SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH 1150 Vol 38 No. 6 November 2007 THE USE OF HERBAL MEDICINES DURING PREGNANCY AND PERINATAL MORTALITY IN TUMPAT DISTRICT, KELANTAN, MALAYSIA Azriani Ab Rahman 1 , Zulkifli Ahmad 1 , Lin Naing 2 , Siti Amrah Sulaiman 3 , Abdul Manaf Hamid 1 and Wan Nudri Wan Daud 1 1 Department of Community Medicine, 2 School of Dental Sciences, 3 Departments of Pharmacology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Krian, Kelantan, Malaysia Abstract. The objective of this case-control study was to determine the association between herbal medicine use during pregnancy and perinatal mortality in Tumpat District, Kelantan, Malaysia. Cases were mothers who gave birth from June 2002 to June 2005 with a history of perinatal mortality, while controls were those without a history of perinatal infant mortality. A total of 316 mothers (106 cases and 210 controls) were interviewed. The use of unidentified herbs prepared by traditional midwives and other types of herbal medicines during the first trimester of pregnancy were positively associated with perinatal mortality (OR=5.24, 95% CI=1.13; 24.23 and OR=8.90, 95%, CI=1.35; 58.53, respectively). The use of unidentified “Orang Asli” herbs and coconut oil during the third trimester of pregnancy were negatively associated with perinatal mortality in Tumpat (OR=0.10, 95% CI=0.02; 0.59 and OR=0.48, 95% CI=0.25; 0.92, respectively). These findings suggest the use of unidentified “Orang Asli” herbs and coconut oil in late pregnancy are protective against perinatal mortality, while the use of unidentified herbs prepared by traditional midwives and other types of herbal medicines in early pregnancy has an increased risk of perinatal infant mortality. Pharmacological studies to confirm and identify the compounds in these herbs and their effects on the fetus should be conducted in the future. crown rump heel length equal to or greater than 25 cm, or early neonatal death (0-6 days) (MOH, 2000). In 2000, the perinatal mortality rate was 47 per 1,000 births in the world (WHO, 2006). In the study area, Tumpat, the perinatal mortality rate in 2003 was 13.68 per 1,000 births (Kelantan State Health Depart- ment, 2004) which was higher than the rate in Kelantan (11.59 per 1,000 births) (Kelantan State Health Department, 2004) and in Ma- laysia overall (9.1 per 1,000 births) (MOH, 2004). Several factors, such as low maternal educational level, low household income, too young and too old mothers, primiparity, grandmultiparity and maternal diseases have been among the factors found to be associ- ated with perinatal death (Kliegman. 1998). Al- Correspondence: Dr Azriani Ab Rahman, Depart- ment of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malay- sia, 16150 Kubang Krian, Kelantan, Malaysia. Fax: 609-765 3370 E-mail : azriani@kb.usm.my INTRODUCTION Herbal medicines are defined as plant- derived material or preparations with therapeu- tic benefits, and contain raw or processed in- gredients from one or more plants (WHO, 2000). The use of herbal medicines during pregnancy is common, ranging from 7.0 to 55.0% (Tiran, 2003). Perinatal mortality is defined as death of a fetus weighing at least 500 g or born after 22 weeks gestation or a