Conditions:
Pregnancy and Breast-Feeding Support

Principal Proposed Treatments
  • Nausea and Vomiting, Vitamin B6, Ginger, Acupressure/Acupuncture, Varicose Veins, Oxerutins, Citrus Bioflavonoids, Horse Chestnut, Gotu Kola, Hemorrhoids, Oxerutins, Citrus Bioflavonoids, Prevention of Hypertension and Preeclampsia, Calcium, Vitamin C, Vitamin E, Constipation, Psyllium Husks, Anemia, Iron, Prevention of Neural Tube Defects, Folate, Assisting Childbirth, Castor Bean Oil
Other Proposed Treatments
  • Nausea, Vitamin K, Vitamin C, Red Raspberry, Preeclampsia and Hypertension (Prevention), Zinc, Folate, Fish Oil, Preeclampsia and Hypertension (Treatment), Magnesium, Calcium, Evening Primrose Oil, Constipation, Flaxseed, Dandelion Root, Glucomannan and Lactulose, Prevention of Neural Tube Defects, Zinc, Assisting Childbirth, Red Raspberry, Leg Cramps, Magnesium, Calcium, Vitamin B1, Vitamin B6, Gingivitis, Folate, Diabetes in Pregnancy, Chromium, Vitamin B6, Jaundice of Pregnancy, SAMe (S-Adenosylmethionine), Prevention of Prematurity, Fish Oil, Calcium, Zinc, Magnesium, Iron, Prevention of Low Birth Weight, Calcium, Zinc, Magnesium, Folate, Fish Oil, Vitamin D, B Vitamins, Iron, Breast-Feeding (Milk Production), Milk Thistle, Breast-Feeding (Weaning), Sage
Apparently Ineffective Treatments
  • Prevention of Preeclampsia, Magnesium, Breast Engorgement, Cabbage Leaves
Treatments to Avoid in Pregnancy and Lactation
  • Many natural treatments are unsafe in pregnancy and/or nursing. See the discussion at end of the article.

Pregnancy is a time of amazing transitions. Body systems that once sustained a single human now support two. Organs, blood vessels, body chemistry, even the solid supporting structures of a woman's body all go through changes; in the meantime, the fetus's body grows from a tiny bundle of cells to a full-sized baby.

It's no wonder that women feel the desire for remedies to help with these transitions. From ancient times, women have tried herbs and other natural treatments to ease discomforts or assist with pregnancy, childbirth, and breast-feeding. However, pregnancy is also a time when the potential risk of any treatment rises dramatically. Seemingly benign medications—even natural ones—have been found to cause birth defects or increase the risk of complications. Some traditional remedies, such as blue cohosh for labor stimulation, must be discarded for safety reasons.

Thorough study is needed before any treatment can be considered absolutely safe in pregnancy—and in many cases, this research has not yet been completed. It's important to talk with your doctor before deciding to use any treatment, whether it be natural or conventional.

Principal Proposed Treatments for Pregnancy and Breast-Feeding Support

Please note thatthe safety of the following treatments has not been confirmed, except for nutrients such as vitamins and minerals, where appropriate dosages for pregnancy have been established.

Nausea and Vomiting

Nausea afflicts the majority of women during the first trimester of pregnancy. Two natural therapies, vitamin B₆ and ginger, have some evidence supporting their use. In addition, acupuncture/acupressure may be helpful.

Vitamin B₆

Vitamin B₆ supplements have been recommended for years to treat morning sickness. In 1995, a large double-blind study validated this use.¹ A total of 342 pregnant women were given placebo or 30 mg of vitamin B₆ daily. Participants then graded their symptoms by noting the severity of their nausea and recording the number of vomiting episodes. The women in the B₆ group experienced significantly less nausea than the placebo group, suggesting that regular use of B₆ can be helpful for morning sickness. However, despite the benefits for nausea, vomiting episodes were not significantly reduced.

Ginger

Ginger is a nausea remedy recommended by many physicians as well as by traditional healers from a number of countries. A double-blind placebo-controlled trial of 70 pregnant women evaluated the effectiveness of ginger for morning sickness.² Participants received either placebo or 250 mg of powdered ginger 3 times daily for a period of 4 days. The results showed that ginger significantly reduced nausea and vomiting. No significant side effects occurred.

Benefits were also seen in a trial of 27 women.³

Note: Ginger has not been proven safe for pregnant women.

For dosage and safety information, see the article on nausea.

Acupressure/Acupuncture

Several studies have evaluated treatment on a single acupuncture point, P6, traditionally thought to be effective for relief of nausea and vomiting. This point is located on the inside of the forearm, about 2 inches above the wrist crease. Most trials have investigated the effects of pressure on this point (acupressure) rather than needling. The most common means used involves a wristband with a pearl-sized bead in it situated over P6. It exerts pressure by itself while it is worn, and the user can also press on it for extra stimulation.

A recent double-blind placebo-controlled study of 97 women found evidence that wristband acupressure may help relieve symptoms of morning sickness.⁴ Participants wore a either real wristband or a phony one that appeared identical. Both real and fake acupressure caused noticeable improvement in more than half of the participants. However, women using the real wristband showed better effects in terms of the duration of nausea. The intensity of the nausea was not significantly different between groups.

These results are consistent with previous studies, such as a double-blind placebo-controlled crossover trial of 60 women in early pregnancy that used wristband acupressure.⁵ The results showed a 60% reduction in symptoms in the acupressure group, compared to only a 30% reduction in the placebo group. Interestingly, wearing a band on one wrist was no more effective than wearing a band on both. Benefits were also seen in a small crossover trial.⁶

Furthermore, a double-blind placebo-controlled study of 60 pregnant women found that 10 minutes of self-applied manual acupressure on either P6 or a sham point 4 times daily improved symptoms.⁷ Improvement was also seen in a single-blind crossover study of acupuncture in 33 women.⁸

Other Herbs and Supplements for Nausea

A combination of vitamin K (at a dose of 5 mg—enormously higher than nutritional needs), and vitamin C (25 mg) is sometimes recommended for morning sickness, based on an uncontrolled study conducted in the 1950s.⁹Red raspberry is also frequently recommended, but there is no evidence that it works.¹⁰

Varicose Veins

Increased pressure from the expanding abdomen and other factors can lead to pooling of fluid in the legs (venous insufficiency) and varicose veins. In Europe, a variety of herbal treatments are used for this condition in pregnancy, including oxerutins and related citrus bioflavonoids; an extract of horse chestnut called escin; and gotu kola.

Among this plethora of treatments, only one double-blind trial has been performed on pregnant women with varicose veins.¹¹ In this study of 69 women, researchers found oxerutins more effective than placebo. Good evidence from other double-blind studies of non-pregnant people supports the effectiveness of oxerutins,^12,13 escin,^14–17 gotu kola,^18,19 and the citrus bioflavonoid combination of diosmin/hesperidin²⁰ for venous insufficiency and varicose veins.

Safety in pregnancy has been not been established for any of these treatments. However, pregnant women have participated in clinical trials of oxerutins,^21,22 diosmin/hesperidin,²³ and escin.²⁴

For more information, see the article on varicose veins.

Hemorrhoids

Hemorrhoids are actually varicose veins in or around the anus. Oxerutins and citrus bioflavonoids have been studied for hemorrhoids during pregnancy.^25,26

A double-blind study enrolling 97 pregnant women found oxerutins (1,000 mg daily) significantly better than placebo at reducing the pain, bleeding, and inflammation of hemorrhoids.²⁷ Evidence for citrus bioflavonoids is limited to one open trial.²⁸ Other natural treatments for varicose veins are often recommended for hemorrhoids as well, although research on their use for this condition in pregnancy is lacking.

For more information, see the article on hemorrhoids.

Prevention and Treatment of Pregnancy-Related Hypertension and Preeclampsia

Pregnant women occasionally experience an increase in blood pressure known as gestational hypertension or pregnancy-induced hypertension (PIH). In a more severe condition called preeclampsia, a rise in blood pressure is accompanied by protein in the urine and sometimes by sudden weight gain, swelling in the face or hands, and other symptoms. When left untreated, preeclampsia can lead to seizures (called eclampsia) or liver, kidney, or bleeding problems in the mother, and distress or growth retardation in the fetus. Unless preeclampsia is mild, doctors usually seek to deliver the baby early.

Both calcium and antioxidant vitamins appear to hold promise for preventing preeclampsia or PIH.

Calcium

Although the largest study does not agree, analysis of the results of nine high-quality studies conducted to date suggests that calcium may have a role in preventing PIH and preeclampsia, at least in some groups of women.^29,30

Calcium appears to offer the additional benefit of reducing blood levels of lead during pregnancy.³¹

What Is the Scientific Evidence for Calcium?   A meta-analysis of 10 studies of calcium supplementation in pregnancy, involving a total of more than 6,000 women, found that calcium slightly reduced the risk of preeclampsia and hypertension, particularly in two groups of women: those at high risk for hypertension and/or those with low calcium intake.³² However, the largest single study in the meta-analysis found no benefits.³³ In this double-blind study, researchers gave either 2 g of calcium or placebo daily to 4,589 women from weeks 13 to 21 of their pregnancy onward. In the end, researchers found no significant decreases in rates of hypertension or preeclampsia, not even when they looked specifically at women whose daily calcium consumption mirrored that of developing countries.

The meta-analysis included this study in its calculations, but still found that, statistically, calcium seemed to be helpful. The bottom line: Calcium may be of some benefit for those pregnant women at high risk for hypertension or deficient in calcium. However, for well-nourished, low-risk women, effects are likely to be minimal or nil.

For more information, including dosage and safety issues, see the full calcium article.

Antioxidant Vitamins

An exciting preliminary study of 283 women raises hopes that vitamin C and vitamin E might help prevent preeclampsia in women at increased risk for the disorder.³⁹ In this double-blind study, high-risk women took either placebo or a combination of 1,000 mg vitamin C and 400 IU vitamin E daily throughout the second half of their pregnancies. Those whom researchers determined to be low-risk before 24 weeks, according to a Doppler ultrasound test, were withdrawn from the trial. In the final analysis, 17% of women in the placebo group developed preeclampsia, compared to only 8% of women in the treatment group—a significant difference.

An earlier double-blind study found a combination of vitamin C, vitamin E, and the drug allopurinol was no more effective than placebo.⁴⁰ However, this trial studied women who were already severely preeclamptic. Researchers speculated that starting sooner might have made the treatment more effective.

Other Natural Preventives or Treatments for Hypertension or Preeclampsia

Evidence is conflicting or weak for other possible preventives for preeclampsia or PIH, despite a number of large double-blind studies. Substances studied in controlled trials include zinc,^41,42,43folate,⁴⁴ and fish oil or one of its components.^45–48 Two double-blind trials, one of 400 pregnant women and the other of 568, found no evidence that magnesium supplements could significantly prevent preeclampsia.^49,50

Other studies have looked at possible treatments for PIH or preeclampsia once these conditions have begun, but the results have not been impressive. One double-blind trial of 58 women compared intravenous and oral magnesium to placebo for established PIH. Researchers found that magnesium decreased blood pressure, but apparently not enough to reduce the need for prescribed blood pressure medications.⁵¹ In other double-blind studies, neither evening primrose oil nor calcium supplements were more effective than placebo in treating established preeclampsia among 47 and 75 women, respectively.^52,53

Constipation

The seed husks of the psyllium plant may be helpful in controlling constipation. This treatment is commonly recommended by physicians when increased fluids and dietary fiber don't work. Flaxseed has also been tried for constipation in pregnancy. However, flaxseed contains estrogen-like substances that might pose hazards to the fetus. One study found an effect on reproductive organs and function in baby rats whose mothers ate large amounts of flaxseed during pregnancy.⁵⁴

Other natural remedies with minimal or no evidence include dandelion root⁵⁵ and a combination of glucomannan and lactulose, which was helpful to pregnant women in an uncontrolled study.⁵⁶

Note: Avoid use of powerful laxatives, including natural remedies such as buckthorn, cascara, rhubarb, castor bean oil, and senna, as these can induce uterine contractions.⁵⁷ (See Stimulation of Labor, below.) The traditional remedy yellow dock, though milder, might warrant similar caution.^58,59

Anemia

Iron supplements can be key in treating anemia in pregnancy, but may not be good for you or the baby if you are not anemic.^60,61,62 If you are not anemic, talk to your doctor before taking iron supplements.

Prevention of Neural Tube Defects

Folate supplements can help prevent a serious and common type of birth defect known as neural tube defects (NTDs), whereas there is little evidence that any other supplement has the same effect. Impressive results from a number of double-blind studies^63,64,65 persuaded the U.S. Food and Drug Administration to require that many grain products be fortified with folate.⁶⁶

One preliminary study of 859 babies suggests that zinc may help prevent NTDs as well, but evidence so far is weak.⁶⁷

Assisting Childbirth

Early research suggests that castor bean oil may help stimulate labor. Other traditional remedies such as black cohosh and red raspberry have not yet been found to be effective.

Castor bean oil was noted by the ancient Egyptians to stimulate labor, and is still used by some conventional physicians and midwives to induce contractions—for example, if labor does not occur spontaneously after the waters have broken. A recent controlled trial in 100 pregnant women compared oral castor oil to no treatment, finding that 57.7% of those given castor oil began labor within 24 hours, compared to only 4.2% of those without treatment.⁶⁸ Other preliminary studies also suggest that castor oil may help.^69,70 Unfortunately, castor oil is a strong laxative, and diarrhea is a nearly universal effect—not a particularly pleasant experience during childbirth.

In addition, considering how common this treatment is, research on its safety and effectiveness is surprisingly scant. One case of a potentially fatal complication linked to use of castor oil has been reported, though some have questioned whether the castor oil was responsible.^71,72 In addition, an observational study of South African women found that those self-treating with castor oil and/or other traditional herbs had a higher incidence of meconium (fetal feces) in the amniotic fluid, a sign of fetal distress.⁷³

Other remedies commonly (but perhaps inappropriately) used by midwives include evening primrose oil and the herbs red raspberry leaf, blue cohosh, and black cohosh.⁷⁴ However, there is no real evidence that any of these treatments work, and blue cohosh, at least, is clearly dangerous.

One double-blind placebo-controlled trial evaluated the effects of red raspberry in 192 pregnant women.⁷⁵ Treatment (placebo or 2.4 g of raspberry leaf daily) began at the 32nd week of pregnancy and was continued until the onset of labor. The results failed to show any statistically meaningful differences between the groups. Red raspberry did not significantly shorten labor, reduce pain, or prevent complications.

Blue cohosh is a toxic herb and should not be used. One published case report documents profound heart failure in a baby born to a mother who used blue cohosh to induce labor.⁷⁶ Severe medical consequences were also seen in a child whose mother took both black and blue cohosh.⁷⁷ None of these treatments has been established as safe in pregnancy, and none should be used without the close supervision of your health practitioner.

Other Proposed Treatments for Pregnancy and Breast-Feeding Support

Other natural remedies have been recommended for treating discomforts and complications of pregnancy, decreasing risks to the baby, or assisting with breast-feeding or weaning.

Leg Cramps

Early research suggests that magnesium may benefit pregnant women with leg cramps, but less evidence supports the use of calcium, vitamin B₁, and vitamin B₆ for this condition.

A double-blind study of 73 women with this painful symptom found that oral magnesium was significantly more effective than placebo in decreasing their distress.⁷⁸

Calcium has also been studied for this problem, but research so far gives little indication that it helps.^79,80,81 A combination of vitamins B₁ and B₆ has also been suggested for leg cramps, but evidence is minimal.⁸²

Gingivitis

A lesser-known problem in pregnancy is an increased tendency toward swollen or bleeding gums—a condition known as gingivitis. Two small double-blind studies suggest that folate mouthwash may help gingivitis in pregnancy. However, folate supplements do not appear to be especially effective against gingivitis.^83,84

Diabetes in Pregnancy

One placebo-controlled study of 30 women suggests that chromium may be useful for gestational diabetes, the term for diabetes that occurs during pregnancy.⁸⁵Vitamin B₆ has also been proposed for this condition, but evidence in support of its effectiveness is minimal.⁸⁶

Jaundice of Pregnancy

A condition called intrahepatic cholestasis may occur during pregnancy, causing jaundice and other complications. Preliminary evidence suggests that the supplement SAMe might be helpful.^87,88

Prevention of Prematurity

Despite numerous studies, there is no definitive evidence that fish oil, calcium, zinc, magnesium, or iron can help prevent premature births. Folate has also failed to prove effective for this purpose.

Interesting preliminary evidence suggests that fish oil might be helpful in this regard, but more research is needed.^89,90 Double-blind studies have evaluated the minerals calcium,^91,92,93zinc,^94–97 and magnesium,^98,99,100 with mixed results. In addition, a number of trials suggest that anemia is linked to prematurity; however, evidence as to whether iron supplements can help remains inconclusive.^101,102 Several studies have evaluated folate but did not find it effective for preventing premature birth.¹⁰³

Prevention of Low Birth Weight

Babies born below a specific weight (5-1/2 pounds) are at greater risk for complications.

Researchers have studied a number of supplements, including calcium, zinc, magnesium, folate, fish oil, several vitamins, and iron, in hopes of helping babies gain weight in the uterus, but have found few clear-cut answers.

A recent meta-analysis of seven controlled studies looked at the effects of calcium supplementation on birth weight.¹⁰⁴ These studies predominantly focused on preventing hypertension and/or preeclampsia in the mother, both of which can result in low-birth-weight babies. Overall, calcium appeared to decrease the percentage of babies weighing under 5 pounds 8 ounces.¹⁰⁵ However, other analysts looking at a somewhat different group of studies came to the opposite conclusion.^106,107

Quite a few double-blind studies have examined zinc for preventing low birth weight,^108–114 as well as magnesium,^115,116,117 with mixed results. Results have been similarly mixed in other controlled trials of folate^118,119 and fish oil, or one of its fatty acids.^120,121,122Vitamin D and B vitamins have also been proposed, but so far evidence of their usefulness is weak.^123,124

Several decades ago, iron was believed to be helpful in preventing low birth weight. However, a recent large-scale unblinded study of well-nourished women found that routine iron supplements in pregnancy had no effect on birth weight.¹²⁵ In addition, as previously noted, iron supplementation in pregnant women who are not anemic may not be good for either mother or baby.

Breast-Feeding Support

Natural remedies such as chasteberry, milk thistle, and sage traditionally have been used to promote milk production or for other purposes related to breast-feeding, but scientific evidence for these treatments is largely lacking.

Chasteberry, though traditionally used to promote milk supply, actually inhibits prolactin, a hormone that is vital to milk production.^126,127 For this reason, chasteberry should not be used in pregnancy or breast-feeding.

The herb milk thistle has also historically been used to promote lactation, but no studies have been performed to establish whether it is effective. Sage leaf tea has traditionally been recommended to dry up milk supply (for example, in weaning), but again, studies are lacking.¹²⁸ The effects of a mother's use of sage or milk thistle on a breast-feeding infant have not been established.

According to several studies, the folk remedy of applying cabbage leaves to the breasts, either as leaves or as a cream, doesn't seem to resolve breast engorgement significantly better than placebo, cold compresses, or no treatment.^129,130,131

Treatments to Avoid During Pregnancy

Virtually no herb has been established as safe in pregnancy. Some herbs are known to be toxic, such as blue cohosh and pennyroyal. Other herbs that are traditionally regarded with caution include feverfew, juniper, licorice, nettle, red clover, shepherd's purse, and yarrow, along with many others.¹³² Modern research has raised concerns about many other herbs and supplements such as garlic, ginkgo, policosanol, St. John's wort, and high-dose vitamin E. Excess vitamin A is known to cause birth defects.

This list is not all-inclusive. Be sure to contact your health-care provider before taking any natural remedies during pregnancy.

Treatments to Avoid During Breast-Feeding

Treatments to avoid during breast-feeding include those that may decrease the milk supply, such as chasteberry and sage, as well as those that can cross into the breast milk and adversely affect the infant. The second category includes herbs such as borage, butterbur, kava, and licorice, which may be toxic to the infant, and others such as cascara sagrada or black cohosh, which may give the baby diarrhea or an upset stomach.^133,134 The lignans in flaxseed, which have hormonal effects, also cross into breast milk.¹³⁵

This list is not all-inclusive. Be sure to contact your health-care provider before taking any natural remedies while breast-feeding.

Last reviewed March 2002 by Medical Review Board

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