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Pregnancy and Naturopathy

Prenatal Vitamins

Prenatal vitamins are recommended for almost all pregnant women. But as many as 60% of pregnant and breastfeeding women also use alternative therapies, including natural medicines such as herbals, single vitamins and minerals, and other supplements.

These women use natural medicines for a variety of reasons. In many cases, the natural medicines are used for everyday non-pregnancy or non-lactation related conditions such as the common cold, headache, and general health.

But natural medicines are also often used specifically for pregnancy- and lactation-related conditions such as morning sickness or stimulating breast milk production.

Pregnant and lactating women often use these products on the advice of friends or family, rather than health professionals such as an obstetrician or gynecologist. In fact, physicians rarely recommend natural medicines (other than prenatal vitamins, of course) for their patients. Only about 8% of pregnant women who use natural medicines are doing so based on the advice of a physician, pharmacist, or other health professional.16017

However, other practitioners often recommend natural medicines for pregnant and lactating women. According to some surveys, 90% or more of nurse midwives report recommending alternative therapies for their patients, often including natural medicines.

Natural medicines are commonly used by patients specifically for pregnancy-related conditions. Morning sickness is one of the most common reasons pregnant women turn to natural medicines, but these products are used for a variety of other conditions as well.

Morning Sickness

Ginger is one of the best known natural medicines used for pregnancy-related nausea and vomiting…”morning sickness.” It’s also one of the best studied. Several small clinical trials show that taking a supplement of ginger 250 mg four times daily reduces pregnancy-related nausea and vomiting better than placebo.

Although ginger appears to be helpful for morning sickness, the safety of its use during pregnancy is not well established. Some research suggests that ginger could potentially affect fetal sex hormones. There is also a case report of spontaneous abortion during week 12 of pregnancy in a patient who used ginger for morning sickness. However, neither of these reports is a very reliable indicator of ginger’s safety during pregnancy.

Clinical research in pregnant women suggests that ginger can be used safely for morning sickness without harm to the fetus. The risk for major malformations in infants of women taking ginger does not appear to be higher than the baseline rate of 1% to 3%. As with any medication given during pregnancy, the potential benefit to risk must be weighed.

Pyridoxine (vitamin B6) is also commonly used for morning sickness. In fact, the American College of Obstetrics and Gynecology (ACOG) considers pyridoxine a first-line treatment.14446 Some clinical research shows that taking 25 mg every 8 hours for 72-96 hours significantly reduces pregnancy-related nausea and vomiting compared to placebo. Lower doses also help for nausea, but might not work as well for preventing vomiting. Doxylamine is often added when patients don’t respond to pyridoxine alone.

German chamomile and raspberry leaf are also tried for morning sickness, but there is no reliable evidence that they are effective for this use.

Additionally, the safety of German chamomile during pregnancy is not known. Raspberry leaf has been safely used during pregnancy around the time of delivery; however, the safety of raspberry leaf in the first trimester, when morning sickness typically occurs, is not known.

Peppermint oil or tea is also commonly tried for morning sickness. There is evidence that it can help for “soothing” the digestive tract and for upset stomach. But there is no reliable evidence that it works for pregnany-related nausea and vomiting. There is also no reliable information about the safety of peppermint during pregnancy.

Leg Cramps

Leg cramps can be a troubling problem for many pregnant women. One of the most common approaches to treating them is taking magnesium. But evidence is conflicting. Some clinical research shows that taking 120 mg in the morning and 240 mg in the evening seems to significantly reduce cramping. But other clinical research shows that taking 360 mg daily is not effective.

Calcium is also tried for leg cramps. Preliminary clinical research shows that taking elemental calcium 1 gram twice daily can reduce the occurrence of leg cramps in the second and third trimester.

Some people also try vitamin E. There is contradictory evidence about whether it works for nocturnal leg cramps; however, there is no reliable research that it is effective for pregnancy-related leg cramps.

Edema

Swelling in the hands, feet, and ankles is a common complaint of pregnant women; however, there are few treatment options.

Alternative System of Medicine: Reflexology is an alternative treatment modality that some women are trying for edema. Reflexology involves applying pressure to specific points on the feet, hands, and ears. It’s believed that applying pressure at these points will stimulate specific areas, tissues, or organs of the body resulting in improved outcomes. Preliminary research suggests that reflexology can improve feelings of well-being and reduce stress, tension, discomfort, and pain.

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Pre-eclampsia

Magnesium sulfate given intramuscularly or intravenously is considered the agent of choice for managing pre-eclampsia.

Calcium also seems to play a role in the development of pre-eclampsia. Clinical research shows that taking an elemental calcium 1-2 grams daily decreases the risk of pregnancy-related hypertension and pre-eclampsia by about 50% compared to placebo. The effect seems to be greatest in high-risk women and women with low calcium levels. The benefit of calcium in women with normal calcium concentrations is not clear.

Advise all pregnant and lactating women to ensure that they are taking the recommended amount of calcium, which is 1000 mg/day for women 19-50 years old…1300 mg/day for women under 19 years. Explain that not all prenatal vitamins contain this amount. Some do, but others contain much less.

It is theorized that oxidative stress might play a role in the development of pre-eclampsia. As a result there has been a lot of interest in using antioxidant supplements to prevent pre-eclampsia.

A combination of vitamin C and E has been used in several clinical trials. Some clinical research shows that the combination might help prevent pre-eclampsia in high-risk patients. However, other research has not been positive. An analysis of these antioxidant studies shows that, overall, taking vitamin C and vitamin E does NOT significantly reduce the risk of developing pre-eclampsia.

Labor Facilitation and Induction

Naturopaths commonly use a variety of natural medicines to help facilitate or induce labor.

Raspberry leaf is one of the most common natural medicines used for this purpose. Raspberry leaf might have some effects on uterine smooth muscle. Low doses are thought to stimulate contractions, whereas higher doses are thought to have spasmolytic effects. Very little clinical research has evaluated the use of raspberry leaf for facilitating or inducing labor. One clinical trial shows that raspberry leaf does not reduce time in labor or decrease the need for analgesics in the perinatal time.

Black cohosh is used by as many as 45% of nurse midwives to induce labor. However, there is no reliable evidence that it is safe or effective for this use.

Black cohosh is also often used to induce labor. Although the name sounds similar, it is not related to black cohosh. Blue cohosh does have uterine stimulate activity and might stimulate labor; however, the effectiveness of blue cohosh for this use has not been evaluated in clinical research.

Blue cohosh is considered UNSAFE to use during pregnancy. Several blue cohosh constituents are potentially teratogenic. Use of blue cohosh near term can cause life-threatening toxicity in the newborn infant. Blue cohosh should be avoided at all stages of pregnancy.

Castor oil is routinely used by midwives for stimulating labor. Castor oil is thought to cause hyperemia in the gastrointestinal tract, resulting in a reflex stimulation of the uterus. It might also increase prostaglandin production, resulting in uterine stimulation. Some clinical research shows that giving a dose of 60 mL of castor oil results in labor initiation within 24 hours in about 50% or more women who are at term. Although there is not much data available regarding safety, there is no evidence suggesting harm to the fetus or mother.

Advise patients that, if they are not at term, they should not take castor oil, blue cohosh, or any other natural medicine that might have uterine-stimulating effects. Taking these products could potentially cause premature labor.

Labor Pain

Motherwort is sometimes used by midwives for labor pain. It’s thought to have mild sedative and spasmolytic effects. It might also increase uterine tone. However, there is no reliable evidence that it is safe or effective for reducing labor pain.

Post-partum Hemorrhage

Shepherd’s purse is thought to have antihemorrhagic properties. Therefore, some midwives recommend it for post-partum bleeding. However, there is no reliable information about effectiveness of shepherd’s purse for this use.

Most natural medicines that women use related to lactation are those that are thought to stimulate or increase milk production. Agents that increase milk production are referred to as “galactagogues.”

There are many purported natural galactagogues.. alfalfa, blessed thistle, caraway, chasteberry, fennel, goat’s rue, and others. But none of these have reliable clinical evidence that they work for this purpose.

Fenugreek is especially popular for this use. Many swear by it for increasing milk production, but there is no reliable research demonstrating this effect. Fenugreek should not be used during pregnancy because it can stimulate the uterus. The safety of fenugreek after pregnancy and during breastfeeding is not known, however, there are no known reports of adverse events in the nursing baby. Taking high doses of fenugreek can cause body odor that smells like maple syrup. This can occur in the mother as well as the nursing infant.

Breast Engorgement

For breast engorgement, some women use green cabbage leaves. Chilled green cabbage leaves provide relief similar to applying chilled gel packs.

A cream containing cabbage leaf extract has also been tried; however, it doesn’t reduce symptoms better than placebo.

Caffeine Use During Pregnancy and Lactation

The safety of using caffeinated products, and how much is acceptable, is a common question pregnant and breastfeeding women have. Many women drink coffee, tea, or caffeinated soda on a regular basis, and therefore experience some caffeine-related dependence. When they become pregnant, discontinuing or cutting back caffeine intake substantially can be a challenge.

Caffeine crosses the placenta, but it’s not considered a teratogen. Fetal blood and tissue levels are similar to maternal concentrations.
The use of caffeine during pregnancy is controversial; however, moderate consumption of less than 200 mg/day has not been associated with clinically important adverse fetal effects.

Consuming over 200 mg/day is associated with a significant increased risk of miscarriage.
High maternal doses of caffeine throughout pregnancy have also resulted in symptoms of caffeine withdrawal in newborn infants. Advise mothers to keep caffeine consumption below 200 mg/day. This is similar to the amount of caffeine in about 2 cups of coffee or tea.

There is less concern about the mother consuming caffeine during breastfeeding, but caution is still warranted. The breast milk concentration of caffeine is approximately 50% of the mother’s serum concentration. Drinking 1-2 caffeine-containing beverages per day during lactation does not produce unacceptable levels of caffeine in breast milk.
Consuming large amounts of caffeine can cause wakefulness or irritability in breastfed infants. It can also cause feeding intolerance and gastrointestinal irritation in infants.6026

Remind pregnant women that caffeine can show up in many unexpected places. Supplements containing green tea extracts, guarana, cola nut, and mat can contain significant amounts of caffeine.

*Note: Caffeine content can vary considerably depending on how coffee, tea, or other beverages are prepared.

The Bottom Line

Our understanding of the safety of conventional drugs during pregnancy and lactation is very limited due to a lack of research done in this area. For natural medicines, the amount of research is even less. As a result, there is a major shortage of reliable information about the effects of these products in pregnant or lactating women.

Despite the general lack of information in this area, there are a few natural medicines that are worth considering. For morning sickness, pyridoxine and possibly ginger are worth a try. For leg cramps, magnesium can be effective for many women.

Antioxidants should not be recommended for preventing pre-eclampsia, but women should be advised to ensure adequate intake of calcium, at least 1000 mg/day.

For facilitating or inducing labor, castor oil seems to work for many women without evidence of adverse events.

Although many natural medicines are used for stimulating milk production, evidence supporting these uses is lacking. However, chilled cabbage leaves seem to be beneficial for relieving breast engorgement.

As with conventional drugs, careful consideration of the risk vs. benefit should be done before recommending natural medicines for pregnant or lactating women. Products without clear benefit and safety should be avoided.

For more information on specific programs to address your blood pressure, contact Dan Prater, ND on 219.613.1161 or via email.

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