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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.

Pregnancy Risk Category Breastfeeding Risk Category
Acorus Calamus
(Sweet Flag Root)
Possibly Hazardous L4
Aloe Vera Possibly Hazardous L3
Ascorbic Acid
(Ascorbicap, Cecon, Cevi-Bid, Ce-Vi-Sol, Vitamin C)
A (first, second trimester)
C (third trimester)
(B-Caro-T, A-Caro-25, Lumitene, Vitamin A)
C L3
(Vitamin B7)
Probably Safe L1
Black Cohosh X L4
Blessed Thistle Possibly Hazardous L3
Blue Cohosh
(Blue Ginseng, Squaw Root, Papoose Root, Yellow Ginseng)
X L5
(Borage Oil, Beebread, Bee Plant, Burrage, Starflower Ox)
X L5
Calcium Salt Probably Safe L3
X L3
Camphor C L3
(Marijuana, Pot, Weed, Tetrahydrocannabinol)
C L5
Castor Oil
(Alphamul, Neoloaid, Emulsoil, Catrol Oil, Seda-rash, Exzem Oil)
X L3
Chamomile Possibly Hazardous L3
(Bruisewort, Blackwort, Slippery Root, Russian Comfrey, Knitbone)
X L5
Cranberry Extract Probably Safe L3
Docosahexaenoic Acid (DHA) Probably Safe L3
(American Cone Flower, Black Eyed Susan, Snakeroot, Antifect)
C L3
Eicosapentaenoic Acid (EPA) Probably Safe L3
Eucalyptus Probably Safe L3
Evening Primrose Oil
(EPO, Efamol)
Unknown L3
Fennel Possibly Hazardous L3
Fenugreek Possibly Hazardous L3
(Pediaflor, Flura, Fluor-A-Day, Fluotic, Fluorigard)
C L2
Folic Acid
(Folacin, Wellcovorin, Apo-Folic, Folvite, Novo-Folacid, Accomin, Bioglan Daily, Magafol, Vitamin B-9)
A L1
Garlic C L3
Gentian Violet C L3
Ginger C L3
Ginkgo Biloba
C L3
(Panax, Minomycin)
B L3
Glucosamine C L3
Gold Compounds
(Ridaura, Myochrysine, Solganal, Myocrisin)
C L5
(Iodosorb, Iodex, Iodoflex)
Possibly Hazardous L4
(Fer-In-Sol, Infufer, Jectofer, Slow-Fe, Feospan, Femiron, Ferate, Ferrimin 150, Proferrin ES, Spatone, Ferretts IPS)
Probably Safe L1
Iron Dextran
(Infed, Dexferrum)
C L2
Iron Sucrose
B L3
(Awa, Kew, Tonga)
Hazardous L5
Kombucha Tea Hazardous L5
Lead Hazardous L5
Menthol Probably Safe L3
Mercury Hazardous L5
Milk Thistle
(Holy Thistle, Lady Thistle, Marian Thistle, Silybum, Silymarin)
Probably Safe L3
Mineral Oil
C L3
Moringa Oleifera
(Moringa, Mulunggay, Natalac)
Possibly Hazardous L3
(Niacin-Time, Niacor, Slo-Niacin, Niaspan FCT, Niodan, Vitamin B-3)
A L3
Nicotinic Acid
(Nicobid, Nicolar, Niacels, Niacin, Nicotinamide, Niaspan, Vitamin B-3)
A (first, second trimesters)
C (third trimester)
Omega-3-Acid Ethyl Esters
(Lovaza, Fish Oil)
C L3
Pantothenic Acid
(Vitamin B-5)
C (if dose exceeds RDA)
Pectin Probably Safe L3
(AquaMEPHYTON, Konakion, Mephyton, Vitamin K1)
C L1
Probiotics Probably Safe L3
(Vitamin B-6, Hexa-Betalin, Pyroxin, Comploment Continus)
A L2
L4 (high doses)
(Quinamm, Novo-Quinine, Biquinate, Myoquin, Quinbisul, Quinate)
D L2
(Vitamin B-2, Abdec, Accomin)
A L1
(Dalmatian Sage, Spanish Sage)
Possibly Hazardous L4
Silver Possibly Hazardous L4
St. John’s Wort C L2
Stevia Probably Safe L3
Tea Tree Oil
(Melaleuca Oil)
Possibly Hazardous L3
(Vitamin B1, Betaxin
A L1
Turmeric Possibly Hazardous L3
Valerian Officinalis
(Valerian Root, Garden Valerian, Garden Heliotrope, All-heal)
Probably Safe L3
Vitamin A
(Aquasol A, Del-VI-A, Vitamin A, Retinol, Aveleum)
A L3
Vitamin B-12
(Cyanocobalamin, Rubramin, Anacobin, Cytacon)
A L1
Vitamin D
(Calciferol, Delta-D, Calcijex, Drisdol, Hytakerol, Radiostol)
A L2
Vitamin E
(Alpha Tocopherol, Aquasol E, Bio E)
A L2
Zinc Salts
A L2


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.


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.

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