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    Pregnancy and Breastfeeding Risk Categories: Herbs, Minerals, and Vitamins

    Prenatal Vitamins

    From Acorus Calamus to Zinc Salts, learn about the safety of the most common herbs, minerals, and vitamins during pregnancy and breastfeeding with the following general overview of herbs, minerals, and vitamins.

    Herb/Mineral/Vitamin
    Pregnancy Risk CategoryBreastfeeding Risk Category
    Acorus Calamus
    (Sweet Flag Root)
    Possibly HazardousL4
    Aloe VeraPossibly HazardousL3
    Ascorbic Acid
    (Ascorbicap, Cecon, Cevi-Bid, Ce-Vi-Sol, Vitamin C)
    A (first, second trimester)
    C (third trimester)
    L1
    Beta-carotene
    (B-Caro-T, A-Caro-25, Lumitene, Vitamin A)
    CL3
    Biotin
    (Vitamin B7)
    Probably SafeL1
    Black CohoshXL4
    Blessed ThistlePossibly HazardousL3
    Blue Cohosh
    (Blue Ginseng, Squaw Root, Papoose Root, Yellow Ginseng)
    XL5
    Borage
    (Borage Oil, Beebread, Bee Plant, Burrage, Starflower Ox)
    XL5
    Calcium SaltProbably SafeL3
    Calendula
    (Marigold)
    XL3
    CamphorCL3
    Cannabis
    (Marijuana, Pot, Weed, Tetrahydrocannabinol)
    CL5
    Castor Oil
    (Alphamul, Neoloaid, Emulsoil, Catrol Oil, Seda-rash, Exzem Oil)
    XL3
    ChamomilePossibly HazardousL3
    Comfrey
    (Bruisewort, Blackwort, Slippery Root, Russian Comfrey, Knitbone)
    XL5
    Cranberry ExtractProbably SafeL3
    Docosahexaenoic Acid (DHA)Probably SafeL3
    Echinacea
    (American Cone Flower, Black Eyed Susan, Snakeroot, Antifect)
    CL3
    Eicosapentaenoic Acid (EPA)Probably SafeL3
    EucalyptusProbably SafeL3
    Evening Primrose Oil
    (EPO, Efamol)
    UnknownL3
    FennelPossibly HazardousL3
    FenugreekPossibly HazardousL3
    Fluoride
    (Pediaflor, Flura, Fluor-A-Day, Fluotic, Fluorigard)
    CL2
    Folic Acid
    (Folacin, Wellcovorin, Apo-Folic, Folvite, Novo-Folacid, Accomin, Bioglan Daily, Magafol, Vitamin B-9)
    AL1
    GarlicCL3
    Gentian VioletCL3
    GingerCL3
    Ginkgo Biloba
    (Ginkgo)
    CL3
    Ginseng
    (Panax, Minomycin)
    BL3
    GlucosamineCL3
    Gold Compounds
    (Ridaura, Myochrysine, Solganal, Myocrisin)
    CL5
    Iodine
    (Iodosorb, Iodex, Iodoflex)
    Possibly HazardousL4
    Iron
    (Fer-In-Sol, Infufer, Jectofer, Slow-Fe, Feospan, Femiron, Ferate, Ferrimin 150, Proferrin ES, Spatone, Ferretts IPS)
    Probably SafeL1
    Iron Dextran
    (Infed, Dexferrum)
    CL2
    Iron Sucrose
    (Venofer)
    BL3
    Kava-Kava
    (Awa, Kew, Tonga)
    HazardousL5
    Kombucha TeaHazardousL5
    LeadHazardousL5
    MentholProbably SafeL3
    MercuryHazardousL5
    Milk Thistle
    (Holy Thistle, Lady Thistle, Marian Thistle, Silybum, Silymarin)
    Probably SafeL3
    Mineral Oil
    (Paraffin)
    CL3
    Moringa Oleifera
    (Moringa, Mulunggay, Natalac)
    Possibly HazardousL3
    Niacin
    (Niacin-Time, Niacor, Slo-Niacin, Niaspan FCT, Niodan, Vitamin B-3)
    AL3
    Nicotinic Acid
    (Nicobid, Nicolar, Niacels, Niacin, Nicotinamide, Niaspan, Vitamin B-3)
    A (first, second trimesters)
    C (third trimester)
    L3
    Omega-3-Acid Ethyl Esters
    (Lovaza, Fish Oil)
    CL3
    Pantothenic Acid
    (Vitamin B-5)
    A
    C (if dose exceeds RDA)
    L1
    PectinProbably SafeL3
    Phytonadione
    (AquaMEPHYTON, Konakion, Mephyton, Vitamin K1)
    CL1
    ProbioticsProbably SafeL3
    Pyridoxine
    (Vitamin B-6, Hexa-Betalin, Pyroxin, Comploment Continus)
    AL2
    L4 (high doses)
    Quinine
    (Quinamm, Novo-Quinine, Biquinate, Myoquin, Quinbisul, Quinate)
    DL2
    Riboflavin
    (Vitamin B-2, Abdec, Accomin)
    AL1
    Sage
    (Dalmatian Sage, Spanish Sage)
    Possibly HazardousL4
    SilverPossibly HazardousL4
    St. John’s WortCL2
    SteviaProbably SafeL3
    Tea Tree Oil
    (Melaleuca Oil)
    Possibly HazardousL3
    Thiamine
    (Vitamin B1, Betaxin
    AL1
    TurmericPossibly HazardousL3
    Valerian Officinalis
    (Valerian Root, Garden Valerian, Garden Heliotrope, All-heal)
    Probably SafeL3
    Vitamin A
    (Aquasol A, Del-VI-A, Vitamin A, Retinol, Aveleum)
    AL3
    Vitamin B-12
    (Cyanocobalamin, Rubramin, Anacobin, Cytacon)
    AL1
    Vitamin D
    (Calciferol, Delta-D, Calcijex, Drisdol, Hytakerol, Radiostol)
    AL2
    Vitamin E
    (Alpha Tocopherol, Aquasol E, Bio E)
    AL2
    Zinc Salts
    (Zinc)
    AL2

     

    Pregnancy Risk Categories

    A. Controlled Studies Show No Risk

    Adequate, well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester of pregnancy.

    B. No Evidence of Risk in Humans

    Adequate, well-controlled studies in pregnant women have not shown increased risk of fetal abnormalities despite adverse findings in animals, or, in the absence of adequate human studies, animal studies show no fetal risk. The chance of fetal harm is remote but remains a possibility.

    C. Risk Cannot Be Ruled Out

    Adequate,well-controlled human studies are lacking, and animal studies have shown a risk to the fetus or are lacking as well. There is a chance of fetal harm if the drug is administered during pregnancy, but the potential benefits may outweigh the potential risks.

    D. Positive Evidence of Risk

    Studies in humans, or investigational or post-marketing data, have demonstrated fetal risk. Nevertheless, potential benefits from the use of the drug may outweigh the potential risk. For example, the drug may be acceptable if needed in a life-threatening situation or serious disease for which safer drugs cannot be used or are ineffective.

    X. Contraindicated in Pregnancy

    Studies in animals or humans, or investigational or post-marketing reports, have demonstrated positive evidence of fetal abnormalities or risks which clearly outweighs any possible benefit to the patient.

    Breastfeeding Risk Categories

    L1. Safest

    Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote, or the product is not orally bioavailable in an infant.

    L2. Safer

    Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; and/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

    L3. Moderately Safe

    There are no controlled studies in breastfeeding women; however, the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.

    L4. Possibly Hazardous

    There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

    L5. Contraindicated

    Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

    Disclaimer: The information provided in this article is not meant to replace the professional medical advice from your health care provider. For detailed information on specific medications or for information on medications not listed, please consult your health care provider.

    References

    Hale, Thomas W. 2008. Medications and mothers’ milk, 13th edn. Amarillo, Texas: Hale Publishing.
    Hale, Thomas W. 2010. Medications and mothers’ milk, 14th edn. Amarillo, Texas: Hale Publishing.
    Hale, Thomas W. 2012. Medications and mothers’ milk, 15th edn. Amarillo, Texas: Hale Publishing.

    Image Credits

    Prenatal Vitamins: http://commons.wikimedia.org/wiki/File:Prenatal_vitamin_tablets.jpg

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