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Herbs and alternative remedies
Pregnancy can be an ideal time to use herbal and alternative remedies. Herbs are often mild preparations of natural compounds that can be just perfect for some of the discomforts and illnesses during pregnancy. Several studies have shown that as many as 50% or more of women will choose herbs and alternative remedies as therapies during pregnancy [ ].
Although herbal therapies have been used for centuries, herbs are complex mixtures of many compounds, and some have potentially significant negative effects for both the pregnant woman and the fetus. In the companion book Drugs during Pregnancy and Lactation , third edition, edited by Schaefer, Peters, and Miller [ ], we focused on the safety of herbs during pregnancy and counseled health care providers that the use of some herbs during pregnancy can have significant risks depending on the herb, the purity of the preparation, and the timing of use during pregnancy. In this chapter, we have focused on the herbs and alternative remedies that are potentially safe and efficacious for many conditions during pregnancy. Using the best available up-to-date scientific evidence, evidence based and traditional, we have listed and categorized herbs, supplements, and other alternative remedies that are potentially safe and efficacious for many of the common medical conditions and discomforts that occur during pregnancy.
For herbs and supplements, we have listed forms and dosage. It is important to recognize that herbs are extracts of plants or plant roots, and they therefore contain numerous compounds. This is very different to a pharmaceutical preparation, which is usually a single active ingredient. Different forms of herbal preparations will have different compounds and concentrations depending on how the plant or plant root is extracted. Herbal preparations are usually available in the following forms: teas or infusions (hot water extracts of dried herbs), capsules, dried extracts, and tinctures (alcohol extracts of dried herbs). The most common forms of herbs used in pregnancy are teas or infusions. These usually have the lowest concentration, contain the least amount of compounds, and therefore are the safest. Capsules and dried extracts are the next most commonly used. Tinctures should be avoided during pregnancy because of their higher concentrations as well as the use of alcohol as a carrier.
A very important difference between the use of herbs or supplements and a pharmaceutical preparation is the integrity and purity of the specific herb or supplement preparation [ ]. Herbs and supplements are often produced in other countries where lead and other impurities can be a problem. There is no Food and Drug Administration oversight of these products, so it is extremely important that patients as well as providers find guidance on product selection from sources such as ConsumerLab.com [ ]. ConsumerLab.com independently and periodically evaluates individual products for purity and integrity. We strongly recommend frequent evaluation of the integrity of the individual preparation. Patients and providers should also be aware of potential herb–drug interactions with all herbal and alternative remedies [ ].
We also have discussed the use of hypnosis and meditation as alternative remedies for many of the common discomforts and illnesses in pregnancy and delivery, where otherwise medications might be needed.
21.1
Herbal teas frequently used during pregnancy
The herbs most frequently used during pregnancy are teas or infusions. Some herbal teas have specific indications; others are used by patients as general health tonics. Although there are minimal clinical trials available, and minimal evidence-based proof of safety and efficacy in terms of Western medical standards, herbal teas have been used for centuries and are regarded as safe and efficacious during pregnancy. It is the general recommendation [ ] that consumption of herbal teas be limited to two cups per day during pregnancy. This is similar to the safety data regarding coffee. The safety is unknown when used at higher levels. The following herbal teas are frequently and safely used during pregnancy [ , , , ]:
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Red raspberry leaf – Relief of nausea, increase in milk production, increase in uterine tone, and ease of labor pains. There is some controversy over the use of red raspberry leaf in the first trimester, primarily because of concern of stimulating the uterine tone and potentially causing miscarriage. Use in the second and third trimester is generally considered safe. In a small study, red raspberry leaf, when used to induce and shorten labor, has been associated with increased cesarean delivery [ ].
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Peppermint – Nausea and flatulence. Tea is the most common. Enteric-coated tablets (187 mg three times a day maximum) are also used. Peppermint may cause gastroesophageal refiux.
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Chamomile (German) – Gastrointestinal irritation, insomnia, and joint irritation. Potentially significant herb–drug interactions have been reported when used together with drugs with sedative properties [ , ].
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Dandelion – A mild diuretic, and to nourish the liver; known for high amounts of vitamins A and C, and the elements of iron, calcium, and potassium, as well as other trace elements.
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Alfalfa – General pregnancy tonic; a source of high levels of vitamins A, D, B, and K, minerals, and digestive enzymes; thought to reduce the risk of postpartum hemorrhage.
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Oat and oat straw – Sources of calcium and magnesium; helps to relieve anxiety, restlessness, insomnia, and irritable skin.
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Nettle leaf – Traditional pregnancy tonic; source of high amounts of vitamins A, C, K, calcium, potassium, and iron. NB: nettle root is different from nettle leaf; it is used for inducing abortions and is otherwise not safe in pregnancy.
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Slippery elm bark – Nausea, heartburn, and vaginal irritations.
21.2
Essential oils used as aromatherapy during pregnancy
Some essential oils are frequently used as aromatherapy during pregnancy, and the ones described below are considered to be safe and efficacious during pregnancy based on traditional and historic use. They should always be used carefully, in well-diluted form, and in an aromatherapy diffuser. They should not be ingested. Such essential oils and their uses are listed below [ , , ]:
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Chamomile – Respiratory tract disorders.
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Tangerine – Antispasmodic, decongestant, and general relaxant.
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Grapefruit – Stimulant and antidepressant.
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Geranium – Dermatitis, hormone imbalances, mood dysfunction, and viral infections.
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Rose – Astringent, used for mild inflammation of the oral and pharyngeal mucosa.
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Jasmine – Stimulant, antidepressant, and anxiety.
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Ylang-ylang – Antispasmodic, cardiac arrhythmias, anxiety, antidepressant, hair loss, and intestinal problems.
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Lavender – Loss of appetite, nervousness, and insomnia.
21.3
Herbs used as capsules or dried extracts
21.3.1
Ginger
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Nausea and vomiting of pregnancy. Dose: 250 mg 3–4 times per day.
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Ginger is the herb with the most evidence-based data showing efficacy and safety in pregnancy. When used at 250 mg 3–4 times a day, it is considered safe and effective for nausea and vomiting of pregnancy, as well as hyperemesis gravidarum [ , , ]. Most of the antiemetic activity is believed to be due to the constituent 6-gingerol which acts directly in the gastrointestinal tract. The constituent galanolactone also acts on 5-HT3 receptors in the ileum, which are the same receptors affected by some prescription antiemetics. Ginger's antiemetic activity may also involve the central nervous system, where the constituents 6-shogaol and galanolactone act on serotonin receptors [ ]. The continual use of ginger throughout pregnancy has been associated with a nonsignificant increase in the incidence of stillbirth and a significant decrease in gestational age at delivery [ ]. Ginger has also been identified as a source of potentially significant herb–drug interactions with insulin, metformin, and nifedipine, medicines commonly used during pregnancy [ ].
21.3.2
Cranberry
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Prevention and treatment of urinary tract infection. Dose: 300–400 mg 3 times a day. Can cause gastrointestinal upset.
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Cranberry is one of the most commonly used herbs during pregnancy, primarily for the prevention and treatment of urinary tract infections. Although there is a long history of the safe and efficacious use of cranberry during pregnancy, there are very little evidence-based data [ , , , , ]. The literature does suggest that cranberry capsules may be more efficacious than cranberry juice. Studies on the pharmacology of cranberry show that the proanthocyanidins in cranberry interfere with bacterial adherence to the urinary tract epithelial cells [ ].
21.3.3
Echinacea
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Prevention and treatment of upper respiratory tract infections, vaginitis, and herpes simplex virus. Dose: 900 mg of dried root or equivalent 3 times a day.
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There is a long history of safe and efficacious use of Echinacea in pregnancy [ , , , ]. Two scientific studies are frequently cited as evidence-based studies showing its safety in pregnancy [ , ]. The efficacy is based on tradition, not evidence based. Echinacea is known to inhibit the influenza virus and the herpes simplex I and II viruses. It has been shown to increase the proliferation of phagocytes in the spleen and bone marrow, stimulate monocytes, increase the number of polymorphonuclear leukocytes and promote their adherence to the endothelial cells, and activate macrophages [ ].
21.3.4
St. John's wort
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Treatment of mild to moderate depression, anxiety, and seasonal affective disorder. Dose: 300 mg 3 times daily, of a standardized extract.
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Although there is minimal evidence-based medicine of its safety or efficacy in pregnancy, St. John's wort is considered safe in pregnancy by the German Commission E, the American Herbal Products Association, and much traditional literature [ , , , ]. It is very commonly used in pregnancy for mild to moderate depression. Studies have shown that St. John's wort acts as an SSRI (selective serotonin reuptake inhibitor), and inhibits the reuptake of serotonin, norepinephrine, and dopamine. Also of significance is that the hypericin in St. John's wort induces some of the cytochrome P450 enzymes and may interfere with the metabolism of other drugs similarly metabolized [ , ]. St. John's wort can cause photosensitization, so caution must be exercised, and patients advised [ ].
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