Herbal Medicine and Pregnancy
Written by Jill Dunn - MHSc Complementary Medicine, Registered Naturopath, Registered Medical Herbalist, Registered Nurse (Non-practising)
Most health problems that arise during pregnancy can be prevented by attention to good nutrition, and in an ideal situation the mother and father-to be would have sought naturopathic advice and commenced a healthy eating and lifestyle regimen 6-12 months prior to pregnancy. But what if you havent? It is never too late to start and many annoying symptoms can be overcome with the correct nutritional advice.
Problems such as morning sickness and mood swings can be related to erratic blood sugar levels, cramp and backaches to calcium, magnesium or vitamin D deficiency, increased pigmentation of the skin (chloasma) to vitamin B6 deficiency, anaemia to iron, folic acid and vitamin B12. Varicose veins and haemorrhoids can be aggravated by constipation and insufficient fibre in the diet, and require flavonoids (from fresh fruit, particularly berries) which strengthen collagen tissue. But what about the use of herbal medicine during pregnancy?
Pregnant women and their midwives or doctors are increasingly aware that unnecessary use of pharmaceutical medications during pregnancy should be avoided. Herbal medicine has a long history of use during pregnancy and lactation, although there is limited scientific research to support this. For this reason herbal medicine should also be used with care at this time. Although we must be sensible about this, and keep in mind that many herbs like other plants, have been used as foods and contain pharmacologically active compounds that include vitamins and minerals, although if consumed in large quantities could have some adverse effect. It is therefore important if consuming any herbal teas during pregnancy, that unless prescribed by a registered medical herbalist, the same tea is not consumed more than once daily. Tiny amounts of marjoram, thyme and sage, although considered mild uterine stimulants, are generally harmless in cooking. Only small amounts of parsley and garlic should be used during pregnancy.
The use of herbal tonics during pregnancy
There are three herbal teas, red raspberry leaf, nettle and oatstraw, which herbalists generally recommend during pregnancy. Red raspberry leaf is a uterine tonic and is considered to be empirically safe and effective (having been used for childbearing for thousands of years). Tonics are considered to provide additional essential nutrients and to improve uterine muscle tone. Red raspberry leaves (Rubus idaeus) are one of the safest, best-known and most widely used uterine tonics. The leaves contain the compound fragarine, which is responsible for the uterine tonic effect. Raspberry leaf is used to regulate uterine muscle action and to prevent or reduce the risk of uncoordinated contractions during labour, a problem associated with long drawn out labours and failure to progress. Raspberry leaf tea can be taken during pregnancy from 20 weeks onward, and should not be used during the first trimester because of a slight possibility of miscarriage. Red raspberry leaves also provide a range of nutrients such as manganese, iron, calcium and selenium, vitamins A and C, and assist the production and maintenance of breast milk.
Nettle tea (Urtica dioica) is rich in vitamins and minerals such as calcium, cobalt, iron, phosphorus, potassium, zinc, copper, sulphur, vitamin B complex especially B1 and B2 and carotenoids. The leaves and stalks also provide smaller amounts of manganese, selenium, silicon, vitamin B3 (niacin), C, D and K. Nettle tea can be taken twice daily during the last trimester of pregnancy to provide additional iron and vitamin K. Nettle is historically reputed to help reduce the likelihood of haemorrhage following childbirth. Two cups of nettle infusion daily, for two weeks (an infusion is a tea that has been left to steep covered for 10-15 minutes) also helps improve the quality and quantity of many women's breast milk.
Oatstraw tea is another useful beverage for the pregnant and breastfeeding women. Oat straw is the dried leaves and twigs of the oat plant, which produces oat seed that is processed into rolled oats. Oats and oat straw help strengthen the nervous system and are considered nerve tonics. Rich in minerals, oats and oat straw also help build strong bones and teeth and strengthen capillaries and veins, and provides some support to those troubled by varicose veins and haemorrhoids. Oatstraw tea can be taken during pregnancy and breastfeeding as an additional source of nutrients. To make an oatstraw tea (or a decoction which better extracts oats nutrients), simmer 30 grams of dried oatstraw in 1 litre of water for 20 minutes, strain and refrigerate. It can be taken hot or used cold to water down fruit juice. Oatstraw tea can also be used to replace water when making porridge.
Herbs to avoid during pregnancy
It should be remembered that pregnancy is a normal state, and apart from the nutritive plants mentioned above, does not require herbal medicines unless specifically indicated. However, sometimes a woman may suffer from severe morning sickness or influenza. Ginger root (Zingiber officinale), at one gram per day, has been shown in several small studies to be advantageous in the treatment of nausea and vomiting during pregnancy.1,2 Ginger root can be taken fresh as an infused tea or used dry in tea bags and should not exceed 2 grams per day. Echinacea is another herb that is used to assist recovery from influenza. In a study that followed 206 women who had used echinacea products during pregnancy (112 of whom had taken it during the first trimester) and compared pregnancy outcomes with a control group, it was found that use of echinacea during the time of organ development was not associated with an increased risk of major malformation.3
The following herbs should not be used to self-medicate, however at times they maybe prescribed by a registered medical herbalist in order to treat specific conditions in the short term. This list may not be complete, therefore before using any herbal products during pregnancy or breastfeeding, check with the company that produced the product, or otherwise a registered medical herbalist. For a list of registered medical herbalists in your region see www.nzamh.org.nz/map
Known poisons in pregnancy
- Aconite (Aconitum napellus)
- American mandrake (Podophyllum)
- Bittersweet (Solanum dulcamara)
- Blood root (Sanguinaria canadensis)
- Boldo (Peumus boldo)
- Bryony (Bryonia alba)
- Coltsfoot (Tussilago farafara)
- Comfrey (Symphytum officinale)
- Datura (Datura stramonium)
- Ephedra sinica (Ephedra)
- Greater celandine (Chelidonium majus)
- Grounsel (Senecio vulgaris)
- Horsechestnut (Aesculus hippocastanum) in high doses
- Life root (Senecio aureus)
- Poke root (Phytolacca americana)
- Sassafras (Sassafra officinale)
- Tobacco ( Nicotiana tabacum)
- Wild cherry bark ( Prunus serotina)
Uterine stimulants or emmenagogues (Some of these are used in very late pregnancy but should only be taken if prescribed by a registered herbal practitioner or midwife)
- Angelica (Angelica archangelica) not to be taken in high doses
- Birthwort (Aristolochia serpentaria)
- Black cohosh (Cimicifuga racemosa)
- Blue cohosh (Caulophyllum thalictroides)
- Dong quai (Angelica polymorpha)- not to be taken during 1st trimester or where there is a tendency to miscarriage
- Feverfew (Tanacetum parthenium)
- Mugwort
- Pasque flower (Anenome pulsatilla)
- Pennyroyal (Mentha pulegium)
- Rue (Ruta graveolens)
- Southernwood
- Tansy (Tanacetum vulgare)
- Thuja (Thuja occidentalis)
- Wormwood
Berberine containing herbs
- Barberry (Berberis vulgaris)
- Golden seal (Hydrastis Canadensis)
- Oregon mountain grape (Berberis aquifolium)
Pure essential oils should never be taken internally. Essential oils are highly concentrated and should only be used in low quantities for flavouring, for example peppermint, aniseed or orange, or in a diluted form for external applications.
Avoid use of the following essential oils during pregnancy:
- Aniseed (Pimpinella anisum)
- Arnica (Arnica Montana)
- Basil (Ocymum basilicum)
- Birch (Betula alba)
- Bitter almond (Prunus amygdalis var: amara)
- Boldo leaf (Peumus boldus)
- Calamus (Acorus calamus-acorus)
- Camphor (Cinnamomum camphora)
- Cassia (Cinnamomum cassia)
- Cedarwood (Juniperus virginiana)
- Cinnamon bark (Cinnamomum zeylanicum)
- Clary sage (Salvia sclarea)
- Clove (Eugenia caryophyllata)
- Cypress (Cupressus sempervirens)Not during first 4 months
- Fennel (Foeniculum vulgare)
- Horseradish (Cochlearia armoricia)
- Hyssop (Hyssopus officinalis)
- Jasmine (Jasminum officinale)
- Juniper (Juniperus communis)
- Marjoram (Origanum majorana)
- Mugwort (Artemisia vulgaris) sometimes called Armoise
- Mustard (Brassica nigra)
- Origanum (Origanum vulgare, [Spanish] Thymus capitatus)
- Parsley seed (Petroselinum sativum)
- Pennyroyal (Mentha pulgium, Hedeoma pulgioides)
- Peppermint (Mentha piperita)
- Pine [dwarf] (Pinus pumilio)
- Rosemary (Rosmarinus officinalis)
- Rue (Ruta graveolens)
- Sage (Salvia officinalis)
- Sassafras (Sassafras albidum, Ocotea cymbarum)
- Savin (Juniperus sabina)
- Savory (Satureia hortensis, Satureia montana)
- Southernwood (Artemisia abrotanum)
- Tansy (Tanacetum vulgare)
- Thuja [Cedar leaf] (Thuja occidentalis)
- Thuja plicata
- Thyme (Thymus vulgaris)
- Wintergreen (Gaultheria procumbens)
- Wormseed (Chenopodium anthelminticum)
- Wormwood (Artemisia absinthium)
Laxative herbs have been traditionally avoided during pregnancy because of possible uterine stimulation in some individuals
- Aloes resin (Aloe barbadensis)
- Buckthorn (Rhamnus catharticus)
- Cascara sagrada (Rhamnus purshiana)
- Culvers root or blackroot (Veronicastrum virginica)
- Rhubarb (Rheum officinale)
Phytoestrogen (plant oestrogens) containing herbs should not be used in excess until further research is carried out
- Soy products
- Flaxseed (Linum usitatissimum)
- Alfalfa (Medicago sativa)
- Red clover (Trifolium pratense)
- Pumpkin seed oil (Curcubita maxima)
Hormone-like activity
- Wild yam (Dioscorea villosa)
Others
- Adhatoda vasica
- Andrographis paniculata
- Broom (Sarothamnus scoparius)
- Bugleweed (Lycopus virginicus)
- Cinnamon (Cinnamomum species) except in low doses as a spice
- Corydalis ambigua
- Embelia ribus
- Mistletoe (Viscum album)
- Nutmeg (Myristica fragans) except in low doses as a spice
- Panax notoginseng
- Periwinkle species (Vinca species)
- Saffron (Crocus sativus) except in low doses as a spice
- Sage (Salvia officinalis)
- Salvia miltiorrhiza
- Squill (Urginea species)
- Tribulus terrestris
- Tylophora indica
- Uva ursi (Arctostaphylos uva-ursi)
- Yarrow (Achillea millefolium)- high doses
St. John's Wort (Hypericum perforatum) is a useful herbal treatment for mild to moderate depression, and no increase in frequency of malformation or other harmful side effects on the foetus have been observed, based on its limited use in pregnant women. However evidence of foetal damage in animal studies does exist4. Therefore, we at present do not recommend products containing St. John's wort during pregnancy, and only recommend the use of St. John's wort postnatally, where there are clear indications for its use e.g. postnatal depression (along with B Complex and zinc). Licorice extract (Glycyrrhiza glabra) can be used in small amounts only, as long as there is no high blood pressure. Licorice extract intake, even as a confectionary, should not exceed three gram per day, as it may cause increased sodium retention.
References
- Fischer-Rasmussen,W. Kjaer, S.K. Dahl, C. & Asping, U. 1990, Ginger treatment of hyperemesis gravidarum. European Journal of Gynaecology and Reproductive Biology, 38, pp. 19-24.
- Vutyavanich, T. Kraisarin, T. & Ruangsri, R. 2001, Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstetrics and Gynecology, 97, pp. 577-582.
- Gallo, M. Sarkar, M. Au,W. Pietrzak, K. Comas, B. Smith, M. Jaeger, T.V. Einarson, A. & Koren, G. 2000, Pregnancy outcome following gestational exposure to Echinacea: a prospective controlled study. Archives of Internal Medicine, 160, pp. 3141-3143.
- Mills, S. & Bone, K. 2005, The essential guide to herbal safety. Elsvevier Churchill Livingstone, St. Louis, Missouri
Bibliography
Bone, K. 2002, Safe use of herbs in pregnancy Phytotherapy review and commentary. Townsend Letter for Doctor and Patients January 2002 (on line)http://www.findarticles.com/p/articles/mi_m0ISW/is_2002_Jan/ai_81138244/print [Accessed 13th January 2005].
Mills, S. & Bone, K. 2000, Principles and Practice of Phytotherapy Modern Herbal Medicine, Churchill Livingstone, London.
Talalaj, S. & Czechowicz, A.S.1989, Herbal remedies Harmful and beneficial effects. Hill of Content, Melbourne.
Wren, R.C. Revised by Williamson, E.M. & Evans, F.J. 1985, Potters New Cyclopedia of Botanical Drugs and Preparations. C.W. Daniel. Saffron Walden, Essex.
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