The Use of Herbal Supplements and Remedies During Pregnancy and Breastfeeding

There is a massive emphasis on ‘natural’ products in mainstream media these days. Everywhere we turn, ‘ herbal’, ‘natural’, and other commonly used tags such as ‘ miracle cure’ and ‘homemade’ are used to describe apparently instant solutions to common problems.  With the advent on the internet, many websites consist of the seemingly amazing properties of supplements to boost memory, to better overall physical health, and to enhance almost any function of any organ in the body.  Nevertheless,  most of these claims are unsubstantiated.   The fact that this field of medicine is outside the regulation by the FDA,  it is replete with fictitious claims and potential hazards.   How reliable are these compounds and how does one go about establishing any of the claims seen on the supplements over the counter or in advertisements online?

The FDA maintains a list of products that they approve. Most herbal supplements are not approved by the FDA. In most instances, the products sold over the counter mention that they are not FDA approved for any of their claims and are not intended to diagnose or treat any medical conditions. The first step in determining whether an herbal or natural supplement is effective and safe is to check the FDA page about any of their comments about it. This information can be found here.  

There are some common myths associated with most herbal, homeopathic, and natural products. People assume that if the supplement they are consuming won’t help them, it might not necessarily hurt them either. This is not true. Many products can have potential undesirable side effects or even interactions with medications that the patient may already be taking. Another myth generally seen in the population is the assumption that ‘natural’ means safe. It does not. Many poisons are also natural! People rely on labels to read the warnings associated with side effects of products; however, most people are not aware that labels do not always reflect warnings. In order to gather accurate information on any product, the manufacturing authority of the product can be directly contacted. Most of the time, they give out information on the safety of their product when asked.  Sometimes, products are recalled when they are known to be unsafe or adulterated. However, the general population does not realize that it can take years for recalled products to be withdrawn from the market. Therefore, in light of all the above mentioned myths concerning unregulated products, when you are pregnant or breastfeeding,  it is always a good idea to gather more information on any additional supplement, whether by checking a government authority such as the FDA or by contacting the manufacturer directly.1

An important concern is using these supplements or natural remedies when pregnant or breast feeding. Since the FDA does not regulate most supplements, it is difficult to determine their safety and efficacy. Pregnant and breastfeeding women are advised to consult their physicians before starting any additional supplements or changes in their diets.  There are a few remedies that have been well studied in pregnant and breastfeeding women. A generalized overview of them is presented here.  But in reality,  the vast majority of herbal remedies are totally unstudied in pregnant or breastfeeding mothers.

Sinusitis is a fairly common problem. Symptoms can range from facial pain in the forehead or on the cheeks to discomfort when bending over. Saline sprays are available over the counter to help irrigate the sinuses in order to facilitate fluid flow. This practice is considered safe and effective for symptomatic relief of sinusitis, rhinitis, and alleviating allergies. It is also considered safe in pregnant as well as breast feeding women. Children suffering from rhino sinusitis should be treated following consultation with their pediatricians.2, 3

It is generally believed that vitamin C may help boost the immune system and fight the common cold.  However, extensive study has suggested that taking vitamin C in order to prevent a cold is not an effective remedy.  As with any compound, too much vitamin C also leads to toxicity.  On the other hand, deficiency of vitamin C produces a range of conditions from scurvy to liver and renal failure.  The normal recommended amount of vitamin C in pregnant women is 85 mg/day and for breastfeeding women it increases to 120 mg/day. Side effects are generally not seen until consumption increases to massive amounts of 1800 mg.  High doses of vitamin C stimulate the liver to metabolize it at a high rate.  Hence, too much vitamin C during pregnancy may in fact cause scurvy in the newborn soon after delivery. Therefore, vitamin C should be used with care in pregnant and breastfeeding mothers, and at lower levels.   Conversely, low levels of vitamin C can also have detrimental health affects for the fetus.  Usually the diet, or prenatal vitamins, is an adequate provider of sufficient vitamin C levels. For the prevention of a cold, when the first symptoms become noticeable, a serving of orange juice and the recommended pre-natal vitamin should be used.4, 5

Zinc is also a mineral used to counteract the common cold. Though required for necessary functions in the body, the recommended daily allowance of zinc for adults is 12 to 15 mg/day.  There have been various studies concerning the use of zinc to fight the common cold. While one study suggested that zinc can decrease the duration of symptoms of cold, other studies have found no difference.  

Therefore, at this time, there is no good evidence to suggest that zinc really helps fight the common cold.  There are several compounds of zinc that are used. While zinc acetate and zinc gluconate are considered safe in pregnant and breast feeding women, zinc sulfate is known to actually cause harm to the immune system.  Zinc is also known to be concentrated in human milk, so care must be used to ensure only low levels are required in breast feeding women.6 Other remedies that are used for the cold include Siberian ginseng and andrographis. These should be avoided in pregnant and breastfeeding women.

Headaches are a fairly common occurrence amongst the general population. While they may cause significant concern for new mothers just learning to care for a baby, some alternatives do exist to treat the symptoms of a headache. These include caffeine, peppermint oil, riboflavin (vitamin B2). Caffeine is commonly used in combination with other analgesics such as acetaminophen for headache relief.  Caffeine can help alleviate the symptoms of a headache; however, a subset of the population can actually experience headaches due to caffeine use or with caffeine withdrawal.  Caffeine does cross the placenta in pregnant women. It is recommended to keep daily caffeine intake to below 200 mg.

 

Doses higher than this have been known to cause miscarriage, premature birth and low birth weights.  For these reasons, about 2 cups of coffee, soda, or tea per day are generally considered safe to consume in pregnancy.  Caffeine does transfer into human milk,  and high consumption may cause irritability and insomnia is breastfed infants; however, prolonged use at high levels can cause problems in the infant.7 Peppermint oil is sometimes applied to the forehead and temples to reduce headaches. It is considered safe for both oral and topical use in pregnant women. That said, it should not be applied to infants and children. Peppermint oil should also not be used in women who breastfeed because it has been shown to suppress lactation.

Riboflavin is a vitamin found in sufficient amounts in the normal diet. The dose that seems to help alleviate headache and migraine symptoms is 200 times the access of recommended daily allowance.  Thus, it is not advised for use in pregnant and lactating women.8, 9 Other natural remedies for headache that are not recommended for pregnant and breastfeeding women include feverfew, 5-hydroxytryptophan (5-HTP), and willow bark.

Some types of Honey is believed to produce a healing effect when applied topically to wounds or burn sites.10, 11 Although safe for pregnant and breastfeeding women, honey must never be given orally to infants due to the risk of botulism.12

In conclusion, any products that are not FDA regulated, whether they are herbal or homeopathic, natural or supplemental, should be carefully researched by the individual mom before being consumed in pregnant and breastfeeding women for the safety of the women as well as the child.

In general,  the InfantRisk Center does not normally advise mothers as to the safety of herbal products.  While we get thousands of these questions,  in reality,  we, nor anyone else,  know if they are safe in pregnant and breastfeeding mothers.  Thus we suggest mothers use great caution in using any herbal products,  especially while they are pregnant and breastfeeding.   It always comes down to risk vs benefit.  The benefit of herbal remedies is highly questionable, the risks can be substantial,  and the benefits of breastfeeding are simply enormous.  

 

Adapted and expanded by Saneea Almas, MD and Thomas Hale, Ph.D. from an original article written by Laura Muscianese, MS1.

 

1.         FDA. Tips for Dietary Supplement Users. 2014, 2015.

2.         Achilles N, Mosges R. Nasal saline irrigations for the symptoms of acute and chronic rhinosinusitis. 2013;13(2):229-235

3.         Kessel J, King D, Spurling G. Saline nasal irrigation for acute upper respiratory tract infections. 2010

4.         Yakoot M, Salem A. Efficacy and safety of a multiherbal formula with vitamin C and zinc (Immumax) in the management of the common cold. 2011;4:45-51

5.         Wintergerst E, Maggini S, Hornig D. Imune-enhancing role of vitamin C and zinc and effect on clinical conditions. 2006;50(2):85-94

6.         Godfrey J, Sloane B, Smith D, Turco J, Mercer N, Godfrey N. Zinc gluconate and the common cold: a controlled clinical study. 1992;20:234-246

7.         Migliardi J, Armellino J, Freidman M, Gillings D, Beave W. Caffeine as an analgesic adjuvant in tension headache. 1994;56(5):576-586

8.         Boehnke C, Reuter U, Flach U, al e. High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care center. 2004;11:475-477

9.         Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis: A randomized controlled trial. 1998;50:466-470

10.      Cooper R, Molan P, Krishnamorthy L, Harding K. Manuka honey used to heal a recalcitrant surgical wound. 2001;20(758-9)

11.      Kwakman P, Akker JVd, Guclu A, al e. Medical-grade honey kills antibiotic-resistant bacteria in vitro and eradicates skin colonization. 2008;46:1677-1682

12.      Tanzi M, Gabay M. Association between honey consumption and infant botulism. 2002;22:1479-1483

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