BACKGROUND AND PURPOSE:

• Herbal medicinal product use is common in pregnancy and the postpartum period
• Evidence for safety and herb-drug interactions is limited
• Muñoz Balbontín et al. (Obstetrics & Gynecology, 2019) assessed the incidence of adverse events and herb-drug interactions

METHODS:

• Systematic review
• Inclusion criteria
  • Human studies focusing on pregnant or postnatal women
  • Study type: RCTs | Nonrandomized comparative studies | Meta-analysis | Observational studies | Mixed methodology studies| Case reports | Case series
  • ≥1 of the following
    • Adverse events, including malformations | Herb-drug interactions
• Exclusion criteria
  • Sudy type: Abstracts | Preliminary reports | Pilot studies | Correspondence articles | Studies focusing on homeopathic treatments or other alternative treatments | Low-quality case reports
• 2 independent reviewers

RESULTS:

• 74 studies included
  • 47 herbal medicinal products
  • 1,067,071 women
• Almond oil (for stretch marks) was associated with preterm birth
  • Odds ratio (OR) 2.09 (95% CI, 1.07–4.08)
• Oral raspberry leaf was associated with cesarean delivery
  • adjusted OR 3.47 (95% CI, 1.45–8.28)
• Heavy licorice use (>500 mg/wk throughout pregnancy) was associated with
  • Preterm birth adjusted OR 2.5 (95% CI, 1.1–5.1)
  • Early preterm birth (<34 wks) adjusted OR 3.07 (95% CI, 1.17–8.05)
• Mwanaphepo (African herbal medicine), used for induction, was associated with
  • Maternal morbidity (emergency cesarean, PROM, postnatal morbidity, any delivery problem)
    • Adjusted OR 1.28 (95% CI, 1.09–1.50)
  • Neonatal death/ morbidity (death, meconium, LBW, preterm birth or any neonatal morbidity)
    • Adjusted OR 1.22 (95% CI, 1.06–1.40)
• Fourteen studies reported absence of adverse events
• Herb–drug interactions: Reported by 4 studies but without subsequent adverse events

CONCLUSION:

• The authors provide an extensive literature review including evidence of adverse maternal and newborn outcomes and herb-drug interactions
• The authors state that

…herbal medicinal products should not be recommended during pregnancy until robust evidence of safety is available.

Learn More – Primary Sources:

Herbal Medicinal Product Use During Pregnancy and the Postnatal Period

Related ObG Topics:

Herb-drug Interactions – How Severe are Potential Adverse Drug Reactions?

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