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

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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

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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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Written by Heather Johnson

Heather is a writer, librarian, linguist, wife, and mother who loves her husband, children, dogs, and cat. She has a bachelor's degree in English with a minor in creative writing and master's degrees in library and information science and English studies with a concentration in linguistics.

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