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Herbal medicinal product use during pregnancy and the postnatal period: a systematic review.

Mu�oz Balbont�n, Yolanda; Stewart, Derek; Shetty, Ashalatha; Fitton, Catherine A.; McLay, James S.


Yolanda Mu�oz Balbont�n

Derek Stewart

Ashalatha Shetty

Catherine A. Fitton

James S. McLay


To report the incidence and nature of herbal medicinal products’ adverse events and herb–drug interactions used by some pregnant and postnatal women. The Allied and Complementary Medicine Database, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, the Cochrane Library, MEDLINE, Scopus, Web of Science, and were searched from inception until August 2018. Any studies reporting adverse events, herb–drug interactions or absence thereof associated with herbal medicinal products used during pregnancy or the postnatal period were included. Conference abstracts, pilot studies, and nonhuman studies were excluded. All included studies were critically appraised by two independent reviewers. Database searches retrieved 3,487 citations. After duplicate removal and review of titles, abstracts, and full-text, 115 articles were critically appraised. After excluding irrelevant and low-quality articles, 74 articles were included for data extraction and synthesis. Adverse drug reactions, congenital malformations, fetal growth retardation or herb–drug interactions were the primary study objective reported by 19 of the 74 included studies, 16 cohort studies, one cross-sectional survey, and two randomized controlled trials. A total of 47 herbal medicinal products and 1,067,071 women were included in this review. Use of almond oil was associated with preterm birth (odds ratio 2.09, 95% CI 1.07–4.08), oral raspberry leaf was associated with cesarean delivery (adjusted odds ratio [AOR] 3.47, 95% CI 1.45–8.28); heavy licorice use was associated with early preterm birth by 3.07-fold (95% CI 1.17–8.05). African herbal medicine mwanaphepo was associated with maternal morbidity (AOR 1.28; 95% CI 1.09–1.50), and neonatal death or morbidity. Fourteen studies reported absence of adverse events. Four studies reported herb–drug interactions, but none studied adverse events arising from them. The use of herbal medicinal products during pregnancy and the postnatal period should be discouraged until robust evidence of safety is available.


MUÑOZ BALBONTIN, Y., STEWART, D., SHETTY, A., FITTON, C.A. and MCLAY, J.S. 2019. Herbal medicinal product use during pregnancy and the postnatal period: a systematic review. Obstetrics and gynecology [online], 133(5), pages 920-932. Available from:

Journal Article Type Article
Acceptance Date Jan 31, 2019
Online Publication Date Apr 5, 2019
Publication Date May 31, 2019
Deposit Date Apr 19, 2019
Publicly Available Date Apr 19, 2019
Journal Obstetrics and gynecology
Print ISSN 0029-7844
Electronic ISSN 1873-233X
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 133
Issue 5
Pages 920-932
Keywords Herbal medicine; Pregnant; Postnatal; Women; Safety
Public URL