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Pregnancy and Herbs

NEW REPORT IDENTIFIES LEVELS OF EVIDENCE FOR SAFETY, EFFICACY OF 60 HERBS
 
(August 24 2005) – PHOENIX, AZ – Malpractice rates for gynecologic physicians are among the highest in the profession. Now, for the first time, these doctors can obtain clearly presented data about the levels of evidence for some of the most commonly used herbs consumed during pregnancy and lactation.  
 
The Report
 
A soon to be released report, entitled Safety and Efficacy of Commonly Used Herbs During Pregnancy and Lactation, is the work of a team of Canadian researchers. The team is comprised of Jean Jacques Dugoua, ND, Department of Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, CN; Edward Mills, PHD, MSc., Ph.D. (Cand.), Department of Epidemiology and Biostatics, McMaster University, Ontario, CN; Dugald Seely, ND, MSc. (Cand.), Institute of Medical Science, University of Toronto, Toronto, CN; Dan Perri, MD, BscPharm, FRCP(C), Department of Clinical Pharmacology and Toxicology, University of Toronto, Toronto, CN; and Gideon Koren, MD, The Motherisk Program, Hospital for Sick Children, University of Toronto, Toronto, CN.
Dr. Dugoua will present his team’s findings at the 20th Annual Meeting and Convention of the American Association of Naturopathic Physicians (AANP) http://www.naturopathic.org/. The meeting is being held August 24-26, 2005 at the Arizona Biltmore Hotel, Phoenix, AZ.

Methodology
The researchers conducted their analysis in two phases:
Data Selection
The researchers searched seven databases for reports relating to 60 herbs, ten supplements and eight vitamins. The databases included AMED, CINAHL, Cochrane CENTRAL, Cochrane Library, MedLine, Natural Database, and Natural Standard. Each database was examined in duplicate for data from its inception through June 2004. Unpublished research and bibliographies were also included.
Assessment of the Levels of Evidence for Select Herbs, Vitamins and Supplements
Based on the data, a level of evidence was assigned to each herb, vitamin or supplement. Rankings were assigned to each item, in descending order:
LEVELS OF EVIDENCE FOR HERBS
A
Very Strong Scientific Evidence
Statistically significant evidence of benefit from one or more systematic reviews or meta-analysis.
B1
Strong Scientific Evidence
Statistically significant evidence of benefit from one or more properly conducted random control trials (RCTs).
B2
Good scientific evidence
Statistically significant evidence of benefit from one or more RCTs. The RCTs, however, are either of small sample size or have discrepancies in their methodologies.
C
Fair Scientific Evidence
Statistically significant evidence of benefit from one or more cohort studies or outcome studies.
D
Weak Scientific Evidence
Evidence from case series.
E
Theoretical and/or Clinical evidence
Evidence from case reports or expert opinion or laboratory studies.
F
Historical or traditional evidence
Historical or traditional evidence of use by medical professionals, herbologists, scientists or aboriginal groups.
LEVELS OF EVIDENCE FOR VITAMINS AND SUPPLEMEMENTS
1a
VERY STRONG SCIENTIFIC EVIDENCE
Statistically significant evidence from one or more systematic reviews or RCTs.
1b
Strong Scientific evidence
Statistically significant evidence from one or more cohort studies or control study.
1c
Good Scientific evidence
Evidence from one or more case series.
2
Fair Scientific evidence
Evidence based on case reports.
3
In vitro scientific evidence
Evidence based on scientific studies conducted on animals, insects or microorganisms or laboratory studies on human cells.
4
Theoretical evidence
Evidence based on scientific theory or expert opinion.
5
Unknown
No available information.

Highlights of the Results
The researchers identified the following:
 
LEVELS of EVIDENCE OF SAFE USE DURING PREGNANCY and lactation
Name
Use
Level of Evidence Rating
Cranberry
Used to treat urinary tract infection.
A
Echinacea
Used to treat upper respiratory tract infections.
A
Garlic
Reduces blood pressure, cholesterol and stomach /colorectal cancer prevention.
A
Ginger
Reduces/eliminates nausea during pregnancy.
A
Ginseng (Korean)
Diabetes type II, Improves memory, Potentiates against influenza and the common cold, Improves cognitive function.
B1
Ginseng (Siberian)
Coronary artery disease.
B1
Horse chestnut
Used to treat varicose veins.
A
Milk thistle
Used to support the liver.
A
Raspberry
Supports and nourishes the uterus.
B1
St. John’s Wort
Helps to reduce depression.
A
Turmeric
Reduces arthritic conditions; acts as an anti-inflammatory.
B1
Valerian
Used for sleep.
B1

LEVELS of EVIDENCE
 FOR CAUTIONARY USE  DURING PREGNANCY

Herbs
Name
Use/Contraindication
Level of Evidence Rating
Calamus
Weak evidence of use in UTI and digestive disorders
Cancerous to the liver.
3
Barberry
Used as an anti-microbial.
Can aggravate jaundice.
3
Foxglove
Contains digitalis.
May cause musculoskeletal malformations.
2
Goldenseal
Anti-microbial. Can aggravate jaundice in the newborn.
3
Juniper berries
Used to treat common cold.
Potential abortifacient.
3
Mother’s Cordial containing blue cohosh
Used to stimulate the uterus.
Can cause heart problems and lack of oxygen to organs in newborns.
3
Borage oil
Used to treat arthritis.
May be teratogenic and induce labour.
1a
Deadly nightshade
Used for irritable bowel syndrome, migraines, PMS.
Teratogenic.
2
Parsley
Used as an antioxidant.
Abortifacient.
1b
Pennyroyal
Abortifacient.
2
Oregon Grape root
Used as an anti-microbial for acute infection during pregnancy.
Can aggravate jaundice in the newborn.
3
 
Vitamins and Supplements
Vitamin A
Needed in pregnancy but not beyond 6,000 IU per day, as higher doses can be teratogenic.
1a
Vitamin D
Prevents against rickets.
Safe.
1a
Vitamin E
May prevent pre-eclampsia, decreases malformations.
1a
Vitamin K
Treats hemolytic disease of the newborn.
1a
Folic acid
Improves hemoglobin levels, prevents birth defects.
1a
B6
Reduces nausea of pregnancy.
Reduces dental decay during pregnancy.
Reduces malformations.
Improves oxygenation to baby.
1a
Fish oils
Reduces cholesterol, prevents heart disease, lowers blood pressure;
improves IQ in newborn; minimal risk.
1a
Probiotics
Treats diarrhea.
May reduce preterm babies.
1a
 
Additional Findings
The researchers also found that fish oils and probiotics were safe for use during pregnancy, and that the use of Vitamin A should not exceed 6,000 IU per day as it may be teratogenic at higher doses.

Conclusions
This is the first time that herbs used during pregnancy have been independently ranked according to the available evidence surrounding the safety and efficacy of these products. The researchers hope additional research will be conducted to enhance the clinician’s and patient’s understanding of the effects of consumption on pregnant women and their fetus.
 
The authors also urge that women not assume that herbs are safe simply because they are “natural.” They recommend all pregnant and lactating women consult a licensed health care professional before consuming any herb.
-end-
The American Association of Naturopathic Physicians (AANP) was founded in 1985 to provide alternative methods for healing human diseases and disorders than have been traditionally offered in the United States. Members of the AANP must have graduated from one of North America’s six accredited graduate schools of naturopathic medicine and served a clinical residency.
Editor’s Note: To schedule an interview with Dr. Dugoua,
please contact Donna Krupa at 703.527.7357 (office); 703.967.2751 (cell) or djkrupa1@aol.com.
For more information about naturopathic physicians, log on to http://www.naturopathic.org/