Safe use of herbal drugs during pregnancy and lactation

Abstract

Pregnancy is very specific period in which special warnings in drug use, including herbal drugs are recommended. This is related on period of lactation, too, since all drugs distributed and excreted into human milk potentially producing effects on nursing babies. There are no limits for use during pregnancy and lactation only for few herbal drugs. Some herbal drugs are contraindicated for use in these conditions due to their known adverse effects on fetus and newborns. However, for most herbal drugs there are no data, or they are very scarce, on the use during pregnancy and lactation. According to general recommendations in these cases, such herbal drugs should only be used after consulting a physician or under his supervision. However, for safety reasons, their use should be avoided every time if it is possible, especially in the first trimester when a fetus is the most vulnerable. Some herbal drugs can be used for therapy of pregnancy-related conditions (e.g. ginger for nausea and vomiting, and Lini semen, Plantaginis ovatae semen/testa and Psyilii semen for constipation). The use of herbal drugs for stimulation of lactation is traditional, and for none of them a clinical confirmation on efficacy and safety exist.

Trudnoća je veoma specifičan period u kome treba biti posebno oprezan pri primeni lekova, uključujući i biljne. Ovo se odnosi i na period dojenja, budući da se svi lekovi, u većem ili manjem stepenu, raspodeljuju i izlučuju mlekom s mogućim ispoljavanjem dejstava na odojče. Za manji broj biljnih lekova ne postoji ograničenje za primenu u ovim stanjima, neki su kontraindikovani zbog poznatih neželjenih efekata na plod i odojče, dok za najveći broj biljnih lekova podaci o primeni u trudnoći i tokom perioda dojenja ne postoje ili su nepotpuni. U skladu sa opštom medicinskom praksom, oni se ne smeju koristiti bez savetovanja i nadzora lekara. Međutim, iz bezbednosnih razloga, najbolje je izbegavati ih tokom trudnoće i dojenja, kada god je to moguće, naročito u prvom trimestru kada je fetus najosetljiviji. Izvesne biljne droge mogu da se koriste za terapiju propratnih tegoba u trudnoći (npr. rizom đumbira, Zingiberis rhizoma kod mučnine i povraćanja, seme lana, Lini semen, seme i semenjača ispagule, Plantaginis ovatae semen/testa i seme indijske bokvice, Psyllii semen kod opstipacije). Primena biljnih droga za stimulaciju laktacije isključivo je tradicionalna, tj. ni za jednu ne postoji klinička potvrda efikasnosti i bezbednosti ovakve primene.