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Opinion: Why pregnant women should avoid zobo – Research reveal

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Zobo, a popular Nigerian beverage made from the dried calyxes of hibiscus flowers, is cherished for its vibrant colour, refreshing taste, and numerous health benefits.

Rich in antioxidants, vitamins, and minerals, zobo is often consumed as a delicious and nutritious alternative to sugary drinks.

However, despite its many gains, zobo, according to several health experts, can pose certain risks when consumed during pregnancy.

Medical doctors and researchers, the world over, have linked the consumption of this drink to an increased risk of losing a pregnancy, especially at its initial stage.

In a fact-check piece by Dubawa, several experts agreed with the claim that the consumption of zobo during pregnancy could lead to a higher risk of miscarriage.

A matron at Novelty Hospital, Abuja, Grace Odoma, speaking on the matter, told Dubawa that zobo contains an agent that inhibits the production of oestrogen which is vital to fertility.

“Oestrogen is a female hormone which helps to regulate the secretion of gonadotropin hormone which is required for fertility to take place, also it helps in maturation and maintenance of the uterus which houses the foetus.

“This zobo contains an agent that inhibits the production of estrogen how ever leading to numerous side effects such as low birth weight, miscarriages (preterm labour for 24 weeks gestation) and can cause abortion leading to bleeding as the uterus will contract uncontrollably leading to excess loss of blood,” she noted.

A gynaecologist at the National Hospital, Abuja, Dr Jeremiah Agim, provided links to two studies that showed that hibiscus sabdariffa (zobo) relaxes the uterus instead of causing contractions. He said there had been arguments that it is the pineapple in the zobo that causes the contraction.

Although these studies also show that pineapples have a contractile effect on rat and human pregnant myometrial muscle in vitro, the expert noted that further studies were needed to fully establish this claim.

Another health practitioner, Dr Lynda Effiong-Agim, who is also a medical officer at Chivar Specialist Hospital, Abuja, agreed with other experts, however, noting that the study on rats alone was enough to be cautious with its use during pregnancy.

“It should be avoided in pregnancy. Animal studies have shown the relationship between consuming zobo (hibiscus sabdariffa) and miscarriage. Although human studies have yet to be conducted, that alone is enough reason to be cautious,” she said.

But according to a 2013 review of the study, titled, ‘Hibiscus sabdariffa L: Safety and Efficacy during Pregnancy and Lactation’, published in a peer-reviewed journal, Planta Medica, there was no scientific evidence to support the use of hibiscus sabdariffa during pregnancy and lactation.

It, however, stated that there was in vitro evidence from animal studies that the seeds of Hibiscus sabdariffa had a lactogenic effect.

“Animal studies have also shown that there is delayed puberty, the elevation of body weight, and body mass index in female rats that consumed extracts of hibiscus sabdariffa.

“Caution should be exercised with the use of hibiscus sabdariffa during pregnancy and lactation till human research is conducted to determine its safety. There is a need to be cautious when using medications with hibiscus sabdariffa,” the researchers advised.

In another 2016 paper published on the ‘Use, Safety, Efficacy, and Pharmacology of Hibiscus Sabdariffa During Pregnancy and Lactation,’ it was suggested that its use by women during lactation called for an in-depth understanding of its efficacy and potential for causing harm during pregnancy and lactation.

The lead researcher, Nkechi Enwerem, of the Division of Nursing, Howard University, USA, said the seed and calyxes of Hibiscus sabdariffa had been shown to possess some beneficial therapeutic effects and that there was no strong clinical evidence supporting the use of Hibiscus sabdariffa in pregnancy or during lactation.

“Based on in vitro studies, the aqueous seed extract of Hibiscus sabdariffa produced an increase in serum prolactin in a dose-dependent manner in lactating rats.

“At a dose of 1,600mg/kg, it produced a similar lactogenic activity as compared to the metoclopramide treated group,” she stated.

But, a nutritionist with a private clinic in Lagos, Fidelis Chukwuma, speaking with FIDELINFO, quoting from multiple researches, said there could be several negative effects of consuming zobo in pregnancy, not just for the woman but for the developing baby.

He identified high sugar content and gestational diabetes as one of the most deadly risks a pregnant woman would open up to if she consumed the drink during pregnancy.

Gestational diabetes is a form of diabetes that develops during pregnancy and can have serious implications for both the mother and baby.

Untreated or poorly managed GDM, according to medical research by Mayo Clinic, an online health resource, can lead to complications such as macrosomia (large birth weight), preterm birth, preeclampsia, and an increased risk of cesarean delivery.

He said, “Commercially prepared zobo often contains significant amounts of added sugar to enhance its flavour. While this may make the beverage more palatable, it also increases its calorie content and glycemic load.

“For pregnant women, excessive consumption of sugary drinks like zobo can lead to weight gain and elevated blood sugar levels, potentially increasing the risk of developing gestational diabetes mellitus.

“Therefore, pregnant women should be cautious about their sugar intake, including the consumption of sweetened beverages like zobo.”

He also noted that there was a potential for contamination and foodborne illness when a pregnant woman consumed the drink.

“Improper preparation or storage of zobo can increase the risk of contamination with harmful bacteria, such as E. coli, salmonella, or staphylococcus aureus.

“These pathogens can cause foodborne illnesses characterised by symptoms like nausea, vomiting, diarrhea, and abdominal cramps. Pregnant women are particularly vulnerable to foodborne infections due to changes in their immune system and hormonal fluctuations,” he added.

According to a 2007 research work, ‘Maternal Consumption of Aqueous Extract of Hibiscus Sabdariffa During Pregnancy Attenuates Pregnancy Weight Gain and Postpartum Weight Loss,’ by Dr Iyare E. E. of the Department of Physiology, College of Medicine, University of Nigeria, Enugu Campus, Enugu State; and Dr Iyare, F. E. of the Department of Pathology, Ebonyi State University Teaching Hospital, Abakaliki, Ebonyi State, the effect of maternal consumption of aqueous extract of Hibiscus sabdariffa during pregnancy can impact on the weight of the pregnant woman.

This was investigated in Sprague-Dawley rats.

Fifteen in-bred pregnant female Spague-Dawley rats were randomly assigned to groups A, B and C on day one of pregnancy.

Group C rats had tap water while groups A and B rats had 0.6g HS extract and 1.8g HS extract respectively in 100ml tap water to drink throughout pregnancy and through 34 days postpartum.

All the rats in all the groups were fed normal rat chow ad libitum.

Dam weights were measured daily throughout pregnancy and at delivery, 10, 14, 20, and 34 days postpartum.

Results of the present study showed a significant concentration-dependent decrease in both pregnancy weight gain and postpartum weight loss at the doses tested.

“The reduction in the weight gain during pregnancy in the rats that drank aqueous extract of HS during pregnancy (groups A and B) was expected to lead to low postpartum weights at all periods of measurement either as a result of low early postpartum weight gain (due to lactation) or increased postpartum weight loss (due to the suckling pups).

“This, however, was not the case. Rather, there was no difference in postpartum weight changes at all periods of measurement except at PPD 20 and 34 when the weight loss in the exposed group was significantly less than the weight loss in the control group.

“These observations may therefore suggest that exposure to an aqueous extract of HS during pregnancy decreases pregnancy weight gain and postpartum weight loss through a mechanism not yet fully understood.

“We, therefore, hypothesise that HS exposure that commenced on day one of pregnancy through PPD 34 in the exposed groups (A and B) may have induced a state of dehydration (water deprivation) in pregnancy, directly or indirectly, in these dams as evidenced by the reduced fluid intake (table 1) which created an osmotic stress.”

Also speaking, a food microbiologist and public health expert, Emmanuel Onyekwere, noted that, in severe cases, foodborne illnesses during pregnancy could lead to dehydration, electrolyte imbalances, and even miscarriage or stillbirth.

Onyekwere said, “It is essential for pregnant women to ensure that zobo is prepared hygienically, using clean utensils and filtered water, and stored at safe temperatures to prevent bacterial growth and contamination.”

Onyekwere also stated that the consumption of zobo in pregnancy could lead to an interference with nutrient absorption.

According to him, hibiscus leaves, the primary ingredient in zobo, contain certain compounds that may interfere with the absorption of essential nutrients like iron and calcium.

Iron deficiency anemia, he noted, is common during pregnancy and can lead to adverse outcomes such as preterm birth, low birth weight, and developmental delays in the baby.

He added, “Although the exact mechanisms by which hibiscus compounds affect nutrient absorption are not fully understood, pregnant women should be mindful of their dietary choices to ensure adequate intake of iron-rich foods and consider limiting their consumption of zobo, particularly if they are already at risk of iron deficiency.”

A microbiologist and public health researcher currently studying for a doctorate in Spain, Steven Edwards, noted that hibiscuses had uterine-stimulating properties which might lead to complications.

He said, “Traditionally, hibiscus has been used in some cultures as a uterine stimulant to induce labour or regulate menstruation.

“While there is limited scientific evidence to support these claims, consuming large quantities of hibiscus tea or zobo during pregnancy may potentially stimulate uterine contractions, leading to premature labour or miscarriage, especially in women with a history of pregnancy complications.

“Pregnant women are advised to exercise caution and moderation when consuming beverages containing hibiscus during pregnancy, particularly in the third trimester when uterine activity can increase naturally as the body prepares for labour.

“It is always best to consult with a healthcare provider before using herbal remedies or supplements during pregnancy to ensure their safety and efficacy.”

He also noted that there was a risk of drug interactions and medication effects when pregnant women consumed zobo and used the recommended medications used in pregnancy.

Zobo, according to him, may interact with certain medications commonly prescribed during pregnancy, such as anticoagulants (blood thinners) or antihypertensive drugs.

“The hibiscus leaves in zobo contain compounds that can affect blood clotting and blood pressure, potentially interfering with the efficacy of these medications or exacerbating underlying health conditions.

“Pregnant women who are taking medication should consult with their healthcare provider before consuming zobo or other herbal products to avoid potential drug interactions and adverse effects on maternal and fetal health.

“It is essential to disclose all herbal remedies and dietary supplements to healthcare providers to ensure safe and effective management of medical conditions during pregnancy,” he added.

According to research by an online health resource, Health Today, on the hibiscus drink, zobo, when consumed during pregnancy may lead to dehydration and electrolyte imbalance.

“Zobo has diuretic properties, meaning it can increase urine production and potentially lead to dehydration, especially if consumed in large quantities or in combination with other diuretic substances like caffeine.

“Dehydration during pregnancy can compromise maternal health and fetal development, increasing the risk of complications such as preterm labor and birth defects,” the resource noted.

It stated that pregnant women should prioritise staying hydrated with water and consuming a variety of nutrient-rich foods to support maternal and fetal health throughout pregnancy.

“While zobo can be enjoyed in moderation as part of a balanced diet, excessive consumption should be avoided to prevent dehydration and electrolyte imbalances that could negatively impact pregnancy outcomes.

“Pregnant women should exercise caution when consuming zobo, or steer clear totally due to potential risks and negative effects on maternal and fetal health.

“Moderation is key, and pregnant women are advised to consult with their healthcare providers before incorporating zobo or any herbal remedies into their diet during pregnancy.

“By making informed choices and prioritising their health and well-being, pregnant women can ensure a safe and healthy pregnancy for themselves and their babies,” it added

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