Clinical Naturopathy An Evidence Based Guide to Practice (reviewedAust J MedicalHerbalism 22:4;156).
Article Type: Letter to the editor
Author: Stevens, Paul
Pub Date: 03/22/2011
Publication: Name: Australian Journal of Medical Herbalism Publisher: National Herbalists Association of Australia Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 National Herbalists Association of Australia ISSN: 1033-8330
Issue: Date: Spring, 2011 Source Volume: 23 Source Issue: 1
Accession Number: 254971764
Full Text: Clinical Naturopathy An Evidence Based Guide to Practice (reviewedAust J MedicalHerbalism 22:4;156) while a useful addition to the naturopathic texts, makes an ambiguous, poorly informed and potentially dangerous statement regarding the management of urinary tract infections in pregnancy on page 641.

The book states that 'Vaccinium macrocarpon is an effective naturopathic treatment (for pregnancy associated urinary tract infections) with a documented safety profile in pregnancy and therefore offers a valid therapeutic choice'.

Whilst Vaccinium macrocarpon (cranberry) may be an effective evidence based prophylactic, pregnancy associated urinary tract infection (UTI) is an urgent medical condition associated with significant maternal and fetal morbidity/mortality with particularly high risks from ascending infection and pyelonepritis. Emedicine. com states that 'urinary tract infection during pregnancy is independently associated with intrauterine growth restriction, preeclampsia, preterm delivery and cesarean delivery. Untreated upper tract UTIs are associated with low birth weight, prematurity, premature labor, hypertension, preeclampsia, maternal anemia and amnionitis'.

Based on the references provided cranberry does NOT have a role in the acute treatment of such conditions and pregnant patients must have an urgent MSU (mid stream specimen of urine) and antibiotic treatment. My feeling from this chapter is that the whole subject of the common complications in pregnancy is rather glossed over, including the management of gestational diabetes, thyroid monitoring, group B strep, viral infections and asthma. If naturopaths are going to be regarded as primary care providers by regulatory bodies, medical practitioners and patients, which I see as a worthwhile ideal, then the quality of the information they are educated with should reflect this.

Dr Paul Stevens MBChB BHSci GradDipSci, Assoc Nutritionist, Cert Phytotherapy, MACNEM, MNAA MNSA

We would like to thank Dr Stevens for his comments regarding the treatment of urinary tract infections in pregnancy as covered in the text Clinical Naturopathy: an evidence based guide to practice. We wholeheartedly agree with Dr Stevens that UTI in pregnancy is a serious condition and that Vaccinium macrocarpon is not a valid treatment option in acute UTIs.

The use inferred in this context was intended to refer to provide preventative support to patients with recurrent UTIs in pregnancy. We accept that this context was not made as clear as it could have been in the chapter concerned, and we will amend this in later editions.

We hope that naturopaths would recognise the seriousness of acute UTI in general, but particularly in pregnancy. However we also realise that this may not always be the case currently, and as such the chapter which deals specifically with recurrent UTIs (chapter 27) explores this issue in much more detail. However as the text is less than 900 pages it is unable to be completely comprehensive. We would like to point out that it is expected the text will be used in conjunction with other clinical resources, including conventional health science and medical texts. For this reason each chapter lists a number of resources for practitioners for further exploration of areas that could not be extensively covered in the chapters due to the scope and size restrictions of the book.

Although the expansive coverage of material in the textbook made in depth exploration of specific issues difficult, both the chapter of concern and the text in general did in fact discuss some of the issues raised by Dr Stevens. However increased attention to immunity in pregnancy is an excellent suggestion and one which we look forward to adding in later editions. We should also point out that the chapter was not on pregnancy alone, but rather fertility, preconception care and pregnancy combined. This topic could elicit a 900 page text on its own, but the general scope of the text did not allow for focused exploration on this issue. Consultation with practitioners led us to focus on preconception and fertility, as this was identified as more often being managed by naturopaths alone, whereas in the Australian setting pregnancy care is most often co managed with conventional providers.

It is explicitly stated at the start of the pregnancy section that management requires vigilant monitoring and should ideally be in conjunction with a specialist medical practitioner or midwife. It is pointed out that safety in pregnancy includes avoiding indirect harm such as delaying useful conventional treatment when required, of which appropriate acute treatment of UTIs would be a clear example.

As with any first edition we anticipated 'teething problems' and areas which can be improved in later editions. Not only is the text in its first edition, it is also one of the first naturopathic specific texts published, so we expect the text to evolve over time. For this reason we always welcome such suggestions from readers to improve the quality of information found in our text.

Jon Wardle, Amie Steel, Jerome Sarris

Co authors Clinical Naturopathy: an evidence based guide to practice.
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