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Herbs & the Childbearing Cycle Class III: Pregnancy

This Photo by Unknown Author is licensed under CC BY-NC The Plan Pregnancy Overview Safety in Pregnancy Support

For slides & references, please visit: https://www.camillefreeman.com/repro

This Photo by Unknown Author is licensed under CC BY Pregnancy Overview Key Points

The body knows how to be pregnant Experiences differ Lower doses work well due to progesterone’s influence Some immune functions suppressed Blood volume rapidly expands in 2nd trimester Blood sugar regulation shifts mid-pregnancy Social and racial disparities exist Safety Considerations

Is the herb safe to take? Safer? Are the products themselves safe? (Quality analysis) Different practitioners have different comfort levels

See: Dr. Eric Yarnell’s list of herbs for use in pregnancy/lactation, Dr. Aviva Romm’s website/textbook/podcast (in resources) Check Evidence-Based Birth website/podcast My List

✓ Allium sativum (garlic) ✓ Mentha spicata & x piperita ( & ✓ (marshmallow) spearmint) ✓ Astragalus membranaceous ✓ Mitchella repens (partridge berry) ✓ Avena sativa (oats) ✓ Passiflora incarnata* (passionflower) ✓ Citrus sinensis (sweet orange) ✓ Plantago spp. (plantain) ✓ Crataegus spp. (hawthorn) leaf, flower ✓ Rubus idaeus* (raspberry leaf) and berry ✓ Rumex crispus (yellow dock) ✓ Dioscorea villosa (wild yam) ✓ Schisandra chinensis* ✓ Echinacea spp, all parts ✓ Scutellaria lateriflora (skullcap) ✓ Euphrasia spp. (eyebright) ✓ Taraxacum officinale (dandelion) root and leaf ✓ Foeniculum vulgaris ( seed)* ✓ Ulmus fulva (slippery elm)* ✓ Galium aparine (cleavers) ✓ Urtica dioica (nettle leaf) ✓ Ganoderma lucidum (reishi) ✓ Vaccinium macrocarpon (cranberry) ✓ Glycyrrhiza glabra* (licorice) ✓ Valeriana officinalis () ✓ Lavandula officinalis (lavender) ✓ Viburnum prunifolium & opulus (cramp bark & ✓ Matricaria recutita () black haw) ✓ Medicago sativa () ✓ Withania somnifera* (ashwagandha) ✓ Melissa officinalis () ✓ Zingiber officinalis* () My Top 5 Pregnancy Herbs

1. Nettle leaf (Urtica dioica) 2. Dandelion root (Taraxacum officinale) 3. Chamomile flower (Matricaria recutita) 4. Marshmallow root (Althaea officinalis) 5. Mints (peppermint/spearmint) (Mentha spicata; M. x piperita)

This Photo by Unknown Author is licensed under CC BY-NC Example Safety Analysis: Chamomile

Survey study suggests increase in low birth weight with “regular” (> 3 months) chamomile use (Facchinetti et al., 2012) Retrospective case control study found no relationship between low birth weight & chamomile use in last 2 trimesters (Moussally & Berard, 2012) Small survey found chamomile (& licorice) associated with SGA, preterm labor & threatened miscarriage (Cuzzolin et al., 2010) 2 cases of premature constriction of the fetal ductus arteriosus after chamomile tea (Sridharan et al., 2009)

This Photo by Unknown Author is licensed under CC BY-NC Ductus arteriosis

Image: Original uploader was BrownCow. - http://en.wikipedia.org/wiki/File:Patent_duc tus_arteriosus.jpg, Public Domain, https://commons.wikimedia.org/w/index.ph p?curid=18938493 Spot the problem? “two cases of premature ductal constriction associated with the maternal consumption of camomile tea (made from the leaves of the Camellia sinensis ). There was no history of NSAID use in either patient.”

- Sridharan et al., 2009 What do we make of this? Supportive Herbs Should everyone take a multivitamin?

Cochrane review in 2017 (Haider & Bhutta) found that MVM = fewer low birthweight (LBW) babies and small-for-gestational-age (SGA) babies (low/middle-income countries) Systematic review & metanalysis (Wolf et al., 2017) in high-income countries = small reduction in NT, urinary, CV and limb developmental issues. No change in preterm birth. Iron, folic acid, calcium (+ vitamin C for smokers) are only single nutrients showing benefit prenatally (Lowensohn et al., 2016) I would add vitamin D, choline, and iodine to list. Nausea/vomiting

50-90% of will have nausea; 25-55% experience vomiting Gastric dysrhythmia; delayed small bowel transit Doesn’t seem to be related to blood sugar changes (Herrell, 2014) Herbs to Consider: Ginger

Most studies flawed. Cochrane Review: “may be helpful” for NVP (Matthews et al., 2015) “Harmless and possibly effective” for NVP (Viljoen et al., 2014) Over 60 d, vitamin B6 (40 mg BID) was more effective than ginger (Khorasani et al., 2020) More effective than placebo & comparable to B6 over 4 days (Sharifzadeh et al., 2018)

Typical dose: 500 mg twice per day in capsule form Other Ideas

Small meals regularly Lower fat/fried food intake Sour foods may help Bitters: dandelion root may help Aromatherapy using mint and lemon have RCT support (Amzajerdi et al., 2019; Yavari Kia et al., 2014) Chamomile, spearmint worth trying as well What about products?

Commonly recommended for 1st trimester NVP (Dickson et al., 2018) Very little evidence of safety THC definitely crosses placenta; haven’t seen data on CBD Studies suggest epigenetic alternations possible after prenatal exposure

This Photo by Unknown Author is licensed under CC BY-SA-NC Cannabis exposure in utero

Figure 1 from (Szutorisz & Hurd, 2018) Miscarriage/Pregnancy Loss

Most prior to week 12 (<5% week 13+) 10-15% of pregnancies end in miscarriage Rates go up with age Different levels of support are needed Primary cause: genetic abnormality Cycle usually returns within 6 weeks Support

Viburnum/Dioscorea (Cramp bark/wild yam) tincture (1:5), take 5 mL every hour if cramping.

Post-miscarriage support: See resources Consider Vitex through first trimester during next pregnancy Consider fertility-building tonics (esp. White peony, A. sinensis, ) prior to TTC again (see previous class) Herbal support for grief if indicated: Rose, hawthorn, lavender Anemia

Blood volume expansion is part of healthy pregnancy Keep an eye out for fatigue, palor 27 mg iron per day recommended during pregnancy Glycinate forms (or extended release) easier on gut Separate iron from MVM + tannin-rich teas/foods (e.g. green/black tea) Can dose every other day (2x dose) if bowels cooperate Herbal Support

Nettles! Liquid iron as a “top off” Blackstrap molasses + yellow dock Iron fish (not herbal…)

This Photo by Unknown Author is licensed under CC BY-SA Red Raspberry Leaf: The Ultimate?

See EMAC Report (2013): Link in resources Case report of person with GDM taking RRL and needing lower dose of insulin (Cheang et al., 2016) Oral RRL use associated with cesarean delivery (AOR 3.47, 95% CI 1.17-8.05) (Munoz Balbontin et al., 2019) RCT using 1.2 g tablets BID from 32w through birth = No adverse effects, did not shorten 1st stage of labor; 2nd stage shortened by 9.5 minutes. No difference in cesearean rates. (Simpson et al., 2001) Retrospective observational study; n=108; may decrease pre/post-term pregnancy. May decrease artificial ROM and cesearean rates (Parsons et al., 1999) Heartburn & Constipation

HEARTBURN CONSTIPATION/HEMORRHOIDS Marshmallow root infusion Compression of veins & progesterone are guilty Elevate head of bed ~ 6 – 8 in. Hydration & movement Eat small meals often Eat enough oil/fat Decrease high-fat/fried foods Psyllium is safe in pregnancy Peppermint may exacerbate Marshmallow, dandelion root Bilberry for blood vessels Topical witch hazel/calendula Vaginal Ecosystem

More lactobacillus = decreased chance of preterm birth L. rhamonsus GR-1 and L. retueri RC-14 Orally in GBS+ folks 35-37 w pregnancy, RCT v. placebo. At admission for labor, 21 people (~43%) in probiotic group went from GBS+ to -, while only 9 (18%) in placebo group did (p=0.007)(Ho et al., 2016) Brands with this combo: Jarrow’s Femdophilus, Integrative Therapeutics Pro-Flora Women’s Blend, RepHresh Pro-B Herbs to consider TOPICALLY: Rose, calendula, green tea, plantain Sleep & Mood

Check omega-3 intake (see safe seafood for pregnancy link in resources) 200 mg Mg glycinate before bed Ask about CBD/Cannabis products Tea: chamomile, lemon balm, skullcap, lavender

Mood: St. John’s wort has some preliminary evidence suggesting safety (Kolding et al., 2015) Check for HDI. Also consider Crateagus leaf/flower, Matricaria recutita, Melissa officinalis, Urtica spp. Are partus preperators necessary? I don’t think so ☺ Thank you for being here! Slides & References: https://www.camillefreeman.com/repro