Herbal medicines. (Drugs, Pregnancy and Lactation).

Because half of all pregnancies are unplanned, many women take herbal medicines in the first trimester before they know they are pregnant; others knowingly take these agents throughout pregnancy A common misconception is that herbals are safe because they're natural, leading some patients to use these products without first consulting their physician. For their part, doctors often don't ask patients whether they are taking herbals.

My colleagues and I in the Motherisk Program have made it one of our research priorities to investigate the safety of herbal medicines used during pregnancy in controlled, prospective studies. We have published a study on echinacea, completed a study on ginger, and have launched a study of St. John's wort.

* Echinacea. This is one of the most popular herbals, used mostly for treating and preventing upper respiratory tract infections (Urns). In a recently reported survey of 734 pregnant women at one medical center, 7% reported using herbal preparations; echinacea, St. John's wort, and ephedra were the most commonly used (Anesth. Analg. 94[3]:690-93, 2002).

In our study we enrolled 206 women who called Motherisk with questions concerning gestational use of echinacea, including 112 who had used it during the first trimester and 17 who used it during all three trimesters. There were no significant differences in the rates of major or minor malformations or spontaneous or therapeutic abortions among these women, compared with two control groups of pregnant women. One control group had taken nonteratogenic drugs for a Urn that were known to be safe during pregnancy; the other group was a general control group of pregnant women (Arch. Intern. Med. 160[20]:314143, 2000).

Like other natural compounds, echinacea is prepared in different ways by different manufacturers, so consistency in dosing is not assured. Herbals are not regulated as medications by the Food and Drug Administration so there are no bioavailability studies to show how much is absorbed.

While there is not much experience with this herbal, our study provides reassuring information that echinacea, as available in the United States and Canadian markets, does not cause any discernible malformations. But there are still not enough data to definitively rule out any risk associated with echinacea use in pregnancy

* Ginger. Ginger is frequently used for morning sickness and other forms of nausea and ...