other KM therapies, conventional medications, and dietary supplements. Section B assessed AEs, defined as any harmful and unintended reactions occurring during or after HM use. Participants reporting AEs provided details on the suspected prescription, herbal composition and dosage, timing of onset, and affected organ systems, categorized into eight systems. Additional information included prior history of similar symptoms, clinical course and outcomes, seriousness criteria, actions taken regarding HM use, re-challenge results, and treatments for AE management. Section C collected obstetric information, including pregnancy status, delivery outcomes, high-risk pregnancy factors, and exposure to potential risk factors during pregnancy. Section D gathered demographic and professional characteristics of respondents. 2.4. Data collection Data were collected using Moaform ( https://moaform.com ), a web-based online survey platform. The survey was conducted from November 2024 to August 2025. All responses were downloaded from the platform, and personal identifying information was removed and anonymized before analysis by the research team. 2.5. Ethical considerations This study was approved by the Institutional Review Board of the Korea Institute of Oriental Medicine (IRB No. I-2408/008-005-02). On the first page of the online survey, participants were provided with a detailed explanation of the study purpose, procedures, potential risks and benefits, and data usage. Informed consent regarding the collection and use of personal and sensitive information was obtained electronically from all participants before proceeding with the survey, in accordance with the Personal Information Protection Act of Korea. Participants who did not provide consent were unable to continue with the survey. All collected data were coded and encrypted, with access restricted to the research team. 2.6. Statistical analysis Descriptive statistics were used to summarize all survey responses. Continuous variables were presented as mean ± standard deviation and compared using independent-samples t-test. Categorical variables were presented as number (percentage) and compared using Fisher's exact test. Exploratory comparisons were performed between spontaneous abortion and live birth groups, and between congenital abnormality and healthy neonate groups. Statistical significance was set at p < 0.05. Data were analyzed using R software (R Foundation for Statistical Computing, Vienna, Austria). 3. Results 3.1. Demographic Characteristics of Respondents Of the 589 responses received, 122 were excluded due to incomplete responses or data inconsistencies, resulting in 467 valid responses for analysis. The mean age was 35.8 ± 4.3 years, with the majority (77.3%) aged between 30 and 39 years. Regarding clinical experience, more than half of the respondents (51.8%) had 5–9 years of experience, followed by 10–14 years (28.1%). The majority held a Bachelor's degree (62.5%). Regarding specialist certification, 31.5% were certified specialists. The most common specialties were Internal Medicine (34.0%) and Acupuncture & Moxibustion Medicine (26.5%), followed by Obstetrics and Gynecology (9.5%). (Table 1 ) Table 1 Demographic characteristics of respondents (n = 467) Classification N (%) or Mean ± SD Age (years) 35.8 ± 4.3 < 30 16 (3.4) 30–34 185 (39.6) 35–39 176 (37.7) ≥ 40 88 (18.8) No response 2 (0.4) Clinical experience (years) < 5 54 (11.6) 5–9 242 (51.8) 10–14 131 (28.1) 15–19 35 (7.5) ≥ 20 5 (1.1) Educational degree Bachelor’s 292 (62.5) Master’s 89 (19.1) Doctoral 86 (18.4) Specialist status General practitioner 320 (68.5) Specialist 147 (31.5) Specialty of Korean Medicine Internal Medicine 50 (34.0) Acupuncture & Moxibustion Medicine 39 (26.5) Obstetrics and Gynecology 14 (9.5) Ophthalmology, Otorhinolaryngology & Dermatology 13 (8.8) Rehabilitation Medicine 12 (8.2) Pediatrics 7 (4.8) Sasang Constitutional Medicine 6 (4.1) Neuropsychiatry 6 (4.1) SD: standard deviation 3.2. Maternal Characteristics and Pregnancy Outcomes Among the 467 respondents, 375 (80.3%) had completed pregnancy resulting in live birth, 71 (15.2%) were currently pregnant at the time of survey, and 21 (4.5%) had experienced abortion, including 17 spontaneous abortions (81.0%) and 4 induced abortions (19.0%). Among women with live births (n = 375), 71.5% delivered vaginally and 28.5% by cesarean section. Regarding gestational age, the majority (93.9%) delivered at term, with preterm delivery occurring in 4.5%. Birth weight was normal (2.5–3.9 kg) in 95.2% of neonates. Congenital or developmental abnormalities were reported in only 3 cases (0.8%). High-risk factors were assessed using multiple response questions. Advanced maternal age (≥ 35 years) was the most commonly reported (36.0%), followed by gestational diabetes mellitus (4.7%) and in vitro fertilization (4.7%). More than half of the respondents (51.2%) reported no high-risk factors. Coffee consumption during pregnancy was reported by 49.9% of respondents, while alcohol consumption (3.0%) and smoking (0.2%) were rare. Radiation exposure through X-ray or CT was reported by 12.0% of respondents. (Table 2 ) Table 2 Maternal characteristics of respondents (n = 467) Classification N (%) Pregnancy status Live birth 375 (80.3) Mode of delivery Vaginal delivery 268 (71.5) Cesarean section 107 (28.5) Gestational age at delivery Preterm (< 37 weeks) 17 (4.5) Term (37–41 weeks) 352 (93.9) Post-term (≥ 42 weeks) 6 (1.6) Birth Weight Low BW (< 2.5kg) 15 (4.0) Normal BW (2.5-4.0kg) 357 (95.2) High BW (≥ 4.0 kg) 3 (0.8) Neonatal development status Healthy 372 (99.2) Congenital/developmental abnormality 3 (0.8) Ongoing pregnancy 71 (15.2) Abortion 21 (4.5) Spontaneous abortion 17 (81.0) Induced abortion 4 (19.0) High-risk factors * Advanced maternal age (≥ 35 years) 168 (36.0) In vitro fertilization 22 (4.7) Gestational hypertension 11 (2.4) Gestational diabetes mellitus 22 (4.7) None 239 (51.2%) Lifestyle during pregnancy * Coffee consumption 233 (49.9) Alcohol consumption 14 (3.0) Smoking 1 (0.2) None 208 (44.5) Radiation exposure (X-ray/CT) Yes 56 (12.0) No 411 (88.0) BW: Birth Weight * Multiple response 3.3. Herbal Prescription Patterns during Pregnancy Among the 467 respondents, the most frequently used herbal prescription was Antae-eum (n = 164, 35.1%), followed by Bulsu-san (n = 142, 30.4%), Dalsaeng-san (n = 139, 29.8%), Dannokyong-tang (n = 75, 16.1%), Nokyongbulsu-san (n = 71, 15.2%), Gamipaljin-tang (n = 57, 12.2%), Gyullyeongbosaeng-tang (n = 47, 10.1%), and Bosaeng-tang (n = 37, 7.9%) (Supplementary Table 1). Antae-eum (n = 164) was primarily used for threatened abortion (48.2%), vitality restoration (37.2%), and facilitation of delivery (32.9%), with a mean dosage of 50.0 ± 42.0 packs. It was most frequently used during the second trimester (43.3%), followed by the first (39.0%) and third trimesters (17.7%). Concomitant Korean Medicine treatments were reported by 27.4% of users, with acupuncture (25.0%) being the most common. Concomitant conventional medicine and supplements were used by 11.0% and 29.9%, respectively. Bulsu-san (n = 142) was predominantly used for facilitation of delivery (95.1%), with a mean dosage of 18.5 ± 15.8 packs. Nearly all users (97.9%) took this prescription during the third trimester. Concomitant Korean Medicine treatments were reported by 19.0% of users, with acupuncture (16.2%) being the most common. Concomitant conventional medicine and supplements were used by 1.4% and 29.6%, respectively. Dalsaeng-san (n = 139) was also primarily used for facilitation of delivery (95.7%), with a mean dosage of 32.1 ± 23.3 packs. Similarly, the majority of users took this prescription during the third trimester (95.7%). Concomitant Korean Medicine treatments were reported by 17.3% of users, with acupuncture (15.1%) being the most common. Concomitant conventional medicine and supplements were used by 4.3% and 30.2%, respectively. Detailed characteristics of herbal medicine use are presented in Supplementary Table 2. 3.4. Adverse Events Associated with Herbal Medicine Use Among 467 respondents, 4 AEs from 3 participants (0.6%) were reported during pregnancy. All cases resulted in recovery or were recovering at the time of survey. Case 1 was a 35-year-old woman with advanced maternal age and radiation exposure history who experienced two separate AEs. The first event involved gastrointestinal symptoms (bloating, dyspepsia) after 15 packs of Anjeon-icheon-tang during the second trimester for threatened abortion and vaginal bleeding. No rechallenge was attempted, and the patient recovered without treatment. The second event occurred with Bulsu-san during the third trimester for facilitation of delivery, presenting as gastrointestinal symptoms (diarrhea, dyspepsia) after 3 packs. Rechallenge was positive, with symptom recurrence upon re-administration, and the patient recovered after herbal medicine treatment. This case resulted in a healthy term delivery via vaginal birth with normal birth weight. Case 2 was a 34-year-old pregnant woman who developed respiratory symptoms (allergic rhinitis, conjunctivitis) after 60 packs of Hwanggeum-tang during the second trimester for vitality restoration. No rechallenge was attempted, and the patient was recovering with herbal medicine treatment at the time of survey. Case 3 was a 28-year-old pregnant woman who experienced gastrointestinal discomfort after 120 packs of Antae-eum during the second trimester. No rechallenge was attempted, and the patient recovered without treatment. All reported AEs primarily involved gastrointestinal (75%) or respiratory (25%) symptoms. No serious AEs, congenital abnormalities, or pregnancy losses attributable to herbal medicine use were reported. (Table 3 ) Table 3 Adverse events during pregnancy Maternal Characteristics Concomitant treatment Herbal Medicine Adverse event Case No Pregnant status Age Gestational age (weeks) Mode of delivery Birth weight (kg)/ Neonatal development status Risk factor Herbal medicine Period of use Purpose of use Adverse Reaction Dose until AE onset Rechallenge/ Recurrence Treatment for AE Outcome 1–1 Postpartum 35 40 Vaginal delivery Healthy /Normal BW Advanced maternal age, X-ray/CT exposure Vitamins, Folic acid, Iron AIT * Second trimester Threatened abortion, Vaginal bleeding GI (bloating, dyspepsia, GI disorder) 15 packs No rechallenge None Recovered 1–2 BSS # Third trimester Facilitation of delivery GI (diarrhea, dyspepsia, GI disorder) 3 packs Rechallenged; AE recurred Herbal medicine Recovered 2 Pregnant 34 - - - Coffee consumption Vitamins, Folic acid HGT † Second trimester Vitality restoration Respiratory (allergic rhinitis, conjunctivitis) 60 packs No rechallenge Herbal medicine Recovering 3 Pregnant 28 - - - Coffee consumption none ATE Second trimester Vitality restoration, Facilitation of delivery GI (abdominal discomfort) 120 packs No rechallenge None Recovered Abbreviations: AE, adverse event; AIT, Anjeon-icheon-tang (Andian Ertian Tang, 安奠二天湯); ATE, Antae-eum (An Tai Yin, 安胎飮); BSS, Bulsu-san (Fo Shou San, 佛手散); BW, birth weight; CT, computed tomography; HGT, Hwanggeum-tang (Huang Qin Tang, 黃芩湯); GI, gastrointestinal * AIT: Ginseng Radix 12g, Rehmanniae Radix Preparata 12g, Atractylodis Rhizoma 12g, Dioscoreae Rhizoma 8g, Corni Fructus 8g, Eucommiae Cortex 6g, Dolichoris Semen 4g, Lycii Fructus 4g, Glycyrrhizae Radix et Rhizoma 4g (per day) # BSS: Angelicae Gigantis Radix 24g. Cnidii Rhizoma 16g, Cervi Parvum Cornu 6g (per day) † HGT: Scutellariae Radix 18g, Pinelliae Tuber 18g, Paeoniae Radix 18g, Zizyphi Fructus 18g, Glycyrrhizae Radix et Rhizoma 12g, Zingiberis Rhizoma Recens 9g (per day) 3.5. Comparison of Herbal Prescription Patterns and Lifestyle Factors between Spontaneous Abortion and Live Birth Groups To explore potential associations between herbal medicine use and pregnancy outcomes, we compared prescription patterns between women who experienced spontaneous abortion (n = 17) and those with live births (n = 375). Antae-eum was significantly more frequently used in the spontaneous abortion group compared to the live birth group (82.4% vs 35.7%, p < 0.001). In contrast, Dalsaeng-san (0.0% vs 35.5%, p = 0.001) and Bulsu-san (5.9% vs 34.7%, p = 0.015) were significantly more frequently used in the live birth group. No significant differences were observed for other prescriptions. However, the spontaneous abortion group demonstrated significantly higher prevalence of known risk factors for pregnancy loss. The mean age was significantly higher in the spontaneous abortion group (39.1 ± 5.3 vs 36.1 ± 4.3 years, p = 0.006), and advanced maternal age was more prevalent (70.6% vs 35.7%, p = 0.008). Notably, smoking was significantly associated with spontaneous abortion (5.9% vs 0.0%, p = 0.043), and alcohol consumption showed a trend toward higher frequency in the spontaneous abortion group (11.8% vs 2.7%, p = 0.090), although this did not reach statistical significance. These findings suggest that the higher frequency of Antae-eum use in the spontaneous abortion group likely reflects confounding by indication rather than a causal relationship, as Antae-eum is traditionally prescribed for threatened abortion. Women at higher risk of pregnancy loss—characterized by advanced maternal age, smoking, and alcohol consumption—were more likely to receive this prescription. Conversely, Dalsaeng-san and Bulsu-san are indicated for facilitation of delivery in the third trimester; women who experienced early pregnancy loss would not have had the opportunity to receive these prescriptions. (Table 4 ) Table 4 Herbal prescription patterns and risk factors between spontaneous abortion and live birth Spontaneous Abortion (n = 17) Live Birth (n = 375) P-value † N (%) N (%) Herbal Prescription Antae-eum 14 (82.4) 134 (35.7) < 0.001 * Bosaeng-tang 1 (5.9) 27 (7.2) 1.000 Gyullyeongbosaeng-tang 0 (0.0) 33 (8.8) 0.381 Geumgwedanggui-san 0 (0.0) 23 (6.1) 0.612 Gamipaljin-tang 2 (11.8) 48 (12.8) 1.000 Gungguigyoae-tang 2 (11.8) 20 (5.3) 0.246 Gyoaesamul-tang 1 (5.9) 18 (4.8) 0.578 Dalsaeng-san 0 (0.0) 133 (35.5) 0.001 * Gunggui-tang 0 (0.0) 25 (6.7) 0.615 Bulsu-san 1 (5.9) 130 (34.7) 0.015 * Dannokyong-tang 1 (5.9) 71 (18.9) 0.332 Nokyongbulsu-san 0 (0.0) 68 (18.1) 0.052 Dangguijakyak-san 1 (5.9) 15 (4.0) 0.515 Custom prescription 0 (0.0) 19 (5.1) 1.000 Others 0 (0.0) 48 (12.8) 0.245 Risk factors Age 39.1 ± 5.3 36.1 ± 4.3 0.006 * Advanced maternal age (≥ 35) 12 (70.6) 134 (35.7) 0.008 * In vitro fertilization 2 (11.8) 17 (4.5) 0.196 Gestational hypertension 0 (0.0) 10 (2.7) 1.000 Gestational diabetes mellitus 0 (0.0) 18 (4.8) 1.000 Coffee consumption 9 (52.9) 178 (47.5) 0.805 Alcohol consumption 2 (11.8) 10 (2.7) 0.090 Smoking 1 (5.9) 0 (0.0) 0.043 * Radiation exposure (X-ray/CT) 0 (0.0) 50 (13.3) 0.145 † Continuous variables compared by independent t-test; categorical variables compared by Fisher's exact 3.6. Comparison of Herbal Prescription Patterns and Lifestyle Factors between Congenital/developmental abnormality and Healthy Neonate Groups Among 375 live births, 3 cases (0.8%) reported congenital or developmental abnormalities. In all three cases, herbal medicine use occurred during the second or third trimester, after the critical period of organogenesis (first trimester). No statistically significant differences were observed in prescription patterns between the congenital abnormality and healthy neonate groups. Regarding lifestyle factors, all three cases reported coffee consumption, while none reported alcohol use or smoking. One case reported radiation exposure (X-ray/CT). No statistically significant differences were observed in lifestyle factors between groups (all p > 0.05). 4. Discussion This study described herbal medicine (HM) use patterns and self-reported AEs among female Korean Medicine doctors (KMDs) who had personally used HM during their own pregnancies within the past year. Among 467 valid responses, 3 participants (0.6%) self-reported AEs, all of which were non-serious and primarily involved gastrointestinal or respiratory symptoms. No serious AEs, congenital abnormalities, or pregnancy losses were reported as attributable to HM use. These findings should be interpreted as descriptive baseline data; the low self-reported AE rate may substantially underestimate the true incidence, given the potential for reporting bias, recall bias, and selection bias inherent to the cross-sectional, self-reported design. Furthermore, the small number of AEs (n = 4) precludes any statistically meaningful subgroup analysis or formal causality assessment, limiting the pharmacovigilance utility of these findings. 4.1. Low adverse event rate and comparison with existing evidence The AE rate of 0.6% observed in the present study is notably low compared with previously reported rates. A Korean medicine literature review synthesizing 52 studies reported that the AE incidence of Korean herbal medicine use during pregnancy was 1.5% when including events with certain or unassessable causality, and 0.3% when restricted to events with confirmed causality; all severe AEs were assessed as unlikely to be causally related to herbal medicine.[ 13 ] The somewhat lower rate in our study may be attributable to the characteristics of our study population; female KMDs, as healthcare professionals, are likely to select prescriptions more judiciously and manage dosing more appropriately than the general population. At the broader international level, the safety of herbal medicine use during pregnancy remains a subject of ongoing investigation. The largest-scale systematic review and meta-analysis to date, synthesizing evidence from 111 studies including RCTs and observational studies, indicated that no significant increase in adverse offspring outcomes was observed with herbal use at the overall level, although isolated safety signals for specific herbal products were identified. [ 16 ] Similarly, it has been noted that while harms have been reported with herbal product use during pregnancy, the overall benefit-to-harm balance remains uncertain due to methodological limitations in the existing literature.[ 17 ] It has further been emphasized that although herbal products are frequently perceived as natural and harmless, they contain active substances that can potentially affect fetal development, underscoring the importance of safety monitoring. [ 18 ] In a retrospective cohort study, adverse reactions were reported in 5.8% of women who used herbal products during pregnancy, with gastrointestinal symptoms being the most commonly observed; importantly, no significant differences in neonatal outcomes including gestational age, Apgar score, and congenital malformations were observed between herbal users and non-users. [ 19 ] 4.2. Characteristics of reported adverse events All AEs reported in this study were non-serious and self-limiting. Gastrointestinal symptoms, including bloating, dyspepsia, and diarrhea, accounted for 75% of reported events, while respiratory symptoms (allergic rhinitis, conjunctivitis) comprised the remaining 25%. These findings are consistent with prior literature indicating that gastrointestinal discomfort is among the most commonly reported adverse effects associated with herbal medicine use during pregnancy.[ 16 , 19 ] Notably, one case demonstrated a positive rechallenge with Bulsu-san, providing stronger evidence for a causal relationship between this prescription and gastrointestinal symptoms. Despite the positive rechallenge, the AE remained non-serious and resolved following herbal medicine treatment. This finding highlights the importance of systematic rechallenge documentation in pharmacovigilance and suggests that even well-established prescriptions may cause mild adverse reactions in individual patients. 4.3. Prescription patterns and confounding by indication The three most frequently used prescriptions in this study were Antae-eum (35.1%), Bulsu-san (30.4%), and Dalsaeng-san (29.8%), reflecting the traditional use of Korean herbal medicine in pregnancy management. Antae-eum was primarily prescribed for threatened abortion, while Bulsu-san and Dalsaeng-san were predominantly used for facilitation of delivery during the third trimester. Our comparison between the spontaneous abortion and live birth groups revealed a significantly higher frequency of Antae-eum use in the spontaneous abortion group (82.4% vs 35.7%, p < 0.001). However, this finding is best understood as confounding by indication, as Antae-eum is traditionally prescribed specifically for threatened abortion. It has been noted in the context of conventional medication studies that observational analyses linking medication use and health outcomes are frequently subject to indication bias, wherein the underlying condition prompting prescription—rather than the medication itself—may account for the observed association.[ 8 ] This principle applies directly to our findings: the spontaneous abortion group was also characterized by significantly higher maternal age (39.1 ± 5.3 vs 36.1 ± 4.3 years, p = 0.006), higher prevalence of advanced maternal age (70.6% vs 35.7%, p = 0.008), and higher rates of smoking (5.9% vs 0.0%, p = 0.043)—all established risk factors for pregnancy loss. This pattern is consistent with evidence from a large-scale meta-analysis showing that observational studies adjusted for confounding did not demonstrate significant associations between prenatal herbal medicine use and major adverse offspring outcomes including miscarriage.[ 16 ] Conversely, the significantly higher use of Bulsu-san and Dalsaeng-san in the live birth group reflects the fact that these prescriptions are indicated for third-trimester delivery facilitation; women who experienced early pregnancy loss would not have had the clinical indication to receive these prescriptions. A systematic review of herbal medicines for induction of labour reported that herbal medicines were effective for labour induction but concluded that safety evidence remained inconclusive due to the lack of high-quality data.[ 20 ] 4.4. Pregnancy outcomes and congenital abnormalities Among the 375 live births, 95.2% were delivered at term, 71.5% were vaginal deliveries, and 95.2% had normal birth weight, suggesting generally favorable pregnancy outcomes in this cohort. Congenital or developmental abnormalities were reported in only 3 cases (0.8%); however, given the absence of clinical verification and a standardized case definition, direct comparison with population-based prevalence estimates was not performed. In all three cases, HM exposure occurred during the second or third trimester, after the critical period of organogenesis, suggesting a low likelihood of teratogenic association. A large-scale meta-analysis reported that prenatal herbal medicine use was associated with a lower risk of birth defects in RCTs (RR = 0.46, 95% CI: 0.22–0.94), primarily among women undergoing assisted reproduction, while observational studies did not show significant associations with congenital abnormalities after adjusting for confounders.[ 16 ] Consistent with these findings, a retrospective cohort study similarly found no significant differences in congenital malformation rates between herbal medicine users and non-users.[ 19 ] 4.5. The role of healthcare provider-patient communication The unique study design employing female KMDs as both practitioners and patients offers distinct advantages for safety surveillance. A systematic review and meta-analysis encompassing 111 studies across 51 countries reported that the pooled prevalence of HM use during pregnancy was 34.4% globally, yet only 27.9% of HM users disclosed their use to healthcare providers.[ 21 ] Non-disclosure was primarily attributed to the perception that HM is harmless (53.6%) and to healthcare providers not inquiring about HM use (39.4%), with 91.7% of women reporting that they had never been asked about HM use during antenatal care.[ 21 ] This substantial disclosure gap has important implications for pharmacovigilance, as underreporting of herbal medicine use limits the ability to monitor AEs in routine clinical settings. In the present study, the respondents' professional background as KMDs substantially mitigated this disclosure gap. Unlike general pregnant populations who may not recognize or accurately describe HM-related AEs, female KMDs possess the clinical knowledge to identify specific prescriptions, recognize AE patterns, and report outcomes using appropriate medical terminology. This capacity for accurate reporting is a key methodological strength of the present study. 4.6. Strengths and limitations This study has several strengths. First, surveying female KMDs who used HM during their own pregnancies ensures high accuracy in prescription identification and AE recognition, as these respondents possess both clinical knowledge and personal experience. Second, the nationwide scope and relatively large sample size for a professional subgroup (n = 467) strengthen the internal validity of the findings; however, generalizability to the broader pregnant population remains limited given the restriction to healthcare professionals and the potential for self-selection bias. Third, the comprehensive questionnaire design captured detailed information on prescriptions, timing, dosage, concomitant treatments, and obstetric outcomes, enabling multifaceted analysis. However, several limitations should be acknowledged. First, as a cross-sectional survey relying on self-reported data, the study is subject to recall bias and reporting bias. Participants who experienced AEs may have been less likely to respond to the survey, and the professional background of KMDs may have led to under-attribution of mild symptoms as AEs; both mechanisms would result in underestimation of the true AE rate. Second, the study population is limited to healthcare professionals, and the findings are not directly generalizable to the general pregnant population, who may use HM without professional guidance and under substantially different clinical circumstances. The restriction to a professional subgroup also introduces selection bias, as KMDs are likely to use HM more judiciously and at more appropriate dosages than the general population, further limiting the external validity of the observed AE rate. Third, the very low number of AEs (n = 4) precludes any statistically meaningful subgroup analysis and renders the observed rate of 0.6% statistically unstable; the true population AE rate may differ substantially from this estimate. Fourth, formal causality assessment using standardized pharmacovigilance tools, such as the WHO-UMC system or the Naranjo algorithm, was not applied to the reported AEs, as the survey design did not capture sufficient clinical detail for systematic causality evaluation. This represents a fundamental limitation of the pharmacovigilance utility of the AE data collected. Fifth, the cross-sectional design precludes establishment of temporal causality between HM use and pregnancy outcomes. Sixth, while the survey collected information on concomitant medications and supplements, potential interactions between HM and concurrent treatments were not systematically evaluated. 4.7. Implications and future directions The present study provides descriptive baseline data on HM use patterns and self-reported AEs among a professional cohort, contributing a foundation upon which more rigorous pharmacovigilance studies can be built. However, several fundamental limitations constrain the interpretability of these findings. The cross-sectional, self-reported design is susceptible to reporting bias and selection bias, the restriction to a professional subgroup limits generalizability to the general pregnant population, and the rarity of reported AEs (n = 4) renders any formal safety conclusion statistically unsupported. Accordingly, these findings should not be interpreted as evidence of an acceptable safety profile, but rather as preliminary descriptive data that highlight the need for more systematic investigation. The benefit-to-harm balance of herbal products during pregnancy remains to be established through higher-quality evidence. [ 17 ] Continuous safety monitoring remains essential, as herbal products contain pharmacologically active substances that may pose risks during pregnancy. [ 18 ] Future studies should prioritize prospective cohort designs with pre-specified pharmacovigilance protocols, including formal causality assessment using standardized tools such as the WHO-UMC system, to enable more rigorous AE evaluation. Multi-center registry-based studies with larger sample sizes would provide the statistical power necessary for meaningful subgroup analyses. Critically, extending the study population beyond healthcare professionals to include general pregnant women who use HM would substantially improve generalizability and policy relevance. The present findings, while limited to a professional cohort, underscore the importance of systematic HM use documentation in clinical settings as a foundation for such future research. Development of evidence-based clinical guidelines for HM use during pregnancy, informed by prospective safety data, remains an important and as yet unmet goal for the field. Declarations Author contributions Conceptualization: Mi Ju Son Methodology: Mi Ju Son, Young-Eun Kim, Anna Kim, Sungha Kim Software: Su-Min Seo Formal analysis: Young-Eun Kim Investigation: Mi Ju Son, Young-Eun Kim Data curation: Mi Ju Son, Young-Eun Kim Writing – original draft: Mi Ju Son Writing – review & editing: Young-Eun Kim, Anna Kim, Su-Min Seo, Sungha Kim Project administration: Mi Ju Son Funding acquisition: Mi Ju Son Supervision: Mi Ju Son Acknowledgement This research was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea, grant number: RS-2023-KH138688. Ethical statement This research was reviewed and approved by the Institutional Review Board of the Korea Institute of Oriental Medicine (I-2408/008-005-02). Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request. References Kennedy D, Batagol R. Drug safety in pregnancy. Aust Prescr. 2025;48(1):5–9. Waggoner MR, Lyerly AD. Clinical trials in pregnancy and the shadows of thalidomide: Revisiting the legacy of Frances Kelsey. Contemp Clin Trials. 2022;119:106806. Carey JC, Martinez L, Balken E, Leen-Mitchell M, Robertson J. Determination of human teratogenicity by the astute clinician method: review of illustrative agents and a proposal of guidelines. Birth Defects Res Clin Mol Teratol. 2009;85(1):63–8. Friedman JM. How do we know if an exposure is actually teratogenic in humans? Am J Med Genet C Semin Med Genet. 2011;157c(3):170–4. Lupattelli A, Spigset O, Twigg MJ, Zagorodnikova K, Mårdby AC, Moretti ME, Drozd M, Panchaud A, Hämeen-Anttila K, Rieutord A, et al. Medication use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open. 2014;4(2):e004365. Anand A, Phillips K, Subramanian A, Lee SI, Wang Z, McCowan R, Agrawal U, Fagbamigbe AF, Nelson-Piercy C, Brocklehurst P, et al. Prevalence of polypharmacy in pregnancy: a systematic review. BMJ Open. 2023;13(3):e067585. Thunbo MØ, Vendelbo JH, Witte DR, Larsen A, Pedersen LH. Use of medication in pregnancy on the rise: Study on 1.4 million Danish pregnancies from 1998 to 2018. Acta Obstet Gynecol Scand. 2024;103(6):1210–23. Thunbo M, Vendelbo JH, Witte DR, Larsen A, Pedersen LH. Maternal Demographic Patterns in Medication use During Pregnancy: A Nationwide Register Study. Basic Clin Pharmacol Toxicol. 2025;136(4):e70020. Pereira G, Surita FG, Ferracini AC, Madeira CS, Oliveira LS, Mazzola PG. Self-Medication Among Pregnant Women: Prevalence and Associated Factors. Front Pharmacol 2021, Volume 12–2021. Gerbier E, Favre G, Tauqeer F, Winterfeld U, Stojanov M, Oliver A, Passier A, Nordeng H, Pomar L, Baud D, et al. Self-Reported Medication Use among Pregnant and Postpartum Women during the Third Wave of the COVID-19 Pandemic: A European Multinational Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(9):5335. Pallivalappila AR, Stewart D, Shetty A, Pande B, McLay JS. Complementary and Alternative Medicines Use during Pregnancy: A Systematic Review of Pregnant Women and Healthcare Professional Views and Experiences. Evid Based Complement Alternat Med. 2013;2013:205639. Bekele GG, Woldeyes BS, Taye GM, Kebede EM, Gebremichael DY. Use of herbal medicine during pregnancy and associated factors among pregnant women with access to public healthcare in west Shewa zone, Central Ethiopia: sequential mixed-method study. BMJ Open. 2024;14(2):e076303. Jo J, Lee SH, Lee JM, Lee H, Kwack SJ, Kim DI. Use and safety of Korean herbal medicine during pregnancy: A Korean medicine literature review. Eur J Integr Med. 2016;8(1):4–11. Jung E-H, Jang S-B, Choi K-H, Yoo D-Y. A Retrospective Study of Patients that Used Herbal Medicine During Pregnancy. J Orient Obstet Gynecol. 2014;27:79–93. Hwang B-K, Namgoong J, Kim S-D, Jung W-J, Park M-S, Moon H-W, Ku S-H, Baek H-K, Jung J-J, Kim S-H. A Survey on the General Public's Perception of Korean Medicine Treatment for Traffic Accident Patient during pregnancy. J Korean Obstet Gynecol. 2022;35(4):19–36. Chen C, Li Y, Wang W, Liu C, Luo Q, Ren Y, Xiong Y, Sun X, Tan J. Benefits and risks of herbal medicine use during pregnancy on offspring outcomes: A systematic review and meta-analysis of randomized controlled trials and observational studies. Pharmacol Res. 2026;224:108092. Onakpoya I. Use of herbal products in pregnancy: harms are reported but the benefit to harm balance is uncertain. BMJ Evidence-Based Med. 2020;25(2):1. Sarecka-Hujar B, Szulc-Musioł B. Herbal Medicines—Are They Effective and Safe during Pregnancy? Pharmaceutics 2022, 14(1):171. Kosar R, Kheirollah G, Mohammadreza J, Mehdi R, Hassan T, Ashraf M, Niayesh M. A Retrospective Cohort Study of Herbal Medicines Use during Pregnancy: Prevalence, Adverse Reactions, and Newborn Outcomes. Traditional Integr Med 2020, 5(2). Zamawe C, King C, Jennings HM, Mandiwa C, Fottrell E. Effectiveness and safety of herbal medicines for induction of labour: a systematic review and meta-analysis. BMJ Open. 2018;8(10):e022499. Im HB, Hwang JH, Choi D, Choi SJ, Han D. Patient-physician communication on herbal medicine use during pregnancy: a systematic review and meta-analysis. BMJ Glob Health 2024, 9(3). Additional Declarations No competing interests reported. Supplementary Files SupplementaryTable1.FrequencyofHerbalPrescriptionsUsedDuringPregnancy.xlsx SupplementaryTable2.CharacteristicsofHerbalMedicinePrescriptionUse.xlsx SupplementaryQuestionnaireEN.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 20 Apr, 2026 Editor invited by journal 20 Apr, 2026 Editor assigned by journal 08 Mar, 2026 Submission checks completed at journal 08 Mar, 2026 First submitted to journal 02 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9014650","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":629467556,"identity":"4e41eb03-6df8-4c6a-a325-9df3ebd6f5e3","order_by":0,"name":"Mi Ju Son","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYFCC8x8OSFQk8EB5CcRoOWB4wOIMaVoYjA9UtsFVEqFFt/FAwoGb89Jk+MUOsH34wJCWT1CL2YEDBw7O3JbDIzk7gXnmDIYcywbCWg42HJbcVsFjcDuBmZmHocKACFsOMxz+Oweq5Q9xWo4xHJBsyIFoYWDIIUbLGYYDEsfSgH5JbGbsMUgjQsuNM8wfJGqS7fmlkw8z/KhIJqyFQeIAjMXYwMBAhAYGBv4GYlSNglEwCkbBiAYAzMk+hpB/foIAAAAASUVORK5CYII=","orcid":"","institution":"Korea Institute of Oriental Medicine","correspondingAuthor":true,"prefix":"","firstName":"Mi","middleName":"Ju","lastName":"Son","suffix":""},{"id":629467566,"identity":"230ba2f2-5344-4d8e-9a44-f83ccbf6e272","order_by":1,"name":"Young-Eun Kim","email":"","orcid":"","institution":"Korea Institute of Oriental Medicine","correspondingAuthor":false,"prefix":"","firstName":"Young-Eun","middleName":"","lastName":"Kim","suffix":""},{"id":629467567,"identity":"96067f9a-e1c1-4e70-a911-d892d89fd049","order_by":2,"name":"Anna Kim","email":"","orcid":"","institution":"Korea Institute of Oriental Medicine","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Kim","suffix":""},{"id":629467568,"identity":"a5fc32ee-aa25-42f7-a475-119d8b60e4d7","order_by":3,"name":"Su-Min Seo","email":"","orcid":"","institution":"Korea Institute of Oriental Medicine","correspondingAuthor":false,"prefix":"","firstName":"Su-Min","middleName":"","lastName":"Seo","suffix":""},{"id":629467569,"identity":"e4596fe2-f74b-4e16-995d-887ff10a948a","order_by":4,"name":"Sungha Kim","email":"","orcid":"","institution":"Korea Institute of Oriental Medicine","correspondingAuthor":false,"prefix":"","firstName":"Sungha","middleName":"","lastName":"Kim","suffix":""}],"badges":[],"createdAt":"2026-03-03 01:38:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9014650/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9014650/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108012902,"identity":"32884f95-0c82-4a85-988b-aff68d560635","added_by":"auto","created_at":"2026-04-28 13:16:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":475857,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9014650/v1/6e6f3ed1-4ca1-4f31-acc8-f55596858e25.pdf"},{"id":108011595,"identity":"c8a1facd-b1e5-413b-8091-8963be2dc186","added_by":"auto","created_at":"2026-04-28 13:15:08","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":9775,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable1.FrequencyofHerbalPrescriptionsUsedDuringPregnancy.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9014650/v1/da571a9cd4433b8aff5dbac0.xlsx"},{"id":108010383,"identity":"8a80d2db-338b-4bbc-8d6d-71603a247a41","added_by":"auto","created_at":"2026-04-28 13:13:21","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18752,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable2.CharacteristicsofHerbalMedicinePrescriptionUse.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9014650/v1/28063cc63e4b69772ecd6f4e.xlsx"},{"id":108010385,"identity":"7d9a7791-7e86-43e7-82ab-ecdae0454381","added_by":"auto","created_at":"2026-04-28 13:13:21","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":17222,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryQuestionnaireEN.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9014650/v1/5442786b7107ea5562e6eada.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Herbal Medicine Use and Self-Reported Adverse Reactions During Pregnancy: A Nationwide Survey among Female Korean Medicine Doctors","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eDuring pregnancy, medication use requires careful consideration to ensure the health and safety of both the mother and the fetus.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Following the 1977 FDA guidelines that excluded women of childbearing potential from early-phase trials, substantial evidence gaps persist regarding drug safety in pregnancy and lactation. Teratogenic risks are mainly identified through case reports or small series. Voluntary reporting systems suffer from bias and incomplete follow-up, while cohort and case\u0026ndash;control studies face major methodological, financial, and data limitations.[\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eMedication use during pregnancy is common and has increased over recent decades. Large population-based and multinational studies report that approximately 80% of pregnant women use at least one prescribed or over-the-counter medication, and polypharmacy affects 4.9\u0026ndash;62.4% of pregnant women.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] These trends have been documented across diverse settings, including registry-based analyses in Scandinavia[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and self-medication studies in Brazil and Europe, [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] yet systematic safety data for medications used during pregnancy remain limited.\u003c/p\u003e \u003cp\u003eGlobally, herbal medicine (HM) use during pregnancy has been increasingly recognized as a public health concern. A systematic review examining complementary and alternative medicine (CAM) use during pregnancy reported a prevalence ranging from 5.8% to 74.2% across different populations, with HM representing one of the most commonly used modalities. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Among 411 systematically sampled pregnant women, 19.7% reported using HMs during their current pregnancy. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Unlike conventional medicines, many herbal products lack robust evidence regarding efficacy and safety, raising concerns about potential teratogenicity in this vulnerable population.\u003c/p\u003e \u003cp\u003eIn Korea, HM has been traditionally used to manage various pregnancy-related conditions, including hyperemesis gravidarum, recurrent pregnancy loss, threatened abortion, and prevention of miscarriage.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Patient satisfaction with HM use was relatively high (mean score 3.44 out of 5), with 72.2% of respondents indicating willingness to use HM again in future pregnancies and 66.7% willing to recommend it to other pregnant women.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Despite relatively high satisfaction rates among those who have used HM during pregnancy, public perception remains cautious. A survey on public awareness of KM treatment during pregnancy found that 45.83% of respondents expressed concerns that HM use during pregnancy could potentially cause preterm birth, miscarriage, or congenital anomalies. This negative perception may be attributable, at least in part, to the lack of systematic safety data on HM use during pregnancy. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eA previous retrospective study examining HM use during pregnancy in Korea reported that adverse events (AEs) were mostly mild or assessed as having unclear or low causality, with all severe AEs classified as unlikely to be causally related to HM. The incidence of AEs including those with certain or unassessable causality was 1.5%, whereas the incidence based solely on events with confirmed causality was 0.3%.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] However, these studies primarily focused on teratogenicity and patient satisfaction, while systematic AE monitoring for specific herbal prescriptions was lacking. Consequently, substantial gaps remain in safety evidence and guideline development for traditional Korean Medicine (KM) during pregnancy.\u003c/p\u003e \u003cp\u003eTo address these limitations, the present study targeted female Korean Medicine doctors (KMDs) who had personal experience with HM use during their own pregnancies. Female KMDs are uniquely positioned for this investigation: they possess professional knowledge to accurately identify specific herbal prescriptions, can recognize and describe AEs using appropriate medical terminology, and their dual role as both healthcare providers and patients enables more precise recall of treatment details. While this professional cohort does not represent the general pregnant population, it provides a well-defined group capable of generating high-quality descriptive data on prescription patterns and AE experiences, which may serve as a foundation for future pharmacovigilance studies targeting broader populations. Therefore, this study aimed to describe herbal medicine use patterns and self-reported AE experiences among female KMDs who used HM during pregnancy, in order to generate descriptive baseline data that may inform the design of future prospective pharmacovigilance studies on HM safety during pregnancy.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study design\u003c/h2\u003e \u003cp\u003eThis was a nationwide, web-based survey designed to investigate AEs associated with herbal decoction use during pregnancy among female KMDs. Female KMDs were selected as the study population because they can accurately report both detailed prescription information and AE experiences from their own HM use during pregnancy, making them uniquely suited for investigating the safety profile of HM use during pregnancy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Participants and recruitment\u003c/h2\u003e \u003cp\u003eThe study population consisted of female KMDs who had experience taking HM during pregnancy within the past year and were able to report information on prescription details, AEs, and obstetric outcomes. The survey was developed using Moaform (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://moaform.com\u003c/span\u003e\u003cspan address=\"https://moaform.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), a web-based online survey platform. The survey link was distributed via email and text messages to all licensed KMDs registered with the Association of Korean Medicine (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.akom.org/english/index\u003c/span\u003e\u003cspan address=\"https://www.akom.org/english/index\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), which maintains up-to-date contact information for all licensed KMDs in Korea and serves as the official provider of mandatory continuing medical education.\u003c/p\u003e \u003cp\u003eThe target sample size was calculated as 500 participants based on the following parameters: an estimated population of 7,000 female KMDs in Korea, a 95% confidence level, a proportion estimate of 0.5, and a margin of error of 4.38%, using the finite population correction formula.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Development of survey questionnaire\u003c/h2\u003e \u003cp\u003eThe questionnaire was a self-administered, web-based survey designed to collect information on HM use and associated AEs during pregnancy. The survey consisted of 35 questions across four sections, with conditional sub-questions based on participant responses, and required approximately 10 minutes to complete.\u003c/p\u003e \u003cp\u003eSection A collected treatment-related information, including HM prescriptions used during pregnancy, number of packs consumed, indications for use, timing of exposure by trimester, and concomitant treatments such as other KM therapies, conventional medications, and dietary supplements.\u003c/p\u003e \u003cp\u003eSection B assessed AEs, defined as any harmful and unintended reactions occurring during or after HM use. Participants reporting AEs provided details on the suspected prescription, herbal composition and dosage, timing of onset, and affected organ systems, categorized into eight systems. Additional information included prior history of similar symptoms, clinical course and outcomes, seriousness criteria, actions taken regarding HM use, re-challenge results, and treatments for AE management.\u003c/p\u003e \u003cp\u003eSection C collected obstetric information, including pregnancy status, delivery outcomes, high-risk pregnancy factors, and exposure to potential risk factors during pregnancy.\u003c/p\u003e \u003cp\u003eSection D gathered demographic and professional characteristics of respondents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Data collection\u003c/h2\u003e \u003cp\u003eData were collected using Moaform (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://moaform.com\u003c/span\u003e\u003cspan address=\"https://moaform.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), a web-based online survey platform. The survey was conducted from November 2024 to August 2025. All responses were downloaded from the platform, and personal identifying information was removed and anonymized before analysis by the research team.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Ethical considerations\u003c/h2\u003e \u003cp\u003eThis study was approved by the Institutional Review Board of the Korea Institute of Oriental Medicine (IRB No. I-2408/008-005-02). On the first page of the online survey, participants were provided with a detailed explanation of the study purpose, procedures, potential risks and benefits, and data usage. Informed consent regarding the collection and use of personal and sensitive information was obtained electronically from all participants before proceeding with the survey, in accordance with the Personal Information Protection Act of Korea. Participants who did not provide consent were unable to continue with the survey. All collected data were coded and encrypted, with access restricted to the research team.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Statistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to summarize all survey responses. Continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and compared using independent-samples t-test. Categorical variables were presented as number (percentage) and compared using Fisher's exact test. Exploratory comparisons were performed between spontaneous abortion and live birth groups, and between congenital abnormality and healthy neonate groups. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Data were analyzed using R software (R Foundation for Statistical Computing, Vienna, Austria).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Demographic Characteristics of Respondents\u003c/h2\u003e \u003cp\u003eOf the 589 responses received, 122 were excluded due to incomplete responses or data inconsistencies, resulting in 467 valid responses for analysis. The mean age was 35.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 years, with the majority (77.3%) aged between 30 and 39 years. Regarding clinical experience, more than half of the respondents (51.8%) had 5\u0026ndash;9 years of experience, followed by 10\u0026ndash;14 years (28.1%). The majority held a Bachelor's degree (62.5%). Regarding specialist certification, 31.5% were certified specialists. The most common specialties were Internal Medicine (34.0%) and Acupuncture \u0026amp; Moxibustion Medicine (26.5%), followed by Obstetrics and Gynecology (9.5%). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of respondents (n\u0026thinsp;=\u0026thinsp;467)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%) or Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.8\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185 (39.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176 (37.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical experience (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (11.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e242 (51.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131 (28.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (1.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational degree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e292 (62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (19.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctoral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (18.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpecialist status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e320 (68.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147 (31.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpecialty of Korean Medicine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (34.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcupuncture \u0026amp; Moxibustion Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (26.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObstetrics and Gynecology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (9.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOphthalmology, Otorhinolaryngology \u0026amp; Dermatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (8.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (8.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePediatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSasang Constitutional Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (4.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuropsychiatry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (4.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eSD: standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Maternal Characteristics and Pregnancy Outcomes\u003c/h2\u003e \u003cp\u003eAmong the 467 respondents, 375 (80.3%) had completed pregnancy resulting in live birth, 71 (15.2%) were currently pregnant at the time of survey, and 21 (4.5%) had experienced abortion, including 17 spontaneous abortions (81.0%) and 4 induced abortions (19.0%).\u003c/p\u003e \u003cp\u003eAmong women with live births (n\u0026thinsp;=\u0026thinsp;375), 71.5% delivered vaginally and 28.5% by cesarean section. Regarding gestational age, the majority (93.9%) delivered at term, with preterm delivery occurring in 4.5%. Birth weight was normal (2.5\u0026ndash;3.9 kg) in 95.2% of neonates. Congenital or developmental abnormalities were reported in only 3 cases (0.8%).\u003c/p\u003e \u003cp\u003eHigh-risk factors were assessed using multiple response questions. Advanced maternal age (\u0026ge;\u0026thinsp;35 years) was the most commonly reported (36.0%), followed by gestational diabetes mellitus (4.7%) and in vitro fertilization (4.7%). More than half of the respondents (51.2%) reported no high-risk factors. Coffee consumption during pregnancy was reported by 49.9% of respondents, while alcohol consumption (3.0%) and smoking (0.2%) were rare. Radiation exposure through X-ray or CT was reported by 12.0% of respondents. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaternal characteristics of respondents (n\u0026thinsp;=\u0026thinsp;467)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePregnancy status\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eLive birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e375 (80.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e268 (71.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e107 (28.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGestational age at delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePreterm (\u0026lt;\u0026thinsp;37 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (4.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTerm (37\u0026ndash;41 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e352 (93.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-term (\u0026ge;\u0026thinsp;42 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eBirth Weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow BW (\u0026lt;\u0026thinsp;2.5kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (4.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNormal BW (2.5-4.0kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e357 (95.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh BW (\u0026ge;\u0026thinsp;4.0 kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNeonatal development status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHealthy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e372 (99.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCongenital/developmental abnormality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eOngoing pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71 (15.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (4.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSpontaneous abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (81.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eInduced abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (19.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHigh-risk factors\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAdvanced maternal age (\u0026ge;\u0026thinsp;35 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e168 (36.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eIn vitro fertilization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (4.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eGestational hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eGestational diabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (4.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e239 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLifestyle during pregnancy\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eCoffee consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e233 (49.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAlcohol consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (3.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e208 (44.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRadiation exposure (X-ray/CT)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (12.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e411 (88.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBW: Birth Weight\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e*\u003c/sup\u003eMultiple response\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Herbal Prescription Patterns during Pregnancy\u003c/h2\u003e \u003cp\u003eAmong the 467 respondents, the most frequently used herbal prescription was Antae-eum (n\u0026thinsp;=\u0026thinsp;164, 35.1%), followed by Bulsu-san (n\u0026thinsp;=\u0026thinsp;142, 30.4%), Dalsaeng-san (n\u0026thinsp;=\u0026thinsp;139, 29.8%), Dannokyong-tang (n\u0026thinsp;=\u0026thinsp;75, 16.1%), Nokyongbulsu-san (n\u0026thinsp;=\u0026thinsp;71, 15.2%), Gamipaljin-tang (n\u0026thinsp;=\u0026thinsp;57, 12.2%), Gyullyeongbosaeng-tang (n\u0026thinsp;=\u0026thinsp;47, 10.1%), and Bosaeng-tang (n\u0026thinsp;=\u0026thinsp;37, 7.9%) (Supplementary Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eAntae-eum (n\u0026thinsp;=\u0026thinsp;164) was primarily used for threatened abortion (48.2%), vitality restoration (37.2%), and facilitation of delivery (32.9%), with a mean dosage of 50.0\u0026thinsp;\u0026plusmn;\u0026thinsp;42.0 packs. It was most frequently used during the second trimester (43.3%), followed by the first (39.0%) and third trimesters (17.7%). Concomitant Korean Medicine treatments were reported by 27.4% of users, with acupuncture (25.0%) being the most common. Concomitant conventional medicine and supplements were used by 11.0% and 29.9%, respectively.\u003c/p\u003e \u003cp\u003eBulsu-san (n\u0026thinsp;=\u0026thinsp;142) was predominantly used for facilitation of delivery (95.1%), with a mean dosage of 18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;15.8 packs. Nearly all users (97.9%) took this prescription during the third trimester. Concomitant Korean Medicine treatments were reported by 19.0% of users, with acupuncture (16.2%) being the most common. Concomitant conventional medicine and supplements were used by 1.4% and 29.6%, respectively.\u003c/p\u003e \u003cp\u003eDalsaeng-san (n\u0026thinsp;=\u0026thinsp;139) was also primarily used for facilitation of delivery (95.7%), with a mean dosage of 32.1\u0026thinsp;\u0026plusmn;\u0026thinsp;23.3 packs. Similarly, the majority of users took this prescription during the third trimester (95.7%). Concomitant Korean Medicine treatments were reported by 17.3% of users, with acupuncture (15.1%) being the most common. Concomitant conventional medicine and supplements were used by 4.3% and 30.2%, respectively.\u003c/p\u003e \u003cp\u003eDetailed characteristics of herbal medicine use are presented in Supplementary Table\u0026nbsp;2.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Adverse Events Associated with Herbal Medicine Use\u003c/h2\u003e \u003cp\u003eAmong 467 respondents, 4 AEs from 3 participants (0.6%) were reported during pregnancy. All cases resulted in recovery or were recovering at the time of survey.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCase 1\u003c/strong\u003e \u003cp\u003ewas a 35-year-old woman with advanced maternal age and radiation exposure history who experienced two separate AEs. The first event involved gastrointestinal symptoms (bloating, dyspepsia) after 15 packs of Anjeon-icheon-tang during the second trimester for threatened abortion and vaginal bleeding. No rechallenge was attempted, and the patient recovered without treatment. The second event occurred with Bulsu-san during the third trimester for facilitation of delivery, presenting as gastrointestinal symptoms (diarrhea, dyspepsia) after 3 packs. Rechallenge was positive, with symptom recurrence upon re-administration, and the patient recovered after herbal medicine treatment. This case resulted in a healthy term delivery via vaginal birth with normal birth weight.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCase 2\u003c/strong\u003e \u003cp\u003ewas a 34-year-old pregnant woman who developed respiratory symptoms (allergic rhinitis, conjunctivitis) after 60 packs of Hwanggeum-tang during the second trimester for vitality restoration. No rechallenge was attempted, and the patient was recovering with herbal medicine treatment at the time of survey.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCase 3\u003c/strong\u003e \u003cp\u003ewas a 28-year-old pregnant woman who experienced gastrointestinal discomfort after 120 packs of Antae-eum during the second trimester. No rechallenge was attempted, and the patient recovered without treatment.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAll reported AEs primarily involved gastrointestinal (75%) or respiratory (25%) symptoms. No serious AEs, congenital abnormalities, or pregnancy losses attributable to herbal medicine use were reported. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdverse events during pregnancy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"16\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eMaternal Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eConcomitant treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003eHerbal Medicine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c16\" namest=\"c12\"\u003e \u003cp\u003eAdverse event\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePregnant status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGestational age (weeks)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBirth weight (kg)/ Neonatal development status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRisk factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHerbal medicine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePeriod of use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003ePurpose of use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAdverse Reaction\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eDose until AE onset\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eRechallenge/ Recurrence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003eTreatment for AE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePostpartum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVaginal delivery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHealthy /Normal BW\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdvanced maternal age,\u003c/p\u003e \u003cp\u003eX-ray/CT exposure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVitamins, Folic acid, Iron\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAIT\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSecond trimester\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThreatened abortion, Vaginal bleeding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eGI (bloating, dyspepsia, GI disorder)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003e15 packs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo rechallenge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e \u003cp\u003eRecovered\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBSS\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eThird trimester\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFacilitation of delivery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eGI (diarrhea, dyspepsia, GI disorder)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3 packs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eRechallenged; AE recurred\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003eHerbal medicine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e \u003cp\u003eRecovered\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePregnant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCoffee consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVitamins, Folic acid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHGT\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSecond trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eVitality restoration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eRespiratory (allergic rhinitis, conjunctivitis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e60 packs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo rechallenge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eHerbal medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eRecovering\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePregnant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCoffee consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eATE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSecond trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eVitality restoration, Facilitation of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eGI (abdominal discomfort)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e120 packs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo rechallenge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eRecovered\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cp\u003e\u003cem\u003eAbbreviations:\u003c/em\u003e AE, adverse event; AIT, Anjeon-icheon-tang (Andian Ertian Tang,\u0026nbsp;安奠二天湯); ATE, Antae-eum (An Tai Yin,\u0026nbsp;安胎飮); BSS, Bulsu-san (Fo Shou San,\u0026nbsp;佛手散); BW, birth weight; CT, computed tomography; HGT, Hwanggeum-tang (Huang Qin Tang,\u0026nbsp;黃芩湯); GI, gastrointestinal\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eAIT: Ginseng Radix 12g, Rehmanniae Radix Preparata 12g, Atractylodis Rhizoma 12g, Dioscoreae Rhizoma 8g, Corni Fructus 8g, Eucommiae Cortex 6g, Dolichoris Semen 4g, Lycii Fructus 4g, Glycyrrhizae Radix et Rhizoma 4g (per day)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e#\u003c/sup\u003eBSS: Angelicae Gigantis Radix 24g. Cnidii Rhizoma 16g, Cervi Parvum Cornu 6g (per day)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e†\u003c/sup\u003eHGT: Scutellariae Radix 18g, Pinelliae Tuber 18g, Paeoniae Radix 18g, Zizyphi Fructus 18g, Glycyrrhizae Radix et Rhizoma 12g, Zingiberis Rhizoma Recens 9g (per day)\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.5. Comparison of Herbal Prescription Patterns and Lifestyle Factors between Spontaneous Abortion and Live Birth Groups\u003c/h2\u003e \u003cp\u003eTo explore potential associations between herbal medicine use and pregnancy outcomes, we compared prescription patterns between women who experienced spontaneous abortion (n\u0026thinsp;=\u0026thinsp;17) and those with live births (n\u0026thinsp;=\u0026thinsp;375).\u003c/p\u003e \u003cp\u003eAntae-eum was significantly more frequently used in the spontaneous abortion group compared to the live birth group (82.4% vs 35.7%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, Dalsaeng-san (0.0% vs 35.5%, p\u0026thinsp;=\u0026thinsp;0.001) and Bulsu-san (5.9% vs 34.7%, p\u0026thinsp;=\u0026thinsp;0.015) were significantly more frequently used in the live birth group. No significant differences were observed for other prescriptions.\u003c/p\u003e \u003cp\u003eHowever, the spontaneous abortion group demonstrated significantly higher prevalence of known risk factors for pregnancy loss. The mean age was significantly higher in the spontaneous abortion group (39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 vs 36.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 years, p\u0026thinsp;=\u0026thinsp;0.006), and advanced maternal age was more prevalent (70.6% vs 35.7%, p\u0026thinsp;=\u0026thinsp;0.008). Notably, smoking was significantly associated with spontaneous abortion (5.9% vs 0.0%, p\u0026thinsp;=\u0026thinsp;0.043), and alcohol consumption showed a trend toward higher frequency in the spontaneous abortion group (11.8% vs 2.7%, p\u0026thinsp;=\u0026thinsp;0.090), although this did not reach statistical significance.\u003c/p\u003e \u003cp\u003eThese findings suggest that the higher frequency of Antae-eum use in the spontaneous abortion group likely reflects confounding by indication rather than a causal relationship, as Antae-eum is traditionally prescribed for threatened abortion. Women at higher risk of pregnancy loss\u0026mdash;characterized by advanced maternal age, smoking, and alcohol consumption\u0026mdash;were more likely to receive this prescription. Conversely, Dalsaeng-san and Bulsu-san are indicated for facilitation of delivery in the third trimester; women who experienced early pregnancy loss would not have had the opportunity to receive these prescriptions. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHerbal prescription patterns and risk factors between spontaneous abortion and live birth\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSpontaneous Abortion (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eLive Birth\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;375)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHerbal Prescription\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntae-eum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(82.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBosaeng-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGyullyeongbosaeng-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.381\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeumgwedanggui-san\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.612\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGamipaljin-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGungguigyoae-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGyoaesamul-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDalsaeng-san\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(35.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGunggui-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.615\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBulsu-san\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.015\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDannokyong-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNokyongbulsu-san\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDangguijakyak-san\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.515\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCustom prescription\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRisk factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e36.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvanced maternal age (\u0026ge;\u0026thinsp;35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(70.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.008\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn vitro fertilization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational diabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoffee consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.805\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.043\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiation exposure (X-ray/CT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eContinuous variables compared by independent t-test; categorical variables compared by Fisher's exact\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.6. Comparison of Herbal Prescription Patterns and Lifestyle Factors between Congenital/developmental abnormality and Healthy Neonate Groups\u003c/h2\u003e \u003cp\u003eAmong 375 live births, 3 cases (0.8%) reported congenital or developmental abnormalities. In all three cases, herbal medicine use occurred during the second or third trimester, after the critical period of organogenesis (first trimester). No statistically significant differences were observed in prescription patterns between the congenital abnormality and healthy neonate groups.\u003c/p\u003e \u003cp\u003eRegarding lifestyle factors, all three cases reported coffee consumption, while none reported alcohol use or smoking. One case reported radiation exposure (X-ray/CT). No statistically significant differences were observed in lifestyle factors between groups (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study described herbal medicine (HM) use patterns and self-reported AEs among female Korean Medicine doctors (KMDs) who had personally used HM during their own pregnancies within the past year. Among 467 valid responses, 3 participants (0.6%) self-reported AEs, all of which were non-serious and primarily involved gastrointestinal or respiratory symptoms. No serious AEs, congenital abnormalities, or pregnancy losses were reported as attributable to HM use. These findings should be interpreted as descriptive baseline data; the low self-reported AE rate may substantially underestimate the true incidence, given the potential for reporting bias, recall bias, and selection bias inherent to the cross-sectional, self-reported design. Furthermore, the small number of AEs (n\u0026thinsp;=\u0026thinsp;4) precludes any statistically meaningful subgroup analysis or formal causality assessment, limiting the pharmacovigilance utility of these findings.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Low adverse event rate and comparison with existing evidence\u003c/h2\u003e \u003cp\u003eThe AE rate of 0.6% observed in the present study is notably low compared with previously reported rates. A Korean medicine literature review synthesizing 52 studies reported that the AE incidence of Korean herbal medicine use during pregnancy was 1.5% when including events with certain or unassessable causality, and 0.3% when restricted to events with confirmed causality; all severe AEs were assessed as unlikely to be causally related to herbal medicine.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] The somewhat lower rate in our study may be attributable to the characteristics of our study population; female KMDs, as healthcare professionals, are likely to select prescriptions more judiciously and manage dosing more appropriately than the general population.\u003c/p\u003e \u003cp\u003eAt the broader international level, the safety of herbal medicine use during pregnancy remains a subject of ongoing investigation. The largest-scale systematic review and meta-analysis to date, synthesizing evidence from 111 studies including RCTs and observational studies, indicated that no significant increase in adverse offspring outcomes was observed with herbal use at the overall level, although isolated safety signals for specific herbal products were identified. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Similarly, it has been noted that while harms have been reported with herbal product use during pregnancy, the overall benefit-to-harm balance remains uncertain due to methodological limitations in the existing literature.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] It has further been emphasized that although herbal products are frequently perceived as natural and harmless, they contain active substances that can potentially affect fetal development, underscoring the importance of safety monitoring. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] In a retrospective cohort study, adverse reactions were reported in 5.8% of women who used herbal products during pregnancy, with gastrointestinal symptoms being the most commonly observed; importantly, no significant differences in neonatal outcomes including gestational age, Apgar score, and congenital malformations were observed between herbal users and non-users. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Characteristics of reported adverse events\u003c/h2\u003e \u003cp\u003eAll AEs reported in this study were non-serious and self-limiting. Gastrointestinal symptoms, including bloating, dyspepsia, and diarrhea, accounted for 75% of reported events, while respiratory symptoms (allergic rhinitis, conjunctivitis) comprised the remaining 25%. These findings are consistent with prior literature indicating that gastrointestinal discomfort is among the most commonly reported adverse effects associated with herbal medicine use during pregnancy.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eNotably, one case demonstrated a positive rechallenge with Bulsu-san, providing stronger evidence for a causal relationship between this prescription and gastrointestinal symptoms. Despite the positive rechallenge, the AE remained non-serious and resolved following herbal medicine treatment. This finding highlights the importance of systematic rechallenge documentation in pharmacovigilance and suggests that even well-established prescriptions may cause mild adverse reactions in individual patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Prescription patterns and confounding by indication\u003c/h2\u003e \u003cp\u003eThe three most frequently used prescriptions in this study were Antae-eum (35.1%), Bulsu-san (30.4%), and Dalsaeng-san (29.8%), reflecting the traditional use of Korean herbal medicine in pregnancy management. Antae-eum was primarily prescribed for threatened abortion, while Bulsu-san and Dalsaeng-san were predominantly used for facilitation of delivery during the third trimester.\u003c/p\u003e \u003cp\u003eOur comparison between the spontaneous abortion and live birth groups revealed a significantly higher frequency of Antae-eum use in the spontaneous abortion group (82.4% vs 35.7%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, this finding is best understood as confounding by indication, as Antae-eum is traditionally prescribed specifically for threatened abortion. It has been noted in the context of conventional medication studies that observational analyses linking medication use and health outcomes are frequently subject to indication bias, wherein the underlying condition prompting prescription\u0026mdash;rather than the medication itself\u0026mdash;may account for the observed association.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] This principle applies directly to our findings: the spontaneous abortion group was also characterized by significantly higher maternal age (39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 vs 36.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 years, p\u0026thinsp;=\u0026thinsp;0.006), higher prevalence of advanced maternal age (70.6% vs 35.7%, p\u0026thinsp;=\u0026thinsp;0.008), and higher rates of smoking (5.9% vs 0.0%, p\u0026thinsp;=\u0026thinsp;0.043)\u0026mdash;all established risk factors for pregnancy loss. This pattern is consistent with evidence from a large-scale meta-analysis showing that observational studies adjusted for confounding did not demonstrate significant associations between prenatal herbal medicine use and major adverse offspring outcomes including miscarriage.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eConversely, the significantly higher use of Bulsu-san and Dalsaeng-san in the live birth group reflects the fact that these prescriptions are indicated for third-trimester delivery facilitation; women who experienced early pregnancy loss would not have had the clinical indication to receive these prescriptions. A systematic review of herbal medicines for induction of labour reported that herbal medicines were effective for labour induction but concluded that safety evidence remained inconclusive due to the lack of high-quality data.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.4. Pregnancy outcomes and congenital abnormalities\u003c/h2\u003e \u003cp\u003eAmong the 375 live births, 95.2% were delivered at term, 71.5% were vaginal deliveries, and 95.2% had normal birth weight, suggesting generally favorable pregnancy outcomes in this cohort. Congenital or developmental abnormalities were reported in only 3 cases (0.8%); however, given the absence of clinical verification and a standardized case definition, direct comparison with population-based prevalence estimates was not performed. In all three cases, HM exposure occurred during the second or third trimester, after the critical period of organogenesis, suggesting a low likelihood of teratogenic association. A large-scale meta-analysis reported that prenatal herbal medicine use was associated with a lower risk of birth defects in RCTs (RR\u0026thinsp;=\u0026thinsp;0.46, 95% CI: 0.22\u0026ndash;0.94), primarily among women undergoing assisted reproduction, while observational studies did not show significant associations with congenital abnormalities after adjusting for confounders.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Consistent with these findings, a retrospective cohort study similarly found no significant differences in congenital malformation rates between herbal medicine users and non-users.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.5. The role of healthcare provider-patient communication\u003c/h2\u003e \u003cp\u003eThe unique study design employing female KMDs as both practitioners and patients offers distinct advantages for safety surveillance. A systematic review and meta-analysis encompassing 111 studies across 51 countries reported that the pooled prevalence of HM use during pregnancy was 34.4% globally, yet only 27.9% of HM users disclosed their use to healthcare providers.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Non-disclosure was primarily attributed to the perception that HM is harmless (53.6%) and to healthcare providers not inquiring about HM use (39.4%), with 91.7% of women reporting that they had never been asked about HM use during antenatal care.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] This substantial disclosure gap has important implications for pharmacovigilance, as underreporting of herbal medicine use limits the ability to monitor AEs in routine clinical settings.\u003c/p\u003e \u003cp\u003eIn the present study, the respondents' professional background as KMDs substantially mitigated this disclosure gap. Unlike general pregnant populations who may not recognize or accurately describe HM-related AEs, female KMDs possess the clinical knowledge to identify specific prescriptions, recognize AE patterns, and report outcomes using appropriate medical terminology. This capacity for accurate reporting is a key methodological strength of the present study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.6. Strengths and limitations\u003c/h2\u003e \u003cp\u003eThis study has several strengths. First, surveying female KMDs who used HM during their own pregnancies ensures high accuracy in prescription identification and AE recognition, as these respondents possess both clinical knowledge and personal experience. Second, the nationwide scope and relatively large sample size for a professional subgroup (n\u0026thinsp;=\u0026thinsp;467) strengthen the internal validity of the findings; however, generalizability to the broader pregnant population remains limited given the restriction to healthcare professionals and the potential for self-selection bias. Third, the comprehensive questionnaire design captured detailed information on prescriptions, timing, dosage, concomitant treatments, and obstetric outcomes, enabling multifaceted analysis.\u003c/p\u003e \u003cp\u003eHowever, several limitations should be acknowledged. First, as a cross-sectional survey relying on self-reported data, the study is subject to recall bias and reporting bias. Participants who experienced AEs may have been less likely to respond to the survey, and the professional background of KMDs may have led to under-attribution of mild symptoms as AEs; both mechanisms would result in underestimation of the true AE rate. Second, the study population is limited to healthcare professionals, and the findings are not directly generalizable to the general pregnant population, who may use HM without professional guidance and under substantially different clinical circumstances. The restriction to a professional subgroup also introduces selection bias, as KMDs are likely to use HM more judiciously and at more appropriate dosages than the general population, further limiting the external validity of the observed AE rate. Third, the very low number of AEs (n\u0026thinsp;=\u0026thinsp;4) precludes any statistically meaningful subgroup analysis and renders the observed rate of 0.6% statistically unstable; the true population AE rate may differ substantially from this estimate. Fourth, formal causality assessment using standardized pharmacovigilance tools, such as the WHO-UMC system or the Naranjo algorithm, was not applied to the reported AEs, as the survey design did not capture sufficient clinical detail for systematic causality evaluation. This represents a fundamental limitation of the pharmacovigilance utility of the AE data collected. Fifth, the cross-sectional design precludes establishment of temporal causality between HM use and pregnancy outcomes. Sixth, while the survey collected information on concomitant medications and supplements, potential interactions between HM and concurrent treatments were not systematically evaluated.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.7. Implications and future directions\u003c/h2\u003e \u003cp\u003eThe present study provides descriptive baseline data on HM use patterns and self-reported AEs among a professional cohort, contributing a foundation upon which more rigorous pharmacovigilance studies can be built. However, several fundamental limitations constrain the interpretability of these findings. The cross-sectional, self-reported design is susceptible to reporting bias and selection bias, the restriction to a professional subgroup limits generalizability to the general pregnant population, and the rarity of reported AEs (n\u0026thinsp;=\u0026thinsp;4) renders any formal safety conclusion statistically unsupported. Accordingly, these findings should not be interpreted as evidence of an acceptable safety profile, but rather as preliminary descriptive data that highlight the need for more systematic investigation. The benefit-to-harm balance of herbal products during pregnancy remains to be established through higher-quality evidence. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Continuous safety monitoring remains essential, as herbal products contain pharmacologically active substances that may pose risks during pregnancy. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFuture studies should prioritize prospective cohort designs with pre-specified pharmacovigilance protocols, including formal causality assessment using standardized tools such as the WHO-UMC system, to enable more rigorous AE evaluation. Multi-center registry-based studies with larger sample sizes would provide the statistical power necessary for meaningful subgroup analyses. Critically, extending the study population beyond healthcare professionals to include general pregnant women who use HM would substantially improve generalizability and policy relevance. The present findings, while limited to a professional cohort, underscore the importance of systematic HM use documentation in clinical settings as a foundation for such future research. Development of evidence-based clinical guidelines for HM use during pregnancy, informed by prospective safety data, remains an important and as yet unmet goal for the field.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Mi Ju Son\u003c/p\u003e\n\u003cp\u003eMethodology: Mi Ju Son, Young-Eun Kim, Anna Kim, Sungha Kim\u003c/p\u003e\n\u003cp\u003eSoftware: Su-Min Seo\u003c/p\u003e\n\u003cp\u003eFormal analysis: Young-Eun Kim\u003c/p\u003e\n\u003cp\u003eInvestigation: Mi Ju Son, Young-Eun Kim\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData curation: Mi Ju Son, Young-Eun Kim\u003c/p\u003e\n\u003cp\u003eWriting – original draft: Mi Ju Son\u003c/p\u003e\n\u003cp\u003eWriting – review \u0026amp; editing: Young-Eun Kim, Anna Kim, Su-Min Seo, Sungha Kim\u003c/p\u003e\n\u003cp\u003eProject administration: Mi Ju Son\u003c/p\u003e\n\u003cp\u003eFunding acquisition: Mi Ju Son\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSupervision: Mi Ju Son\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Korea Health Technology R\u0026amp;D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health \u0026amp; Welfare, Republic of Korea, grant number: RS-2023-KH138688.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was reviewed and approved by the Institutional Review Board of the Korea Institute of Oriental Medicine (I-2408/008-005-02).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKennedy D, Batagol R. Drug safety in pregnancy. Aust Prescr. 2025;48(1):5\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaggoner MR, Lyerly AD. Clinical trials in pregnancy and the shadows of thalidomide: Revisiting the legacy of Frances Kelsey. Contemp Clin Trials. 2022;119:106806.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarey JC, Martinez L, Balken E, Leen-Mitchell M, Robertson J. Determination of human teratogenicity by the astute clinician method: review of illustrative agents and a proposal of guidelines. Birth Defects Res Clin Mol Teratol. 2009;85(1):63\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFriedman JM. How do we know if an exposure is actually teratogenic in humans? Am J Med Genet C Semin Med Genet. 2011;157c(3):170\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLupattelli A, Spigset O, Twigg MJ, Zagorodnikova K, M\u0026aring;rdby AC, Moretti ME, Drozd M, Panchaud A, H\u0026auml;meen-Anttila K, Rieutord A, et al. Medication use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open. 2014;4(2):e004365.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnand A, Phillips K, Subramanian A, Lee SI, Wang Z, McCowan R, Agrawal U, Fagbamigbe AF, Nelson-Piercy C, Brocklehurst P, et al. Prevalence of polypharmacy in pregnancy: a systematic review. BMJ Open. 2023;13(3):e067585.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThunbo M\u0026Oslash;, Vendelbo JH, Witte DR, Larsen A, Pedersen LH. Use of medication in pregnancy on the rise: Study on 1.4 million Danish pregnancies from 1998 to 2018. Acta Obstet Gynecol Scand. 2024;103(6):1210\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThunbo M, Vendelbo JH, Witte DR, Larsen A, Pedersen LH. Maternal Demographic Patterns in Medication use During Pregnancy: A Nationwide Register Study. Basic Clin Pharmacol Toxicol. 2025;136(4):e70020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePereira G, Surita FG, Ferracini AC, Madeira CS, Oliveira LS, Mazzola PG. Self-Medication Among Pregnant Women: Prevalence and Associated Factors. Front Pharmacol 2021, Volume 12\u0026ndash;2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGerbier E, Favre G, Tauqeer F, Winterfeld U, Stojanov M, Oliver A, Passier A, Nordeng H, Pomar L, Baud D, et al. Self-Reported Medication Use among Pregnant and Postpartum Women during the Third Wave of the COVID-19 Pandemic: A European Multinational Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(9):5335.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePallivalappila AR, Stewart D, Shetty A, Pande B, McLay JS. Complementary and Alternative Medicines Use during Pregnancy: A Systematic Review of Pregnant Women and Healthcare Professional Views and Experiences. Evid Based Complement Alternat Med. 2013;2013:205639.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBekele GG, Woldeyes BS, Taye GM, Kebede EM, Gebremichael DY. Use of herbal medicine during pregnancy and associated factors among pregnant women with access to public healthcare in west Shewa zone, Central Ethiopia: sequential mixed-method study. BMJ Open. 2024;14(2):e076303.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJo J, Lee SH, Lee JM, Lee H, Kwack SJ, Kim DI. Use and safety of Korean herbal medicine during pregnancy: A Korean medicine literature review. Eur J Integr Med. 2016;8(1):4\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJung E-H, Jang S-B, Choi K-H, Yoo D-Y. A Retrospective Study of Patients that Used Herbal Medicine During Pregnancy. J Orient Obstet Gynecol. 2014;27:79\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHwang B-K, Namgoong J, Kim S-D, Jung W-J, Park M-S, Moon H-W, Ku S-H, Baek H-K, Jung J-J, Kim S-H. A Survey on the General Public's Perception of Korean Medicine Treatment for Traffic Accident Patient during pregnancy. J Korean Obstet Gynecol. 2022;35(4):19\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen C, Li Y, Wang W, Liu C, Luo Q, Ren Y, Xiong Y, Sun X, Tan J. Benefits and risks of herbal medicine use during pregnancy on offspring outcomes: A systematic review and meta-analysis of randomized controlled trials and observational studies. Pharmacol Res. 2026;224:108092.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOnakpoya I. Use of herbal products in pregnancy: harms are reported but the benefit to harm balance is uncertain. BMJ Evidence-Based Med. 2020;25(2):1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarecka-Hujar B, Szulc-Musioł B. Herbal Medicines\u0026mdash;Are They Effective and Safe during Pregnancy? \u003cem\u003ePharmaceutics\u003c/em\u003e 2022, 14(1):171.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKosar R, Kheirollah G, Mohammadreza J, Mehdi R, Hassan T, Ashraf M, Niayesh M. A Retrospective Cohort Study of Herbal Medicines Use during Pregnancy: Prevalence, Adverse Reactions, and Newborn Outcomes. Traditional Integr Med 2020, 5(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZamawe C, King C, Jennings HM, Mandiwa C, Fottrell E. Effectiveness and safety of herbal medicines for induction of labour: a systematic review and meta-analysis. BMJ Open. 2018;8(10):e022499.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIm HB, Hwang JH, Choi D, Choi SJ, Han D. Patient-physician communication on herbal medicine use during pregnancy: a systematic review and meta-analysis. BMJ Glob Health 2024, 9(3).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Herbal medicine, Pregnancy, Adverse events, Safety, Korean Medicine","lastPublishedDoi":"10.21203/rs.3.rs-9014650/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9014650/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHerbal medicine (HM) has been traditionally used to manage various pregnancy-related conditions, however, systematic safety data remain limited. This study aimed to investigate treatment patterns and self-reported adverse events (AEs) among female Korean Medicine doctors (KMDs) with personal experience of HM use during pregnancy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA nationwide, web-based survey was conducted from November 2024 to August 2025 targeting female KMDs who had used HM during pregnancy within the past year. The questionnaire collected information on prescription patterns, AEs, maternal outcomes, and potential confounders. Descriptive statistics were applied, and group comparisons were performed using independent t-tests and Fisher’s exact tests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 589 responses, 467 valid responses were analyzed. Among respondents, 375 (80.3%) had live births, 71 (15.2%) were currently pregnant, and 21 (4.5%) had experienced abortion. The most frequently used prescriptions were Antae-eum (35.1%), Bulsu-san (30.4%), and Dalsaeng-san (29.8%). AEs were reported by 3 participants (0.6%), accounting for 4 events in total. All events were non-serious; three involved gastrointestinal symptoms and one involved respiratory symptoms. The gastrointestinal events fully recovered, whereas the respiratory event was recovering at the time of survey. One case demonstrated a positive rechallenge with Bulsu-san.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study documented a low self-reported AE rate (0.6%) with herbal medicine use during pregnancy among a professional cohort. Given the cross-sectional, self-reported design, however, underreporting and selection bias cannot be excluded, and these findings should be interpreted as descriptive baseline data rather than definitive safety evidence. Prospective studies incorporating formal causality assessment are warranted to establish more robust safety data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: \u003c/strong\u003enot applicable\u003c/p\u003e","manuscriptTitle":"Herbal Medicine Use and Self-Reported Adverse Reactions During Pregnancy: A Nationwide Survey among Female Korean Medicine Doctors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-28 13:04:54","doi":"10.21203/rs.3.rs-9014650/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-20T09:43:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-20T08:32:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-08T13:02:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-08T13:02:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Complementary Medicine and Therapies","date":"2026-03-03T01:34:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"17236d19-65cc-4343-8596-339970134d42","owner":[],"postedDate":"April 28th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T13:04:54+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-28 13:04:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9014650","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9014650","identity":"rs-9014650","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}