THE DETAILS: Because the extent of herbal use during pregnancy wasn't previously established, researchers with the U.S. Centers for Disease Control and Prevention used data from The National Birth Defects Prevention Study, which included more than 4,200 women who delivered babies without major birth defects between 1998 and 2004. Analyzing the data, researchers found that about 10 percent of the women used herbs right before and during pregnancy. The most commonly used supplements included ephedra (now banned in the U.S.), ginger, and chamomile. The study authors conclude that nearly 400,000 U.S. births involve prenatal exposure to herbal products.
WHAT IT MEANS: There are very different camps of thought when it comes to herbs and supplements during pregnancy. Smack in the middle of arguments by mainstream-medicine and alternative-medicine practitioners sit integrative-medicine physicians like Julie McKee, MD, distinguished professor of medicine at The University of Texas Medical Branch in Galveston. "Many of the discomforts of pregnancy can be handled with herbs and lifestyle so we don't have to resort to medications," she says. If they don't work, she says, then modern medicine may be queued up.
Here's what you need to know about herbs and supplements during pregnancy:
• Start off without. "As a general rule, women should be off of their herbs and medication when they get pregnant, or on as few things as they need to be on," explains Dr. McKee. Likewise if you're trying to or could become pregnant. Fetal development begins right after conception, before women even know they're pregnant. Once you know you're pregnant, you can work with an integrated-medicine expert or naturopath specializing in pregnancy to develop a safe supplement plan.
• Know what you're dealing with. While it's certainly possible to grow your own herbs, many people turn to herbal products instead. If you go this route, it's important to understand that the U.S. Food and Drug Administration (FDA) does not regulate supplements; they only step in and take action when it's clear there's a danger. Just like some restaurants have better-quality food using higher-quality ingredients, some herbal-supplement companies produce a better product. Your best bet for safety is to look for ConsumerLabs.com–certified products, or those bearing either the U.S. Pharmacopoeia’s USP Verified Dietary Supplement, or NSF Certified Dietary Supplement seals. These third-party certifications verify that vitamins and supplements are free of contaminants, that they deliver what their labels claim, and that their manufacturers comply with the FDA’s good-manufacturing practices. Phthalates, harmful plastic-softening and binding chemicals used in fragranced products, vinyl, and makeup, are also sometimes used in pills. Because these chemicals are linked to health problems, call the supplement manufacturer to find out if they are used in the product. If they are, buy from a different company.
• Know the no-nos. There are many herbs and supplements that benefit pregnant women, but science has also shown us that many should not be used during pregnancy at all.
1. Pennyroyal is a good plant to use in the garden to repel bugs, but because it can induce abortion, pregnant women should stay away from it.
2. Saw palmetto is usually used by men, but pregnant women should be sure to avoid it because it induces testosterone activity.
3. Black cohosh (used for menstrual problems) and blue cohosh (used for arthritis) can induce uterine cramps and labor, and can cause premature birth.
4. Red yeast rice can lower your cholesterol, but because it boasts some of the same properties (minus the side effects) of the pharmaceutical drug Lipitor, pregnant women should stay off of it. Lipitor has been shown to cause problems during pregnancy.
5. Vitex, also an herb known as chasteberry, is used by a lot of women for PMS symptoms, and by some for treatment of infertility. Its potential effects on hormones make it a no-go for pregnant women.
6. Red clover. This herb is commonly used during menopause to deal with hot flashes, but it can have estrogenic effects and should be avoided during pregnancy. Note: Tea tree oil and lavender have also been shown to have mild estrogenic effects, but Dr. McKee says occasional use for aromatherapy or in natural bath products shouldn't be a problem, as long as you're not ingesting them. Do not ingest any pure essential oils, and never apply them undiluted to your skin.
7. While these aren't supplements, Dr. McKee also instructs her patients to avoid dying their hair and using other everyday products containing harmful chemcials. "We absorb about 60 percent of the chemicals we use topically—dyes, soaps, shampoos, lotions," she says. "I would be really careful about what even a nonpregnant person should be washing with," says Dr. McKee. An easy way to avoid some harmful chemicals is to stop using personal-care products, laundry products, and cleaners containing synhthetic fragrances.
• Cure morning sickness. It's been widely studied and confirmed that ginger is a great natural remedy for morning sickness. While most of the studies used ginger capsules, which you can commonly find a health food and supplement store, Dr. McKee says you take it by cooking with fresh ginger or using candied ginger in chamomile tea. Dr. McKee also notes that two studies have found that supplementing with 10 to 25 milligrams of vitamin B6 daily significantly reduces the severity of morning sickness, and she has had great success using this with her patients.
Acupuncture also works well for alleviating morning sickness, says Dr. McKee. But if you can't stand the thought of needles, try performing acupressure on yourself. With your palm facing up, use the thumb of your other hand to push down on the center of your wrist, about an inch below the base of your hand; hold for about 30 seconds. Try doing this about a half hour before meals.
• Make a pregnancy toning tea. Midwives believe that red raspberry leaf, available as loose leaves in many health food stores and some grocery stores, can tone the uterus, prepping you for an easier delivery. You can steep the leaves to make a tea, or spice things up, combining it with stinging nettle tea. "It tastes delicious, and people think of it as a uterine tonic," says Dr. McKee. "It is absolutely safe."
The herb also boasts anti-inflammatory properties. Just make sure you buy freeze-dried raspberry leaves. Dr. McKee suggests drinking one cup of tea a day in the first trimester, two a day in the second, and three cups a day in the third trimester. Drink it hot or make it as iced tea: Mix ¼ cup red raspberry leaves with ¼ cup freeze-dried nettle in a quart of boiling water for several minutes, strain, and refrigerate.
If that's not your cup of tea, Dr. McKee says that dandelion tea is also considered safe in pregnancy for an extra boost of healthy antioxidants. You can also sprinkle dandelion greens on your salad for a nutrient boost.
• Use alfalfa for a vitamin K boost. For people who are not allergic to them, alfalfa capsules can be beneficial, particularly for women giving birth out of the hospital. In a hospital, a newborn is injected with vitamin K right after delivery to prevent a rare condition that causes brain hemorrhaging. If you are having a natural birth, your baby won't have that injection, but by taking daily alfalfa supplements, the baby's vitamin K blood levels will be higher. This supplementation is often recommended toward the end of pregnancy, but as with all supplements and medicines, consult with your doctor to see what's right for you.
• Crank up your calcium levels. Because very few people get enough calcium in their diets, Dr. McKee recommends that pregnant and lactating women supplement with 1,200 to 1,500 milligrams of calcium citrate a day. The trick is to split that amount up into three doses a day, or your body won't be able to absorb it all. This helps provide protection from developing preeclampsia, a life-threatening condition in which a pregnant woman develops high blood pressure.
• Find out your vitamin D level. Many studies are finding that not getting enough vitamin D can cause all sorts of physical and mental-health problems. During spring and summer months, our skin makes vitamin D when we're in the sun. But during the winter months in many parts of the country, the UV-ray angle isn't sufficient to spur this production. Plus, we're wearing so much sunscreen we're blocking the production during summer months, too. Ask your doctor for a simple blood test to determine your current vitamin D level, and supplement with vitamin D3 accordingly. "I wouldn't want to take huge levels, but up to 1,000 IU a day would be perfectly safe," says Dr. McKee.
• Factor in omega-3. Just a few fish, such as wild-caught Alaskan salmon, sardines, and mackerel, are low in contaminants like mercury, arsenic, and PCBs, and high in heart-healthy omega-3s that are vital to brain development. Because of that, Dr. McKee suggests her patients choose third-party-certified fish oil (you can get it in a bottle in liquid form if you're skeptical about what capsules are made out of). You can also buy flaxseeds and grind them up right before using them, for a plant-based omega-3 boost. Just make sure your flax is stored in the refrigerator to keep the oils potent.
• Don't drink caffeine, but if you must… Studies have found that drinking just 1½ to 2 cups of coffee a day during pregnancy can raise the risk of miscarriage or low birth weight. While it's best to cut out caffeine altogether, Dr. McKee tells her patients that if they must have a little caffeine, substitute a cup of green tea for the coffee.
• Figure in enough folic acid and the right multi. Dr. McKee suggests all women take a prenatal vitamin (preferably ones derived from whole foods) but stay away from multivitamins that list massive doses of vitamins and nutrients. (You don' need to see several thousand percent of daily recommended allowance of a vitamin or mineral—in fact, it could be harmful.) If you're in childbearing age or you're pregnant, Dr. McKee recommends getting 800 micrograms of folic acid a day. Prenatal multivitamins often have this amount, but check to make sure. Dr. McKee suggests avoiding multivitamins containing iron—you don't need it unless you're anemic. Multivitamins with herbs already mixed in should be avoided, too, because it's hard to ensure quality control with so many ingredients mixed together.