Using herbs during pregnancy and lactation

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By Carolina Brooks, BA, IFMCP

I was recently commissioned to develop a range of nutritional and herbal products to support and optimize the health of pregnant and lactating women. This project allowed me to not only research public and practitioner assumptions about herbal medicine during these life stages, and the overlooked nutritional and health considerations for expectant or new mothers, but also preemptively assess social and behavioral changes we are currently experiencing, including disruptions to food supply that may impact quality and accessibility for many people.

The novel coronavirus (COVID-19) has also brought up significant questions around the vulnerability of pregnant women, particularly a recent research letter in the Journal of the American Medical Association, which discussed a pregnant woman who miscarried in her second trimester where the placenta tested positive for COVID-19. Those in the third trimester are advised to take more stringent precautions around social distancing and hygiene, and women are encouraged to attend their regular appointments. Breastfeeding mothers are advised to continue to do so, as the virus has not been found in breastmilk.

Nonetheless, there has never been a more important time to support patients who are preparing for invitro fertilization procedures or actively trying to conceive, those who are already pregnant, and those who are breastfeeding. This is an area that many practitioners feel uneasy about giving advice, especially as much of the literature is unclear. A big concern is quality and the potential neurotoxic effects of pesticide contamination of crops in utero, as discussed in a 2010 study in Environmental Health, and in breast milk, as discussed in a 2008 article about contaminants in breastmilk in Environmental Health Perspective. It is always preferable to refer to an expert in this area, and practitioners should educate patients and ensure they are buying good quality and organic products.  

The following are some frequently asked questions practitioners may have for their patients during pregnancy.

Why are herbs used during pregnancy and lactation?

In my clinical experience, women seek out support for side-effects, such as nausea, reflux, insomnia, and depression, during pregnancy. They want to know if there is anything to do to reduce risk of miscarriage, to support an easier delivery. Postpartum, what they can take or do to heal faster and prevent infection, and encourage healthy breast milk flow and prevent complications, such as mastitis and oral thrush. While many patients are given medications to address constipation or viral infections during pregnancy, herbal medicines offer safer plant alternatives that do not have the same side effects.

Are herbs safe in all trimesters?

I do use some herb but generally advise patients to avoid all herbs during the first trimester except ginger (Zingiber officinalis) unless they have had a consultation.

The American Pregnancy Association offers advice around herbs and differentiates between “non-herbal teas,” such as black, green and white tea containing caffeine, and medicinal herbal teas, which they purport do not.

To clarify, there are several herbs that naturally contain caffeine and other stimulating alkaloids, including cacao, yerba maté, and guarana. I do not recommend people drink stimulating drinks during pregnancy. Many people believe teas to be innocuous, but if a compound extracts well in water, this can make a strong herbal tea an extremely powerful treatment.

Raspberry leaf is generally promoted for uterine health and is considered safe from the second trimester.  I advise patients to discontinue all adaptogens unless they have had a consultation as there are very few that I consider safe.

If you have put a patient on a protocol involving herbs, including and not limited to a gut clearing protocol, adrenal or support, or liver detoxification herbs, and they contact you to inform you that they are pregnant, ask them to discontinue these products immediately. Herbs are generally contraindicated in pregnancy and breastfeeding unless there is clinical research or a long history of traditional use because absence of proof of harm doesn’t necessarily mean safety.

Certain categories should be avoided during pregnancy, including emmenagogue, abortifacient, teratogen, and stimulating laxative herbs. Essential and volatiles oils are also not considered safe, but many culinary herbs containing volatile oils, such as peppermint, rosemary, coriander, and basil, can be safely used in food seasoning quantities. I still don’t advise my patients to eat a very strong pesto, however, as this could theoretically have emmenagogic effects.

Are herbs safe while breastfeeding?

Herbs that are considered safe during pregnancy are not always considered safe during lactation and vice versa. Blessed thistle (Cnicus Benedictus) and fenugreek (Trigonella foenum-graecum) are considered galactagogues, but blessed thistle is not considered safe during pregnancy due to the volatile oils it contains which may have abortifacient properties, and fenugreek is considered safe in only in culinary quantities during pregnancy as it has oxytocic properties.

Many breastfeeding mothers also do not consider that the coffee, soda, or chocolate they are consuming is causing hyperactivity and fussiness in their baby due to their caffeine content. If a breastfeeding mother comes in complaining of issues with feeding or behaviors, the first thing to evaluate is a mother’s diet and lifestyle. I recently discovered that the patient with attention deficit disorder and high levels heavy metal metals who had smoked throughout her pregnancy because nobody had told her it was not safe. A 2014 paper in International Journal of Research and Public Health confirms that cigarettes contain traces of toxic metals.

There is a lack of education globally around infant exposure to potentially unsafe, toxic and aggravating compounds through breast milk, so it is worth having resources available to educate patients.

References

Baud D, Greub G, Favre G, Gengler C, Jaton K, Dubruc E, Pomar L. (2020) Second-Trimester Miscarriage in a Pregnant Woman With SARS-CoV-2 Infection. JAMA. Published online April 30, 2020. Retrieved from: https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2020.7233

Caruso RV, O’Connor, RJ, Stephens WE, Cummings KM, Fong GT (2013) Toxic metal concentrations in cigarettes obtained from U.S. smokers in 2009: results from the International Tobacco Control (ITC) United States survey cohort. International journal of environmental research and public health, 11(1), 202–217. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924441/

Mead M (2008) Contaminants in human milk: weighing the risks against the benefits of breastfeeding. Environmental health perspectives, 116(10), A427–A434. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569122/

Petit C, Chevrier C, Durand G, Monfort C, Rouget F, Garlantezec R, Cordier S (2010) Impact on fetal growth of prenatal exposure to pesticides due to agricultural activities: a prospective cohort study in Brittany, France. Environmental health, 9, 71. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999589/