Herb Safety and Pregnancy

Great news!  I have another friend who is newly pregnant and we got to spend some quality time together recently shopping for maternity bras and looking at baby name books – very fun.  As a fellow avid coffee drinker, she is now finding herself craving a hot beverage without the caffeine.  Many expectant mothers are concerned about caffeine because lots of sources list it as a concern, especially in any large quantity.  Green and black teas contain caffeine which is a drug that does cross the placental barrier.  So does alcohol which is not indicated in any quantity despite what your doctor may tell you, what your friend did, or what they do in Europe.  I've always thought that caffeine is NOT indicated when pregnant, but many of the experts I consulted told me that it can be taken in moderation....I'm willing to change my opinion when presented new information.  Many people assume that if a tea is “herbal” that it is safe during pregnancy because it has no caffeine.  As I did more research, I found this is not always the case.  But what if you just want a cup of tea? 

Herbs can be very powerful with strong bioactive effects in the body; do not underestimate them.  From my experience at Bastyr University, I recognize several basic herbs that are not indicated during pregnancy because of their uterine stimulating actions namely Black Cohosh, Pennyroyal and Golden Seal (among many others).  These are fairly well-known as substances that are contraindicated during pregnancy.   However and I am certainly no herbalist.  The New York Times just ran an article this past weekend titled: “Really?  Some Herbal Remedies Can Be Useful During Pregnancy” stating a statistic that 50% of pregnant women use herbal remedies during pregnancy, mostly out of fear of using prescription medications.  They concluded that most herbs have not been proven to work (with the exception of ginger for nausea).  And the debate continues.  To dig deeper, I reached out to some experts in the field. 

When I first started trying to find information, it was frustrating to see some sources say that chamomile is safe and some say it is not.  I read that certain parts of the nettle plant are safe, while other parts of the plant are not (how can you know if it’s in a tea?!).   Some sources say that mint is ok and others say not.   Most sources tend to air on the side of caution and rightly so.  You will see on most packages and recommendations: 

* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

                                                                                                                                                        

I will do the same.  It is important to understand that this information is based on evidence that I have found from resources I trust.  If you have specific questions, please seek a medical professional trained in herbs and supplements.  I have listed some resources for you at the bottom of this post.  I am definitely not recommending that a pregnant woman take any supplements mentioned on this post as I am not a midwife or herbalist.   But perhaps I can point you in the right direction….

There are a couple problems when researching herbs for pregnancy, the most important one being that researching the effects of any plant or drug on a fetus is unethical and cannot rightly be done.  Any research on pregnant or breastfeeding women is very difficult to achieve, understandably.  Supplements are not controlled in the US by the FDA and so as a population, we proceed at our own risk. 

The second problem is that the average medical provider does not receive much education in the way of herbs and supplements in medical or nursing school.  For this type of expertise, it really is best to consult a trained herbalist, midwife, or naturopathic doctor specializing in pregnancy from an accredited educational program.  Expert Bastyr alumn Chrissy Valluzzi states: “most of the information you will find out there regarding herbs and pregnancy errs on the side of extreme conservatism, basically stating that because herbs have been researched so little, and even less when it comes to safety during pregnancy, don't take them. We know however that women have been using herbs during pregnancy and birth for as long as our species has been around!”.

In regards to herbs and supplements, the advice “ask your doctor” may not be enough.  For example, my pregnant friend went to her nurse to ask about the safety of tea and got the response:  "I've never tried tea".  Her doctor sent her a follow-up letter in response to the tea questions explaining that teas like "strawberry leaf and camilla" are safe in moderation (FYI the question she asked the nurse specifically was about “raspberry leaf and chamomile”).  Does this mean she is a bad doctor?  No.  Does it mean we need to look elsewhere for advice on herbs and supplements sometimes – Yes!!

One of the best resources I received from a Bastyr nutrition alumn is a website which breaks potentially dangerous herbs for pregnancy into categories based on a literature search of research about herbs that are uterine stimulating or have abortifacient affects (irritating to the placenta or causing unwanted uterine contractions).  They found 565 species.  Please see the site if interested, but the main categories include bitters, strong alkaloids (caffeine coffee and tea fit into this category), all essential oils or oil containing plants taken internally,  and anthraquinone laxatives (senna, etc.).  Just because an herb is on this list, it does not automatically mean it is 100% unsafe.  There may be a part of the leaf or root, a processing, or a volume that would be considered beneficial.

There are some herbs generally considered safe and supportive during and after pregnancy.  These are not my recommendations, but simply information gathered from several searches.  Many of these products will be found in Pregnancy or Mother’s teas you can buy in a grocery store.  The ratings on these herbs come from the Natural Medicines Database.   One of the most commonly indicated herb is red raspberry leaf which they label “likely safe”.  Some providers suggest only using it after the end of your first trimester for added safety.    Peppermint leaf and lemon balm are also listed as “likely safe”.  Ginger root is considered “possibly safe”.   Dandelion, chamomile and rose hips do not have enough information available though are commonly used during pregnancy.  Unfortunately, nettles earned the “likely unsafe” classification though they are widely used and may have health benefits.  Nettles are complicated because safety depends on the part of the plant that is used (leaves vs. root) and the quantity.  It is the leaf that contains iron and is thought to be beneficial in many ways to pregnant women.  Safety of herbs generally tends to be associated with the part of the plant used, the processing technique and the quantity taken.   

I received some great advice from fellow Bastyr alumn Michelle Kyncl, an herbalist at Hierophant Meadery & Apothecary, who similar to myself preaches moderation: 

With herbs and pregnancy, aside from herbs with obvious contraindications, many are actually okay in moderation. You will find that many herbal companies provide a disclaimer on all of their products stating, "Not for use in pregnancy or lactation" or "Consult a physician before use." Often times the truth behind the matter is not that these herbs are unsafe for pregnancy, they have just not been studied.  Considering moderation, something as simple as peppermint can be unsafe for pregnancy. While a cup of mildly steeped peppermint tea for indigestion or nausea is completely safe and very effective, drinking peppermint tea all day long every day can cause premature miscarriage simply because it is a smooth muscle relaxant - and the uterus is smooth muscle.

As I said before, I am not an expert on the topic but I do find it fascinating and timely as I know several pregnant women right now (and just found out about another today – yay!).  I was happy to do a little research and meet some very passionate and educated professionals on the topic along my way.  The information I have presented here is not a suggestion or prescription, but more general information regarding herbs during pregnancy and resources on where to get more information.  What I can tell you that does fit into my scope of professional practice as a dietitian is to avoid alcohol or other substances that have proven to cause harm to a fetus, eat a large variety of colorful fruits and vegetables, get plenty of fiber and water, eat some fat, pay close attention to food safety and consult an expert in the area that you need advice.  Keep in mind that this expert may not necessarily be your doctor. 

*Other resources recommended by Michelle Kyncl: 

"Great Expectations; your all inone resource for pregnancy and childbirth" by Sandy Jones & Marcie Jones.

"Wise Woman Herbal for theChildbearing Year" by Susun Weed.