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Herbs for the pregnant women: sound advice for using medicinal plants to treat common pregnancy ailments.

The past decades have vastly improved outcomes in high-risk pregnancies and births, yet with these improvements has come the omnipresence of technology in nearly all aspects of normal childbearing. The desire to avoid unnecessary interventions and a trend toward what is natural have led many pregnant women to seek alternatives--for example, the use of herbs--for the treatment of common pregnancy complaints. Studies and surveys estimate that up to 45 percent of women have used herbs during pregnancy. (1-5)

ARE HERBS SAFE DURING PREGNANCY?

Herbs have been used for millennia in the treatment of discomforts and problems arising during pregnancy. Childbearing women commonly experience minor complaints for which the use of natural remedies may be gentler and safer than over-the-counter and prescription pharmaceuticals. Little is known scientifically about the risk of using herbs during pregnancy, as most herbs have not been formally evaluated, and ethical considerations limit human clinical investigation during pregnancy. (6-10) Much the same can be said for the use of many pharmaceuticals during pregnancy.

Most of what is currently known about the use of botanicals during pregnancy is based on a significant body of historical, empirical, and observational evidence, and limited pharmacological and animal studies. Overall, most herbs are safe, with little evidence of harm. Few reported adverse events have occurred, and those that have been reported typically involved the consumption of known toxic herbs, adulterants such as unsafe herbs or even pharmaceutical additives, or inappropriate use or dosage of botanical therapies.

However, lack of proof of harm is not synonymous with proof of safety. Some of the harmful effects of herbs may not be readily apparent until after use has been discontinued, or may occur only with cumulative use. While gentle herbs and simple home remedies have a long historical track record of safety, pregnant women are increasingly seeking advice from sources that may not always be reliable--e.g., the Internet--and may be trying to treat potentially serious problems that can arise during the childbearing cycle. (11)

There are different schools of thought on whether or not herbs should be used routinely during pregnancy. Some believe that because most herbs are not proven safe during pregnancy, they should be entirely avoided, while others see certain herbs more as foods that can provide additional sources of nutrition during pregnancy, or as tonics that can encourage and support optimal pregnancy health and uterine function. (12, 13)

Perhaps the most reasonable approach to herb safety is that of risk/ benefit, taking into account the safety of the individual herb, the severity of the symptom and/or condition, and the safety of the corresponding conventional medical approach. However, certain signs and symptoms arising during pregnancy always warrant medical attention, and should not be treated with herbs (see sidebar, "Warning Signs during Pregnancy").

USING HERBS DURING PREGNANCY

The most prudent approach is to avoid using herbs during the first trimester of pregnancy unless medically indicated (e.g., nausea and vomiting in pregnancy, or threatened miscarriage), and after that to use herbs that are known, whether scientifically or historically, to be safe during pregnancy.

Beverage and nutritive teas that are known to be safe in moderate amounts (e.g., red raspberry, spearmint, chamomile, lemon balm, nettles, rose hips), and ingestion of normal amounts of cooking spices, are generally considered safe to be used freely.

The constituents of many herbs--such as nettles (Urtica dioica), milky oats (Arena sativa), and red raspberry leaf (Rubus idaeus)-are mostly benign, nutritive substances such as carbohydrates, vitamins, and minerals. Several herbs have also been scientifically demonstrated to be safe during pregnancy; see "Table 1: Herbs Considered Safe in Pregnancy." On the other hand, there are many herbs whose use in pregnancy is entirely contraindicated, for safety reasons. Extensive 'lists are available; "Table 2: Herbs to Avoid during Pregnancy" lists the most important therapeutic categories and some representative herbs.

Between the lists in these two tables fall those herbs whose use is inappropriate for daily, routine intake, but which can be used if necessary for brief or longer periods for specific conditions. Licorice is one of these: Used for no longer than a week for a sore throat, for example, it can be entirely safe and appropriate. However, licorice is contraindicated for patients with hypertension, and long-term use of even licorice candy containing actual licorice extract has been associated with preterm birth. (14)

An herbalist, midwife, or physician trained in the use of botanicals during pregnancy should be consulted when using herbs medically--that is, to treat a specific symptom or condition--rather than simply nutritively or as a general pregnancy tonic, as one would use red raspberry leaf or nettles. In addition to common complaints of pregnancy, pregnant and lactating women are also subject to the run-of-the-mill complaints and illnesses we ali face--colds, indigestion, headaches, etc.--for which they may seek herbal care. Many of these problems can be addressed safely and gently with mild herbs such as echinacea, ginger, and chamomile, respectively.

COMMON CONDITIONS DURING PREGNANCY AND HERBS FOR TREATMENT: AN OVERVIEW

The herbs cited in the medical literature as most frequently used for pregnancy complaints vary slightly among studies, but include: echinacea, St. John's wort, peppermint, spearmint, ginger root, fennel, wild yam, meadowsweet, blue cohosh, black cohosh, red raspberry leaf, evening primrose, garlic, aloe, chamomile, echinacea, pumpkin seeds, and ginseng. (15-19) In one study, patients cited anxiety, nausea, vomiting, and lower gastrointestinal-tract and urinary-tract problems as the most common reasons for using herbal therapies in pregnancy. (20) And another study indicates midwives most frequently recommend herbs for nausea and vomiting, labor stimulation, perineal discomfort, lactation disorders, postpartum depression, preterm labor, postpartum hemorrhage, labor analgesia, and malpresentation. (21) "Table 3: Herbal Treatment of Common Pregnancy Complaints and Concerns" provides guidelines for commonly used botanical treatments for several pregnancy problems, and provides a brief discussion of the safety of the herbs listed.

PARTUS PREPARATORS

Partus preparators herbs used in the last weeks of pregnancy to tone and prepare the uterus for labor have historically been used to facilitate a rapid and easy delivery. Commonly used partus preparators include blue cohosh (Caulophyllum thalictroides), black cohosh (Actaea racemosa), partridge berry (Mitchella repens), and spikenard (Aralia racemosa), among others. The use of such herbs to prepare women for labor begs the question of why one would use an herbal preparation to prepare the body for something it already naturally knows how to do.

Furthermore, the safety of these herbs prior to the onset of labor is questionable. Case reports have appeared in the literature that suggest an association between blue cohosh and profound cerebral ischemic episodes (stroke) or myocardial infarction (heart attack) in the newborn. (22-23) Blue cohosh contains a number of potent alkaloids, including methylcystine and anagyrine. The latter is known to have an effect on cardiac muscle activity. Other side effects of blue cohosh include maternal headache and nausea. Yet, as previously stated, blue cohosh is one of the botanical medicines widely applied by midwives, and one of those most commonly included in late-pregnancy formulas self-prescribed by mothers. The risks associated with extended third-trimester ingestion of blue cohosh specifically suggest that it should be avoided as a partus preparator. It seems that, unless otherwise indicated for the health of mother and baby, it would be preferable to focus attention on methods of preparing for labor that are non-pharmacological.

FORMS OF ADMINISTRATION APPROPRIATE DURING PREGNANCY

The form in which an herb is administered (e.g., tincture, tea) can affect its strength and efficacy. During pregnancy, various forms of preparation can be used to maximize or minimize the volume and availability of more or less desirable constituents in an herb, as well as minimize exposure to other unwanted substances. For example, using water-based extracts (teas, infusions) can minimize the extraction of potentially harmful bioactive compounds, and avoid the excessive consumption of alcohol from alcohol-based preparations (which, typically, are also more medicinally concentrated). External application of most herbs, including to the vagina (e.g., to treat vaginal infections), is generally considered safe, but the internal and external use of some herbs known to be toxic--for example, poke root, pennyroyal oil, and thuja--should be avoided.

SUMMARY

While herbs can provide substantial relief for common complaints and concerns that arise during pregnancy and childbirth, the power of herbs should be respected during pregnancy; in short, they should be used with caution. However, many herbs may be contraindicated on the basis of very limited findings, erroneous reports, or by association with a problem rather than a proven causal effect. Many herbs that have not been evaluated may nonetheless offer simple, safe, gentle, and effective solutions for common problems of pregnancy, ranging from anemia to vaginitis. Good diet, exercise, a healthful lifestyle, a positive outlook, and strong social support are the cornerstones of an optimal childbearing experience.

HERBS CONSIDERED SAFE IN PREGNANCY 

An overview of herbs that have been demonstrated to be safe to use during pregnancy through clinical trials or scientific evaluation of safety. 

Common name Botanical name Reason for use
Echinacea Echinacea spp Reduce duration or recurrence of colds and upper respiratory infection (URI).
Ginger  Zingiber  Prevent and relieve officinalis nausea and vomiting of pregnancy.
Cranberry  Uaccinium  Prevent and relieve macrocarpon urinary tract infection (UTI). 
Chamomile  Matricaria  Promote general relaxation, recutita treat insomnia, treat flatulence.
Red raspberry Rubus idaeus Mineral-rich nutritive tonic, leaf uterine tonic to promote an expedient labor with minimal bleeding. Can also be used as an astringent in cases of diarrhea.

         

Common Name

Typical Daily Dose

Red raspberry 1.5-5 gm leaf daily in tea or infusion
Echinacea 5-20 ml tincture [alcohol extract]
Ginger Up to 1 gm dried powder daily
Chamomile  1-5 gm daily in tea
Cranberry 16-32 fl oz of juice daily

 

Common Name Comments
Red raspberry Highly astringent leaf herbs can theoretically interfere with intestinal absorption of nutrients. [Editor's note: Use lower dose for long-term administration.]
Echinacea  The dose listed here are considered safe by most herbalists is higher than that used in the study referenced.
Ginger  Higher doses of ginger are traditionally considered to promote menstrual discharge (i.e., they are emmenagogic). Untreated excessive vomiting in pregnancy can cause serious adverse outcomes.
Cranberry  Untreated UTI in pregnancy can cause serious adverse outcomes.
Chamomile  No reasonable contraindications.

 

HERBS TO AVOID DURING PREGNANCY 

The lists of herbs under each category constitute representative examples and are not exhaustive. Additional herbs may fall into any of these categories. 

Abortifacients and Emmenagogues
Angelica  Mugwort 
Rue  Pennyroyal essential oil
Safflower  Scotch Broom 
Tansy Thuja 
Wormwood  Yarrow 
     
Essential Oils and Volatile Oils
Oregano  Pennyroyal 
Peppermint  Sage 
Thyme   Thuja 
Tansy 
Teratogens 
Conium spp Datura spp
Ferual spp Lupinus spp 
Nicotiana spp Prunus spp
Senecio spp Solanum spp
Sorghum  Trachymene spp
Veratrum spp
Alkaloids
Barberry  Borage 
Coltsfoot  Comfrey 
Goldenseal  Oregon Grape
Stimulating Laxatives
Aloes  Buckthorn 
Cascara sagrada Rhubarb 
Castor Oil 
Stimulants/Depressants
Coffee  Ephedra 
Guarana  Kava 
Phytoestrogens 
Hops  Isoflavone extracts
 Red Clover

                   

HERBAL TREATMENT OF COMMON PREGNANCY COMPLAINTS AND CONCERNS 

Symptom / Condition Herbal
Treatment
Typical
Application
Nausea and vomiting  Ginger root Tea Fresh or dried root Other: ginger ale, candied ginger 
Urinary tract infection  Uva ursi  Infusion 
Marshmallow
Root
Decoction
Cranberry  Juice 
Colds Echinacea Tincture or Capsules
Ginger Root Tea
Vaginal Yeast Infection Tea Tree Oil Suppository 
Garlic Suppository
Calendula Oil Suppository - To heal damaged tissue
Iron-deficiency Nettles Infusion
Irritable Uterus Cramp Bark Tincture
Tonic to ease labor, prevent complications Red Raspberry Infusion

  

Symptom/Condition

Dose

Nausea & Vomiting Up to 1 gm daily; take in divided doses as needed for symptomatic relief.
Urinary tract infection  3 gm dried leaves to 150 ml water as a cold or hot infusion steeped for 30 minutes, and taken up to 4 times daily, not to exceed 7 days. Doses should provide no more than the equivalent of 400-840 mg arbutin daily, divided among 2-4 doses. Traditionally combined in equal parts with marshmallow root as an emollient for irritation and inflammation of the urinary tract.

1.5 gm dried root steeped with ova ursi

Prevention: 4-32 fl oz daily 

Treatment: 16-32 fl oz daily 

300-400 mg; 2-3 times daily

 

Colds 3-5 ml up to 4 times per day for 5-7 days

250-1000 mg per day for 5-7 days

Ginger Root See the Ginger entry under "Nausea and vomiting" above.
Vaginal Yeast Infection 3-5 drops per vaginal suppository, inserted 1-3 times daily

1 clove inserted into vagina once per night for 7 nights

Iron-deficiency  7-14 gm daily
Irritable uterus  3-4 ml, repeated up to 6 times daily as needed

 

Tonic to ease labor, prevent complications 1.5-5 gm daily 

Sympton / Condition Safety Comments / Concerns
Nausea and Vomiting Several recent trials demonstrate the safety and efficacy of ginger for the treatment of nausea and vomiting. This herb was previously contraindicated by the German Commission E Monographs (1) and the Botanical Safety Handbook (2) due to concerns over mutagenicity, but these concerns have been resolved; the herb is now considered safe for use in recommended doses.
Urinary tract infection   There is some controversy as to the safety of using uva ursi during pregnancy, based on a single case report in the literature associating its use with uterine contractions. A recent review by Upton suggests that the herb can be safely used during pregnancy for periods of up to 1 week at the recommended dose. 

No known contraindications to use of this herb during pregnancy; theoretically may interfere with the absorption of medications, so use with care for patients taking prescription drugs. 

No known contraindications or restrictions during pregnancy.

Colds Safe use was demonstrated during pregnancy in a retrospective clinical trial.
Ginger root  Traditionally used as a tea of fresh root for the treatment of colds, chills, aches, and dyspepsia associated with colds. See safety comments under "Nausea and vomiting."
Vaginal yeast infection  Safety during pregnancy has not been studied for the external application of these herbs, but there is no known contraindication. Tea tree oil and garlic can cause contact irritation; therefore use the former in suppositories with other herbs and oils. [Editors note: Peel papery cover off un-nicked garlic clove (leave thin membrane). Wrap in layer of gauze. Attach 5"-piece of thread or floss. Dip clove in olive oil. Insert Leave overnight] 
Iron-deficiency / anemia  No studies available; widely used by midwives, who report beneficial effects. Irritable Traditional and empirical evidence only; no known uterus contraindications, though may theoretically lead to postural hypotension in hypotensive women. Tonic to ease No known contraindications. labor, prevent complications

 Source & References: The Free Library by Farlex

 

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