Safety of Popular Herbal Supplements in Lactating Women

Abstract

The increasing popularity and use of dietary supplements has required health care professionals to become more knowledgeable of their properties, interactions, and adverse effects. The objectives of this review were to evaluate the safety of popular dietary supplements in breastfeeding mothers and the effects on the infants. Nine of the most popular herbal dietary supplements were identified based on the 2011 US market report of the top 10 selling botanicals and the most frequently received inquiries by the Ruth A. Lawrence Lactation Study Center at the University of Rochester Medical Center. Relevant publications were identified through June 2014 using PubMed and EMBASE; tertiary references, including the Drugs and Lactation Database and Natural Medicine Comprehensive Database, were also reviewed. These herbals include black cohosh, cranberry, echinacea, evening primrose, garlic, ginseng, melatonin, milk thistle, and St John's wort. Studies varied greatly with regard to study design, herbal intervention, and outcome measures. Findings suggested that dietary/herbal supplements have not been evaluated in high-quality clinical trials, and there is limited evidence supporting safety of use, particularly among lactating women. Therefore, it is essential for physicians to provide counseling for nursing mothers seeking information on dietary supplements, highlighting reliable safety profiles, inquiring about the potential benefits the patient is seeking, and assessing the patient's perception of this supplement during breastfeeding. More research and clinical trials are required in this area to guide the recommendations and expand our current knowledge of these products.

The prevalence, perceptions and behaviors associated with traditional/complementary medicine use by breastfeeding women living in Macau: a cross-sectional survey study

“…This is consistent with previous reports, that the most common use of herbal medicines in breastfeeding women was to improve milk supply [7,12,28] or as a traditional prophylactic for insufficient milk production [43] and engorgement [13]. The breastfeeding women in this study also took T/CM, but to a lesser extent, for more general ailments such as depressive moods, headaches and sleeping problems, similar to previous findings [13]. Given the prevalence and potential serious consequences of undiagnosed and untreated post-natal depression, such symptoms should be medically assessed [52].…”

“…Consistent with previous reports, the use of T/CM in this study was associated with personal preference and a perception that such products are natural, safer and with fewer side effects than conventional treatments [13,28,41,42]. Interestingly, in this study the number of women who perceived T/CM to be safe was substantially lower than those who reported using T/CM during lactation.…”

“…However, a general lack of awareness about the potential risks of the T/CM has been reported [12]. Furthermore, little is known about any safety issues for breastfed children associated with T/CM exposure through breastmilk [13,14].…”

The use of complementary and alternative medicines during breastfeeding: results from the Herbal supplements in Breastfeeding InvesTigation (HaBIT) study

“…According to a review conducted to determine the safety and efficacy of herb use during breastfeeding, most studies were of poor methodological quality [21]. It is also important to note that many CAMs products contain alcohol or caffeine as excipients, which should be avoided in both pregnancy and the breastfeeding period [4]. This is an important safety issue considering that, as reported in our sample, the majority of participating women did not know which types of product (and consequently compounds) they were consuming.…”

Feasibility and Acceptability of Two Complementary and Alternative Therapies for Perceived Insufficient Milk in Mothers of Late Preterm and Early Term Infants

“…However, there remains an overall lack of evidence regarding the effectiveness, safety, and acceptability of many CAM therapies for PIM, including acupuncture, herbal supplements, and relaxation/ visual imagery techniques. [15][16][17] Despite this, herbal supplements are widely used and recommended by lactation consultants. Meditation and other cognitively based relaxation techniques have also emerged as noninvasive, potentially effective interventions for PIM affected by stress or anxiety.…”