Pregnancy support

DEFINITION: Natural and nonmedical treatments of conditions related to fetal development, pregnancy, and childbirth.

• PRINCIPAL PROPOSED NATURAL TREATMENTS
• OTHER PROPOSED NATURAL TREATMENTS

Introduction

Pregnancy is a time of dramatic transitions. Body systems that once sustained a single human now support two. Organs, blood vessels, body chemistry, and even the solid supporting structures of a woman’s body all go through changes; in the meantime, the fetus’s body grows from a single diploid cell called a zygote to a full-sized baby.

Since ancient times, women have tried herbs and other natural treatments to ease discomfort or assist with pregnancy, childbirth, and breastfeeding. However, pregnancy is also a time when the potential risk of any treatment rises dramatically. Seemingly benign medications, even natural ones, have been found to cause congenital abnormalities or disorders or to increase the risk of miscarriage or childbirth complications. Some traditional remedies, such as blue cohosh for labor stimulation, have been discontinued for safety reasons.

Thorough study is needed before any treatment can be considered absolutely safe in pregnancy, and in many cases, this research may never be done because of insurmountable ethical considerations regarding the safety of the fetus. It is important to talk with a doctor before deciding to use any treatment, whether it is natural or conventional.

Principal Proposed Natural Treatments

Many natural treatments have shown promise for conditions related to pregnancy. This section will discuss those treatments (except those for nausea, vomiting, and preeclampsia) with the most scientific support. The safety of the following treatments has not been confirmed, except for nutrients such as vitamins and minerals, for which appropriate dosages for pregnancy have been established.

Venous insufficiency. Increased pressure from the expanding abdomen and other factors can lead to the pooling of fluid in the legs, a condition called venous insufficiency (closely related to varicose veins).

Venous insufficiency occurs outside pregnancy, too, and a variety of natural treatments, including buckwheat and horse chestnut (with esculin removed), have shown promise in their treatment. Common natural treatments for treating venous insufficiency should be avoided by pregnant and breastfeeding women because their safety has not been established; these include butcher’s broom, citrus bioflavonoids, gotu kola, oligomeric proanthocyanidins, and red vine leaf. There are a number of natural self-care measures that can prevent or ease the symptoms of venous insufficiency, including exercising, avoiding tight-fitting clothes, elevating the legs, and avoiding sitting or standing for long periods of time.

Hemorrhoids. Hemorrhoids are varicose veins in or around the anus that cause discomfort and bleeding. Oxerutins and citrus bioflavonoids have been studied for hemorrhoids during pregnancy, although their safety has not been confirmed and should be avoided. Natural self-care measures for the prevention of hemorrhoids during pregnancy include eating a fiber-rich diet, drinking plenty of water, and exercising regularly. Other treatments to ease the pain of hemorrhoids include stool softeners and witch hazel pads.

Anemia. Anemia is common during pregnancy and is usually caused by a deficiency in iron. However, iron supplements can be hard on the stomach, thereby aggravating morning sickness. One study found evidence that a fairly low supplemental dose of iron (20 mg daily) is nearly as effective for treating anemia of pregnancy as 40 mg or even 80 mg daily and is less likely to cause gastrointestinal side effects. (A daily dosage of 20 mg is lower than the amount contained in standard prenatal vitamins.)

Pregnant women who are not anemic should not take more than the recommended daily allowance of iron in pregnancy, as excess iron intake may be harmful to both pregnant women and their fetuses. One study suggests that iron plus folate is more effective for the treatment of iron-deficiency anemia in pregnancy than iron alone, even in women who do not appear to be folate-deficient.

Prevention of neural tube defects and other congenital abnormalities. Folate (folic acid) supplements can help prevent a serious and common type of congenital abnormalities known as neural tube defects (NTDs). Folate, or folate plus multivitamin-multimineral supplements, may help prevent other congenital abnormalities, too, including cleft palate and anomalies of the heart and urinary tract. One preliminary study of 859 babies suggests that zinc may help prevent NTDs, but evidence of this is weak.

Other Proposed Natural Treatments

Other natural remedies have been recommended for treating discomforts and complications of pregnancy or decreasing risks to the fetus and baby.

Assisting childbirth. Castor oil.Castor bean oil was noted by the ancient Egyptians to stimulate labor, and it is still used by some conventional physicians and midwives to induce contractions (for example, it is used when labor does not occur spontaneously after the woman’s water has broken). A controlled trial of one hundred pregnant women compared oral castor oil to no treatment and found that 57.7 percent of those given castor oil began labor within twenty-four hours, compared to only 4.2 percent of those without treatment. A 2022 study published in the Journal of Pharmacopuncture found that taking castor oil helped prepare the cervix for birth and reduce the need for cesarean sections.

In addition, considering how common this treatment is, research on its safety and effectiveness is surprisingly scant. One case of a potentially fatal complication linked to the use of castor oil has been reported, though some have questioned whether the castor oil was responsible. In addition, an observational study of South African women found that those self-treating with castor oil or other traditional herbs (or both) had a higher incidence of meconium (fetal feces) in the amniotic fluid, a sign of fetal distress.

Acupuncture. Acupuncture has shown some promise for reducing pain in labor, but the quality of most of the supporting evidence is relatively poor. In one study, sterile water injections were found to be more effective than acupuncture for lower back pain and relaxation during labor. It is unclear whether or not the persons in the study knew what treatment they were receiving at the time.

In one placebo-controlled trial, real acupuncture was no better than sham acupuncture in relieving pelvic pain before labor. A carefully conducted review of ten randomized, controlled trials involving 2,038 women could not uncover consistent evidence of acupuncture’s effectiveness for labor pain either alone or with other treatments. In one study involving sixty women, postoperative acupuncture or electro-acupuncture reduced pain within the first two hours (but no longer) and demand for pain medication within the first twenty-four hours after cesarean section.

A study of forty-five pregnant women found that women who received acupuncture on the mathematically calculated birth “due date” gave birth sooner than those who did not receive acupuncture. However, this trial used a no-treatment control group instead of sham acupuncture, making its results unreliable. Another study suggested that the use of acupuncture may help stimulate normal-term labor. A third study of 106 women with premature rupture of membranes (water breaking too early) found that acupuncture did not effectively speed up delivery. It should be noted that none of these three studies used sham acupuncture as a control, making their results unreliable. However, in a subsequent trial that attempted to address this problem, real acupuncture administered for two days before a planned induction of labor (artificial stimulation of labor) was no better than sham acupuncture at preventing the need for induction or shortening the time of labor.

Two studies suggest that acupuncture and associated therapies can help “turn” a breech presentation of the fetus. In 2008, researchers published a review of six randomized, controlled trials that investigated acupuncture-like therapies (moxibustion, acupuncture, or electro-acupuncture) applied to a specific acupuncture point (BL 67). They concluded that these therapies were effective at decreasing the incidence of breech presentations at the time of delivery. Again, however, not all of these studies employed a sham-acupuncture group for comparison.

Other natural treatments. One double-blind, placebo-controlled trial evaluated the effects of red raspberry in 192 pregnant women. Treatment (placebo or 2.4 grams [g] of raspberry leaf daily) began at thirty-two weeks of pregnancy and was continued until the onset of labor. The results failed to show any statistically meaningful differences between the groups. Red raspberry did not significantly shorten labor, reduce pain, or prevent complications.

Blue cohosh is a toxic herb and should never be used during pregnancy or while breastfeeding. One published case report documents profound heart failure in a baby born to a mother who used blue cohosh to induce labor. Severe medical consequences were also seen in a child whose mother took both black and blue cohosh.

Proteolytic enzymes may reduce inflammation and discomfort following episiotomy. Hypnotherapy and massage therapy have shown some promise for assisting labor. In a large controlled trial (more than six hundred participants), lavender oil aromatherapy failed to improve pain after childbirth.

Constipation. Constipation is common during pregnancy, for reasons that are not entirely clear. Fiber supplements are commonly recommended for the treatment of constipation in pregnancy because of their apparent safety. Flaxseed is a high-fiber seed, and alternative practitioners often recommend it. However, flaxseed contains estrogen-like substances that might pose hazards to the fetus; one study found an effect on reproductive organs and function in baby rats whose mothers ate large amounts of flaxseed during pregnancy.

Other natural remedies for constipation during pregnancy include drinking plenty of fluids, such as water or prune juice, and exercising regularly.

One should avoid the use of powerful laxatives, including natural remedies such as buckthorn, cascara, rhubarb, castor bean oil, and Senna, because they can induce uterine contractions. The traditional remedy yellow dock, though milder, warrants similar caution.

Leg cramps. Pregnant women sometimes experience painful leg cramps. A double-blind study of seventy-three women with this symptom found that magnesium was significantly more effective than placebo in decreasing their distress. Calcium has also been studied for this problem, but research gives little indication that it helps. A combination of vitamins B₁ and B₆ has also been suggested for leg cramps, but evidence that it helps remains minimal.

Prevention of prematurity. Not entirely consistent evidence suggests that the use of fish oil or its constituents by pregnant women might help prevent premature births. Double-blind studies have evaluated the minerals calcium, zinc, and magnesium for this purpose too, but the results have been mixed. A number of trials suggest that anemia is linked to prematurity; however, evidence as to whether iron supplements can help remains inconclusive. Several studies have evaluated folate but did not find it effective for preventing premature birth.

One study failed to find vitamin C helpful for preventing premature birth. However, another study found that vitamin C (100 mg per day after twenty weeks of pregnancy) helped prevent early rupture of the chorioamniotic membrane (water breaking). Another study found that the use of vitamin E (400 international units daily) and vitamin C (500 mg per day) after premature water breaking helped hold off delivery by several days.

Prevention of low birth weight. Babies born below a specific weight (5.5 pounds or 2,500 grams), called low birth weight, are at greater risk for complications. A meta-analysis of seven controlled studies looked at the effects of calcium supplementation on birth weight. These studies predominantly focused on preventing hypertension or preeclampsia (or both) in the pregnant woman, both of which can result in low-birth-weight babies. Overall, calcium appeared to decrease the percentage of babies weighing less than 5 pounds 8 ounces. However, other analysts looking at a somewhat different group of studies came to the opposite conclusion.

Quite a few double-blind studies have examined zinc and magnesium for preventing low birth weight, with mixed results. Results have been similarly mixed in other controlled trials of folate and fish oil or one of its fatty acids. Vitamin D and B vitamins have also been proposed, but evidence of their usefulness is weak.

It was earlier believed that iron was helpful in preventing low birth weight. However, a large-scale unblinded study of well-nourished women found that routine iron supplements in pregnancy had no effect on birth weight. Iron supplementation in pregnant women who are not anemic may not be good for either the woman or the fetus. In another study, a double-blind, placebo-controlled study of 1,877 women, the use of combined vitamin E and vitamin C failed to prove helpful in preventing low birth weight.

Other uses of natural treatments. A common problem in pregnancy is an increased tendency toward swollen or bleeding gums, a condition known as gingivitis. Two small double-blind studies suggest that folate mouthwash may help. However, folate supplements do not appear to be especially effective against gingivitis.

A condition called intrahepatic cholestasis may occur during pregnancy, causing jaundice and other complications. Preliminary evidence suggests that the supplement S-adenosylmethionine might be helpful for preventing this.

A single-blind trial found suggestive evidence that vitamin C, taken at a dose of 100 mg daily, might help prevent bladder infections in pregnancy. A placebo-controlled study of thirty women suggested that the mineral chromium may be useful for gestational diabetes, the term for diabetes that occurs during pregnancy. Vitamin B₆ has also been proposed for this condition, but evidence in support of its effectiveness is minimal.

The use of fish oil or its constituents docosahexaenoic acid (DHA) and eicosapentaenoic acid by pregnant women might help support healthy cognitive and visual function in their children. Also, low levels of vitamin B₁₂ may increase the risk of miscarriage, and B₁₂ supplements may help.

A small preliminary study found that fish oil was significantly more effective than placebo at alleviating postpartum depression. However, two other studies failed to find either fish oil or one of its chief components, DHA, helpful for preventing perinatal (including postpartum) depression.

Herbs and Supplements to Avoid During Pregnancy and Breastfeeding

Virtually no medicinal herb has been established as safe in pregnancy or breastfeeding, and even herbs that might seem safe because of their wide use in cooking could cause problems when they are taken in the form of highly concentrated extracts. For example, based on food use, it is unlikely that cooked garlic presents much risk; however, garlic supplements contain certain rather potent and potentially toxic ingredients present only in raw garlic. Few people eat large quantities of raw garlic on a regular basis, so there is no history of its long-term use to show its effects.

Other herbs that should be avoided during pregnancy include andrographis, boldo, catnip, chasteberry, essential oils, feverfew, juniper, licorice, nettle, red clover, rosemary, shepherd’s purse, and yarrow. For example, chasteberry has shown a potential for inhibiting milk supply. In addition, herbs with estrogen-like properties could possibly affect the fetus; these herbs include soy, isoflavones, red clover, flaxseed, lignans, and hops.

These products have been found on occasion to contain toxic heavy metals, poisonous herbs, or unlabeled prescription drugs. In one case report, a child with brain damage born to a woman using an Ayurvedic formula was found to have the highest blood levels of lead ever recorded in a living newborn. Analysis of the formula revealed a very high lead content and toxic levels of mercury. In general, it is probably accurate to say that no herb can be regarded as definitely benign.

However, other supplements that are not essential nutrients are in much the same position as herbs, and they could conceivably cause harm. For example, the supplement conjugated linoleic acid appears to reduce the fat content of breast milk, with potentially harmful effects on the nursing infant. Chitosan may cause impaired nutrient absorption and, at times, may contain arsenic. (Contamination with toxic substances is also a real possibility with certain calcium supplements, which have been found to contain high levels of lead.) Always consult your doctor before taking a supplement while pregnant or nursing. Other resources, such as the American Pregnancy Association, Planned Parenthood, and the National Institutes of Health, may also be useful sources of information regarding pregnancy support.

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