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The use of botanicals during pregnancy and lactation

Exposures to over-the-counter products are frequent in pregnant women. Perhaps this is a paradoxical response to the decreased use of prescribed medications during pregnancy for fear of teratogenicity. For many women, natural health products such as herbal medicines or supplements may seem a reasonable alternative as the lay media often portrays natural medicines as safe. While the true incidence of natural product use in pregnancy is not known, some studies suggest that as high as sixty percent of pregnant women use natural therapies including herbal medicines either during pregnancy or while planning.1 Pregnant women often consider the use of natural products such as peppermint tea or ginger to help with symptoms of pregnancy such as nausea and vomiting.2 In one study of midwives practicing in North Carolina, half of the respondents admitted to recommending herbal medicines to their patients for pregnancy related conditions. 3 Further to this intended use, it must be remembered that nearly half of all pregnancies are unplanned and unexpected exposures to medicines and supplements in the first trimester are not rare.

Despite the prevalent use of natural health products by pregnant women, there is very little published evidence with regards to the safety and efficacy of natural health products during pregnancy and lactation. Many modern and classic texts warn against the use of natural product supplementation during pregnancy or lactation for up to one-third of the products listed in their monographs. However, most resources provide little information on the data used to evaluate reproductive toxicity apart from reports of historical use of herbs as abortifacients or uterine stimulants or animal data of genotoxicity or teratogenicity. Data on efficacy during pregnancy is similarly scarce from most texts.

To our knowledge, is the first resource that aims to specifically address the lack of data of natural health product use in pregnancy and lactation. While it is not an exhaustive compendium of available supplements, it is a comprehensive listing of common herbs, vitamins and supplements used by pregnant women, drawing on available studies obtained on natural product safety during pregnancy and breastfeeding.


The level or grade of evidence used for indication of the herbal product would be as follows:


Level of evidence


Very strong scientific evidence: Statistically significant evidence of benefit from one or more systematic reviews or meta-analyses


Strong scientific evidence: Statistically significant evidence of benefit from one or more properly conducted randomized controlled trials (RCTs).


Good scientific evidence Statistically significant evidence of benefit from one or more RCTs. The RCTs, however, are either of small sample size or have discrepancies in their methodologies


Fair scientific evidence Statistically significant evidence of benefit from one or more cohort studies or outcome studies


Weak scientific evidence Evidence from case series


Theoretical and/or clinical evidence Evidence from case reports or expert opinion or laboratory studies


Historical or traditional evidence Historical or traditional evidence of use by medical professionals, herbologists, scientists or aboriginal groups



The level of evidence for potential harm from the herbal product will be evaluated as follows:


Level of evidence                                                                                                                          


Very strong scientific evidence: Statistically significant evidence from one or more systematic reviews or RCTs


Strong scientific evidence: Statistically significant evidence from one or more cohort studies or control studies


Good scientific evidence: Evidence from one or more case series


Fair  scientific evidence: Evidence based on case reports


In vitro scientific evidence: Evidence based on scientific studies conducted on animals, insects or microorganisms, or laboratory studies on human cells


Theoretical evidence: Evidence based on scientific theory or expert opinion


Unknown No available information



1. Maats FH, Crowther CA. Patterns of vitamin, mineral, and herbal supplementation use prior to and during pregnancy. Aust NZ J Obstet Gynaecol 2002; 42:494–496.

2. Hollyer T, Boon H, Georgousis A, Smith M, Einarson A. The use of CAM by women suffering from nausea and vomiting during pregnancy. BMC Complementary and Alternative Medicine 2002; 2:5

3. Allaire AD, Moss M-K, Wells SR. Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midmives. Obstet Gynecol 2000; 95:19–23.

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