June 30, 2003 Re: Combination Herbal Tonics in Pregnancy

Noe J, Bove M, Janel K. Herbal tonic formulas for naturopathic obstetrics Alternative and Complementary Therapies. Dec 2002:327-335. This comprehensive article discusses some of the physiological and emotional effects of pregnancy and the role that herbal tonics can play in pregnancy. Herbal tonics can prepare a woman's body for pregnancy and childbirth, support the health of both mother and child during pregnancy, and restore the mother and help her nourish the nursing child after delivery. The authors include detailed instructions about herbal tonics that can be used by women who intend to become pregnant, a tonic for each trimester of pregnancy, a 'mother's cordial' for use from the 36th week of pregnancy through delivery, as well as a tonic for the postpartum period. Each formula gives the common and Latin names of the herbs used, which part is used, the role of the herb in the specific tonic, its proportion, as well as method of preparation and daily dosage. It should be noted that each of these formulæ (excepting the mother's cordial, which is an alcohol extract) requires both decoctions and infusions of different herbs. The article explains the various discomforts which typically accompany pregnancy. For example, water retention results from decreased peripheral circulation in the expectant mother's body, particularly the lower extremities, as the fetus expands in the pelvic region. In a normal pregnancy, a minimum of 6.5 liters of additional fluid is retained. Slightly more than half of this is found in the fetus, placenta, and amniotic fluid. The remainder is accounted for by increased maternal blood volume to support the developing child and increased breast and uterine tissue. This can become particularly noticeable in the late stages of pregnancy. The herbal tonic for the third trimester includes stinging nettle (Urtica dioica) to stimulate circulation. The mother's cordial includes ginger (Zingiber officinale) for the same purpose. Similarly, the preconception formula aims to strengthen the mother's immune system prior to pregnancy. A developing fetus is the preferred recipient of all macro- and micronutrients, oxygenated blood, and factors which potentiate the immune system. A woman's immune system may be depleted simply by carrying a child. Eleuthero (Eleutherococcus senticosus aka Siberian ginseng), milk thistle (Silybum marianum), and bladderwrack (Fucus vesiculosis) in the preconception tonic may exert immunoprotective and immune system strengthening effects. In the third trimester of pregnancy, maternal antibodies pass through the placenta to the fetus, enhancing the newborn's short term passive immune response. Stinging nettle is included in the third trimester tonic to strengthen natural resistance to disease. The authors address concerns about teratogenicity (of, relating to, or causing developmental malformations) at some length, having observed that many pregnant women do not use potentially beneficial herbs because of concerns about negative effects on the fetus. They explain that chemicals cross the placenta more easily if their molecular weight is less than 1,000 and if they are lipid-soluble and nonionizing. Constituents of concern are therefore alkaloids, terpenes, and concentrated volatile phenolic compounds. All of the tonics recommended except the mother's cordial are aqueous extracts which do not recover alkaloids well, thus lowering concentration of these ingredients. Also, volatile oils and terpenes are released during evaporation in preparing infusions, lowering their concentration. Finally the teratogenicity and toxicity of all herbs recommended have been extensively reviewed (though in most cases not extensively researched), and at recommended dosages, there are no references in the literature to support these concerns. However, a tonic intended for use during one stage of pregnancy may not be appropriate for use during another. In particular, formulæ recommended for the second and third trimester and the postpartum period should not be employed during preconception or the first trimester. The article is intended to provide guidance for naturopathic physicians attending pregnant or expectant patients. Little scientific rationale for the recommended practices and formulas is provided. -Mariann Garner-Wizard