Safety considerations during pregnancy and lactation

Background and Perspective: The following risks could potentially be associated with the use of a herbs during pregnancy: • Toxicity to the mother, which may also indirectly impair the health or development of the ,child; • Toxicity to the child (i. e., foetotoxidty); • Developmental malformations (i.e. teratogeneis); • Increased risk of miscarriage; and health defects on the child, both short term and long term (e.g., increased risk of chronic health problems later in life, such as cancer). There is currently no consensus regarding the safety considerations surrounding the use of herbs during pregnancy. On one hand, some regulatory authorities appear to be adopting the policy that if there is no clear evidence of safety from a controlled clinical trial then a herb should not be recommended during pregnancy. This is well illustrated by deliberations of the Complimentary Medicines Evaluation Committee (CMEC) of the Australian Therapeutic Goods Administration (TGA). CMEC assessed the safe use of over- the -counter (OTC) products containing kava (Piper Methysticum) and came to the conclusion, despite the lack of evidence for harm from kava during pregnancy (and well before the link between kava and hepatotoxicit y was suggested), that kava products should carry the following warning : 'Not for prolonged use, If symptoms persist seek advice from a health care practitioner. Those who are pregnant or nursing are not recommended to use Kava.' The American Herbal Products Association suggests that professional advice should be sought before using Kava during pregnancy.