Counseling a pregnant woman about herbs

For the above reasons, it is difficult even for an experienced healthcare provider to counsel a pregnant woman on the use of herbal preparations. As providers, evidence-based medicine is expected. However, few herbs and natural therapies even have good scientific evidence, never mind the evidence-based medicinc that people expect today. RaLher, herbal therapies use more traditional evidence as their proof of safety. This is evidence passed down by culture and tradition, and is often only oral. There is almost no solid scientific evidence regarding the benefits or the risks of herbs in pregnancy to the mother or fetus. It is difficult to reassure patients under these circumstances.

There is some good news, though. There is a considerable body of traditional evidence that can be used as a basis for a discussion with patients. This is traditional evidence - a different kind of evidence-based medicine. It can be very helpful to patients, when put in the proper perspective and used with appropriate understanding. This chapter presents the latest and best evidence that is available, to help counsel pregnant patients, and is organized to optimize the thinking and approach to understanding the most up to-date knowledge regarding the safety of herbs during pregnancy.

Following a general discussion of herbs during pregnancy, descriptions of some of the frequently used herbs during pregnancy are presented here, along with the best evidence available regarding their safety and risk assessment during pregnancy. Next, there is a description of some common herbs where there is controversy over their use during pregnancy. Again, there is a description and discussion of the latest known evidence for these herbs. Finally, there is a list of herbs thought to be contraindicated during prcgnancy. These arc organized into groups according to how they might negatively affect a pregnant woman. This can be helpful in terms of counseling a patient.

The chapter focuses on herbal preparations for the pregnant woman. It does not include information on ayruvedic preparations, Chinese herbs and/or medicines, or homeopathy, where evidenced-based safety data for the pregnant woman are even more limited.

Sections and tables are presented identifying herbs where there is some evidence supporting the safety of their use during pregnancy, but only at the doses and in the preparations mentioned. It should be emphasized that any product can have potential adverse cffccts, based upon the quantity or doses used. Since manufacturing standards have not been established, it is impossible to be certain of the dosage in many products produced around the world. While manufacturers in developed countries have tried to establish more defined preparations, this still remains an area of concern. In addition, the stability of products and possible contamination of the plant or product grown in other parts of the world may still be an issue because of the lack of regulatory standards. Therefore, it is a requirement for any consumers of these products, and the provider counseling them, to evaluate carefully the stated preparation of each product used, focusing upon the reported concentrations of the ingredients, the country of origin, the manufacturer and its reputation, and any reported incidents of contamination for that type of product. For pregnant or lactating women, or any woman of reproductive age, further caution is necessary because of the potential for enhanced effects of these substances on the mother, the embryo/fetus, and the breastfed baby. With regard to purity and the safety of specific products, there is a valuable and important resource. Consumer Labs {ConsumerLab.com) is an independent laboratory for the testing of herbal, vitamin, and mineral supplements. A subscription service at

ConsumcrLab.com is a valuable resource for any provider who counsels patients, including pregnant women, about the purity of specific brands of natural substances.

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